HomeMy WebLinkAboutPermit Electrical 2009-4-23
225'Fifth Streett Springfield, OR 97477 < PH(541)726-3753 + FAX(541)726-3689
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I Date: -'---,L ~ :J.,g - (; q I, '
Electrical 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.
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Business name: h'~ <)'-e- 41-C: Be./.I.4 ;C:J:;,/ t: I a. Fee for branch mCUlts with purchase ofa service or feeder fee: I
Address: ~K-z;97 ~I -64 -< </~ 1 I I Each branch mCUlt _ J.. 1 $ 6.001 $ 1
I Cityl-.S>"...<'/U#:di' 'State:o.( r ZIP: 97V)WI b FeeforbranChCircUlts~~')l\l~~ofaSerYlCeOrfeederfee: 1
I Phon&/ e{fh - -7'00 '7IJ~:f'9'f AZ6 - c.2.96 /1 I Forst branch 't'P~;qt-ll\\ \~~~' r / $ 55.00 $ 551
I E-mail'.sY~'A/9-5:-~- ....-&,.,.:/y('3 ..M-S-<'-"~', E~It,'l'lIN\ifJl~~~b~'w.~~ '(v"I-y $ 6.00. $~"f I
I CCB license no: /"7 9'~/ h I BCD license no.: C -"'-- r~ <;>\ ~~I~!Je~~Vce or feeder nol ,"~/uded I
I Signing supervisor's license no.: ?/'-I-rO--S: ~;\'\\\I\i;W~~~'~SW~tiOnCircle(2) I 1$63.00 $ .1
I 'lj\~ \'- ,.:.I v,S. .
Print name of signing supervisor:2': ~}. ~ M . ':::;-f.?''''-;:;~ ~.'\l;b\~..... or outlme IIghtmg (2) $ 63.00 $ 1
I SignatureOfSigningsupervisor'~- /4!- . ---;''7, ,t"iyYgnalcorcuitoralimited-energypanel, I $ 63.00 $ I
If ',( /-~?~~ alteratlOo,orextenslOn(2)
1 Each additional inspectinn: (1) I $58.00 1 $ 1
A , I!~., ~F,:~L!IGANJ~8_s1;.~~"'f&1
~ 'I I (A). Enter subtotal of above fees
\)'~~6' (M,mmumPermitFee$58.00) $ 7Q. 6".J
~ tS , ~ 1 (B) En, ter 12% surcharge ,(,12 x [AD $ '1 _ 'f! y
~:" I (C) Technology Fee (5% of[AD $ 3. 9f':'
, ~ ' I TOTAL fees and snrtharges (A through C): $ ''1:t. '7f3
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\ ':t7~1 Q-!X~~~q~~ I.
11I:~~~~m~GQR?(4:QFJ:~~N$;ij~I!JC1i\IQf:j~~t?,'ilI ",d,~ f;.,,,,,,, "c"""-:!'\"""
1 I .-./.-.t-- Residential, per unit, service included: .
D Residential Xl 1J0vernment I D Commercial
IE~~t;lElM$i)i;l:fj[~nCiLRMP,.\llli;>MfANI,f!~~'c'.<<ml(;!Iilft!lii.r#.:{~"JfI 11,000 sq. ft, or less (4) $134.00 $
1 Job site address: 3/5" 0 /n a. eM 1 I ~~~~:lditional 500 sq. ft. or portion $ 25.00 $
1 City:S.o4-/ hfl_{;',lrJ... I State: cJ0 I ZIP: 97'-172" 1 1 Limited energy (2) 1 $,32.00 $
I=~~E~~~~~~F~~WJ~~=~~~;: ~~~~r~l~~~r~~ ~e~~:r (~)od"Iar I $ 63.00 $
1 (j A r ,h1!..L(io...e.. (/ PO(\/li d.k.\r::.~', O\~;~C\ '0'1 \i'<~J t.~ ~~~t~:~~,J;{~eders: ,"sial/ail on. allerallOn, relocation
1 ' ~, '[) ~~\~S :~l'~~~' \i'<~~~,;o"\ (:{!~~PJ5'~SS (2) $ 81.00 $
l~t$j~~Jlfe~~ra.~a.JIi;(~O;..iJI.l\I,I;;B.~1fk~K~~"lJ;.,c"":~~_ 5;' ~OJJ'b~OO'am,J's (2) $ 95.00 $
1 NameDY1 ~ 1/;/1,-'/ cSrct.k-\~~~'J:9~" ~\ ,t, ~~W:to\6ljO\~ps (2) $158.00 $
IAddress:~ 0 O-S-r~ft ~y.e;.~~-o\e~~~.;132 .\611Hh;ooo amps (2) . $205.00 $
I City: :5:JJ!_e.rn .1 State: @;@pelc'i'iR(e\ 7"7.)/0 I 1 OverI,OOO amps or volts (2) , $469.00 $
1 Phone: '.--' I Fax: __ I I Reconnect only (2) $ 63.00 $
I E-mail: I I Temporar)'services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less (2) 1 $ 63.00 $ .
