HomeMy WebLinkAboutPermit Electrical 2009-3-31
225 Fifth Streett Springfield, OR 974770 PH(541)726-3753t FAX(541)726-3689
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Pennit no.: 1
I Date: 3/3(0 (
Electric,al Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work'is not started within 180
days of issuance or if work is suspended for 180 days. '
1~~ill!o~C~iEl<30SlE:BN1\nEN['iI~RF:B:QY.~Li:if~\fJlil
I Zoning approval verified? DYes D No ' ,I
~.c~'ljEc3JDR:i'IQ~j![coNSmR:liJ.clFl!':lN~~~1kI1
1 1 I h' Residential, per unit, service included:
o Residential 0 Government W Commercial
'_!f.J0B~$i]T:El1ll11iiQ~1\n~[lQNIlrANDJ1!QGi,\mIQNm:~J1(t~#.1:l I 1,000 sq. ft. or less (1)
I Each additional 500 sq. ft. or portion
Job site address: r'n II fI), (16//-iY left F L P thereof
City: -7f',(.;:ftr/d I State: () R I ZIP: I I Limited energy (2)
Subdivision: {7 0 3 '2 Z I.( z.. I Lot no.: 0 If;Jr-1'' I Each manufactured home or modular $ 63.00 $
~~DESCRIBillI(;)N~OF.:1V\(0RK~i{~'Jf~~,\;,~ dwelhng service or feeder (2) ..
I i\ I ~ Z- ' C \ rc...,,^- '" ~ I Services or feeders: installation, alteration, relocation
I I 200 amps or less (2) I $ 81.00 $
~~~~RROP,ERI.;f~QWNE:~~\t{~~!:W_ll~'f\i~~~il! I 201 to 400 amps (2) J, I $ 95.00 $
Name: C(bVev<-(~ fr..,~+'~'S. u...L 1401 to 600 amps (2) 'I $158.00 $
1 Address: bl ( C/o ~\ ~fL 1 1601 to 1,000 amps (2) . I $205.00 $
I City: -;.f'B I State:~R=NTI rJ;IP.:(J'~I""?l#. re~R~:~I,~~:t!rr or volts (2) $469.00 $
I Phone: ,I Fax:l\ow-rul!\S adoptea uy ,,Ie 'o~e,f96'\h~ fl'J1\t{2) $ 63.00 $
- ,'_~ Thf"lC::P ru __ -.
IE-mail: ..NOtlIlCallLlI.Vu..wO..lO thrall19 i!:~l!il>Ql5frjOOdvices or feeders: insta(lation, alteration. relocation
. ~^Do"?_tltl1-0 -' ~ ()m\1.iihP':i\\riJ,l~ I
This installation is being made onresiprifFijiiqu~anmpropef.Wl cor:e Q. :~-h:~~ (2) $ 63.00 $
owned by me or a member of my lmmeal.at'if,a..\'Vilte!fllili:er. (Not... l'r%olR'~~ (2) $ 8700 $
property is not intended for sale, exchang~llea~e18r ~ffit.@!Bon I Jt~ Ii] I v .
479.540(1) and 479.560(1). IIU\1l0~lce~te'rviS 1-800< 3<:i-211H\4Il600 amps (2) $126.00 $ I
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above J
r::=:;i~C:~~I~$~;~I!~~~~;~!tBtG~"~lf : :r;::~o:i:::~~~ ~i::~i::t:~~::r:~:s:s~~na~:~::eL feeder fee :
I Address: p,O, ~K 5'871 I I Each branch circuit I I $ 6.00 I $ I
I City: ::),,; /1"..... 1 State:C?K 1 ZIP: 97.:5 t>'-I 1 I b. Fee for branch circuits without purcHase ofa service or feeder fee: I
, Phone:.>c>j: ?!Z'l 79 'is I Fax: I I First branch circuit (2) $ 55.00 $ 55 I
I E-mail: J",<..s ""'6~';;ff f d~ /ea.^l{ 1 I Each additional branch circuit I $ 6.00 $ I. I
I CCB license ~o.: I' 7.:>Zr I BCD license no.: C.I~ Z. I 1 Miscellaneous f~$~~",~_der not Included I
I IUC J. 'C'lJ.>\~ (, IF.- Cl.T
Signing supervisor's license no.: 'I?S- 7'> NU ~ rEoM\1 SH~,"J1l.l'l'P ~ ;,1jI't1~1f'f<\%~\L) $ 63.00 $ I
I Print name of signing supervisor: b",,::~;';s A"'''~~M\II:I U\'ID.~itli'lfl~IJRfPiJl\llili\(2) $ 63.00 $ I
I Signature of signing supervisor: p~~ \IJ\\IJ\ENCEJ blli~I~~cUltoraltm,ted-energypanel, $ 63.00 $
,. 00'::'-/ r.O '~ &!li~l@@~, or extensIOn (2)
/' /' AN'!' 180 u~ r Each additional inspection: (I)
~
~ ...{k (A) Enter subtotal ofabovefees
rx.. \.v ~ (Minimum Permit Fee $58.00)
.....\..c.(;[. I (3) Enter 12% surcharge (.12 x [A])
'\ ~ I (e) Technology Fee (5% of[A])
I TOTAL fees and surcharges (A through C):
Iil;l;iS:Gal:lli_l:JJtr;~~~~~
'~jIJ,~1lll""'""'I!"~""I!i!SlD~=t"~I:iiiL1'~t-ml~~
s,eifitem;" &:1f~. :;~ tFMe9~"..~ ~-!1Ra ;
.$tL"'~;~"ITP~~i~~12[; R~i B~~_;1:miE ;;'~.~Q~!~
$134.00
$
$ 25.00
$
$ 32.00
$
$58.00 I $
$ ~ /-
$ 7Yt:.
$ ~(!r
$ 7/~
440-2584-) (9/08ICOM)
Status Pending.'
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINCFIELD
Building/Combination Permit
PERMIT NO: COM2009-00409
ISSUED:'
APPLIED: 03/27/2009
EXPIRES: 09(30/2009
VALUE: $ 5,000.00
SITE ADDRESS: 611 Cloverleaf Lp
ASSESSOR'S PARCEL NO.: 1703224208200
Springfield TYPE OF WORK: OHice
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Dividing One Office Room into Two Office Rooms (in Adnlt Care Facility)
Commercial
Owner: CLOVERLEAF PROPERTIES LLC
Address: 611 N CLOVERLEAF LOOP
SPRINGFIELD OR 97477
Contractor Type
General
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I CONTRACTOR INFORMATION I
License
Expiration Date Phone
Contractor
RICK FIELDER
DOUG MANSFIELD
".. - ':'.1'.' l\' ~....
NJ. ,RLI.I bDlN6I INF0RMf\TlON'litV
ATTE ' doptea Ly .1!~ ,-. '~". 't lorth
lollow rules a#'ot:l5tofie,;:e rules are se -00.-
,.-tilicatlon cc;,._~.. n. ."..nl:\ OAR 952
~'H AR 952_0c.l1elglitfot' Structulifthe rules by
IruG 'r . l-fIHC"'f1les
n 0 You mE!Jype o. ear:. the telephone
VB~a\iing the ~ate~.Tf)!P~~ii\ity NatilicatlOn
number lor Ra~~\)rlI?~:332-2344).
cenEn"I'gY p",ffi:
Sprinkled Building:
Yes
Lot Size:"
Sq Ft Ist'Floor:
Sq Ft 2nd Floor:
Sq Ft Ba!ement:
Sq Ft Garage/Carport
Sq Ft Ot~er:
Occupan~ Load:
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rq<l:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
E \~~Us~b\)fi~rain~:
N01\CE: Ii S\1~\.\. E')(.I'IB EBMIi IS ~of '
~~:~~~E\)\)Il~~~; ~~~~;O~E\) fOB .
CO\lJ\\IJ\E~~~'{ I'EBIOO.
~~'{ 180 '
Page I of 2
Status Pending
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspectio~1 Line
I Valuation Descriotion I
Description Type' of Construction.
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
5,000.00
Bid Amount Use Bid Amount
Total Value of Project
Fees Paid..
Fee Description '
Plan Review Comm/lnd/Public
+ 12% State Surcharg~
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$56.71
$7.32
$3.05
$55.00
$6.00
3/27/09
3/31109
3/31109
3/31109
3/31109
Total Amount Paid
$128.08
Plan Reviews I
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00409
ISSUED:
APPLIED:
EXPIRES:
VALUE:
03/27/2009
09/30/2009
$ 5,000.00
Value
Date Calculated
$5,000.00
$5,000.00
03/27/2009
Receipt;Number
2200900000000000306
2200900000000000311
2200900000000000311
2200900000000000311
2200900000000000311
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I ~"Oll'TNllnsnections.
. 111'111111
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certilY that all
information hereon is t'rue and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springlield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be IIsed on this project.
I further agree to ensufe tbat all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
"
Owner or Contractors Signature
Paee 2 of 2
Date
225 Fifth Street
Springt1eld, Oregon 97477
541-726-3759 Phone '
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal' Number
COM2009-00409
COM2009-00409
COM2009-00409
COM2009-00409
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
2200900000000000311
Date: 03/31/2009
,
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By,
DOUGLAS MANSFIELD
. Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
037186 In Person
Payment Total:
,
~
Page I of I
8:45:30AM
Amount Due
55.00
6.00
3.05
7.32
$71.37
Amount Pai~
$71.37
$71.37
3/31/2009