owned by me or a member of my immediate family. This 201 to 400 amps (2) 1 $ $
property is not intended for sale, exchange, lease, or reni: OAR ' . 87.00
479.540(1) and 479.560(1). 1 401 to 600amps (2) , 1 $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
1~!;:.~Ntri~CJ1l.Q~~INS)l1~TIlE'A;'\1ION~~)~~ 1 Branch circuits: new. alteration. exlension per panel
440-2584-J (9/08/COM) .
Status
Issued
CITY OF SnuflilJFIELD
Building/Combination Permit
PERMIT NO: COM2009-00530
ISSUED: 04/22/2009
APPLIED: 04/21/2009
,EXPIRES: 10/23/2009
VALUE: $ 10,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3150 MAINST
ASSESSOR'S PARCEL NO.: 1702310000400
Springfield TYPE OF WORK: Office
TYPE OF USE: Repair
Pnblic
PROJECT DESCRIPTION: Dryrot Repair and Electrical Work
Owner: STATE BOARD OF FORESTRY
Address: 2600 STATE ST
SALEM OR 97310
I CONTRACTOR INFORMATION I
179416
Expiration Date Phone
I 11/27/2009 541-726-2961
Contractor Type
General
Electrical
Contractor
OWNER
FIRST LIGHT ELECTRIC INC
License
,BUILDING IN~ORMATION.I
# of Units:
Primary Occnpancy Gronp:
Secondary Occnpancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
B
# of Stories:
Height of Strnctnre
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Bnilding:
Lot Size:
SqFt 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
n/a
'.DEVELOP~ENT INFORMA!WN I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Notes:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
. AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS.ABANDONED FOR
ANY 180 DAY PERIOD.
I PUBLIC IMPROVEMENTS I 'res dOll to
I'W req',1 , . .
~. ,. neMH)n " . n Utlltty
ATTENTSidewalk'\fype:/ t\18 Orego t lorth
I \loW rules adOP ".:;, ~'O~ rules arB se ,
o I' t DownspontslDrains:h' OAR 952-00 ,-
NO~~~ ~~2_001-001 0 throu:~s 01 the rules by
m y u may obtain cop t"e telephOne
0090. 0 (Note:". t' n
calling t\18 centeLe on Uti\l\y Notlhca 10
number lor t\18 or1_~00_332-2344).
Center IS
Street Improvements:
Storm Sewer Available:
Special Instruction:
Page I 00
_GI'!AINA.!ffIIil,P,
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CITY OF I'lJ'KmGFIELD .
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-00530
ISSUED: 04/22/2009
APPLIED: 04/21/2009
EXPIRES: 10/23/2009
VALUE: $ 10,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descrintion I
Bid Amount Use Bid Amount'
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amonnt
10,000.00
Value
Date Calculated
Descriotion Tvpe of Construction
Total Value of Project
$10,000.00
$ I 0,000.00
04/21/2009
[.Fpp< P~i<U
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
. Bnilding Permit
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
$16.32
$6.80
$136.00
$9.48
$3.95
$55.00
$24.00
4/22109
4/22/09
4/22/09
4/23/09
4/23/09
4/23/09
4/23/09
2200900000000000410
2200900000000000410
2200900000000000410
2200900000000000419
2200900000000000419
2200900000000000419
2200900000000000419 .
Total A'monnt Paid
$251.55
I Plan Reviews I
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 !'lade theJollowing
work day.
~,i,.prllnl;'"nections I
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Final Building: After all required inspections have been requested and approved and tbe building is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.'
Paee 2 of 3
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-00530
ISSUED: 04/22/2009
APPLIED: 04121/2009
EXPIRES: 10/23/2009
VALUE: $ 10,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is trne and cOlTect, and I fnrther certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure withont permission of the Community Services Division, Bnilding Safety.
I further certify that only contractors and employees who are in cnmpliance with ORS 701.005 will be used on this project.
I further agree to ensure that 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.
~r~
'1- 23 ~dC:;
Owner or Contractors Signature
Date
Page 3 of 3
225 Fifth Street '
Springfi'elil, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00530
COM2009-00530
COM2009-00530
COM2009-00530
Payments:
Type uf Payment
CreditCard
cReceinll
RECEIPT #:
2200900000000000419
Date: 04/23/2009
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
VICKIE GRIMES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
096610 In Person
Payment Total:
.
Page I of (
8:38:27 AM
Amount Due
55,00
24,00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43 ,
4/23/2009