HomeMy WebLinkAboutPermit Electrical 2009-4-23
E.Iectrical Permit Application
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Permit no.:
I Date: I{ - Z:S - 0 ~ I
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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~'i'i~'lro.t/f.L"iGQYEJ:{!IIMENiT;1f.a:P'P.8QVAL~~~ ~~~:;?,~~~EE[S_G8ED.tJI!E~~~~~~
I Zoning approval vert.tied? D Ye s D No i"~:~3:1~~li\'i\jf~1w.1l1~"~."'I""""~'I""'<C-=IIi=- !"
~Numberlor,inspections'Peh;item,(.,)~m Qtyi t1f.i;P~,' '~Qta1~i.
~t(1~1~iC~]1;~9RY[t;di:jt[C~(jNSmR~tC~ljl~Nlf~~~~ ~~~rt~~y.~~&i;tt.F.;.~'g&A;i,{,:;tmf..p$~~,b.~.,'fij l:re-,-....~ ~li1.~~:lE~g It:.,cosJii:m
I Residential, per unit, service included:
o Residential I 0 Government I ;tg.commercial
1~::~:~:;:I;TE;t~~~~~7~~~~~/jjIO!ll~1 I i~;;;d:i:~::II:S;O(:~ ft,orportion :1::::::
I City:S/J/l./nJ'-Fi'efJ.... I State:dll I ZIP: 97l( I I Limited energy (2) I $ 32.00
1~~~~:=~~~;C~~0~:0F.L\W~~~~;~~ I ~~~~I~~s~~~~~~~Fe~~:r(~)od"lar I $ 63.00 $
I";;;~ 'f/t>(rA-C-e.... ._~t?/~:' 'f/.-iJA-T/9' .-. ,~,.' ""~-""I I Services or reeders: installation, alteration. relocation
~ c. 1< '1'.'2.o0.amps or less (2) $ 81.00 $
11"'1' r-1,,~
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~~!i!:f~~;I?~OP.ERif;y<!oV\(NE~~~~~~fh1jifj!~W,; :201,~9400,ill)!ps (2) $ 95.00 $
I Name: UAb:t:,e:~'<- "?}CI"~~~ 1~<2o.;I;4.1if~i:t9:6~~:~ft~\~ $158.00 $
I Address: z,Z.3 , S- W,^; f~ PeA' k . nc<'/d; 1<.991-ti)(J,OQO''!IT'P~ GL~ Te,.,. . $205.00 $
I City: 7?BItJ I State:oIL I ZIP: '7 776Z(I::I[oj~"i~Q.q9;~n'-P,s;.:q:-'Coj\~72)}~:eS v,.,. $469.00 $
Ic -r:;-n-J '<.:j/tl . VlJ'C'S OVi) ..., r. I
I Phone: I Fax: ICf _ R.e:s~n'!.e~t:o"Iy'(~)" &'1} f") . <iTe _ Utll/ $ 63.00 $
1'1..":1... \Jr.... I'VI') " ''-='\, .''''Y -C/f.,. 'Y
I E-mail: I rem.porar;:ye,E;~ic.e~;pr':fe,er~~riG0s:a1l(fton, alteration, relocation
.. ,.. ., I 200 ampS''o'r)Jess'~2)' .'" le/, c'TV/, vUl. I $
i ThIS mstallatlOn IS bemg made on restdentlal or farm property llO~ . V ^. eM 0',. L 63.00 $
, owned by me or a member of my immediate family. This I 201 to 400 amps'(i}1s( 'Ulillc"ul)e -Y I $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR I '{\ "''.'vl) I
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
1!J!'l~-t~~~_C:0NiliM<::jnOR&;;INS;T!A~I!MlI(')N~~~ft~~~~'1 I Branch circuits: new, alteration, extension per panel
I Business name: . IlJw (o%Gf{ :r,A/r- I I a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: IZy;07 M7. 'LNJ. ~/~l'.t- I I Each branch circuit , I $ 6.00 I $
I City: cI/MJr_O()/leIL I State,:>"M~1qJt 1(5684 I b, Fee for branch circuits without purchase ofa service or feeder fee:
I Phone~3-7!f.- miff 1..f~~~~.t;~~9;S~ I First branch circuit (2) $ 55.00 $
I E-mail: ' 78;1!'C'('C'/;J UI/t/)"!.{{!') I I Each additional branch circuit $ 6.00 $
I CCB license no.: 171 ol( 0 I BCD Iicen~~.6r-1~~ti7'19) Miscellaneous rees: service or feeder not included '
I / Z-;o' - 'r. "110. "j/f" I
Signing supervisor's license no.: DIe -1 'f/O~ <741(:;' ~.'E~~rmp or irr:gation circle (2) '$ 63.00
I Print name of signing supervisor: ;j,'_ if,; lis (;; ~ ~~~;,.;utJme Itghtmg (2) $ 63.00
I Signature of signing supervisor: 4- r~\ILda~\!! or a Itmlted-energy panel, $ 63.00 $
/ ~~ ----- a~tjofr:',6r extenSIOn (2)
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\" \.\St ..()., (A) ~nter subtotal ofabov-
"'~ ~ l,J"'" (Mm,mum Permit e $58.00 $ 5 B
/>... ~ ~ I (B) Enter 12% surchar~12 x [Al) $ 6'"
..:..\... ~ I (C) Technology Fee (5% offAl) $ ZJO
\- ~ I TOTAL rees and surcharges (A through C): $ ~? ~,~
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$
440-2584-) (9/08/COM)
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2009-00546
ISSUED: 04/23/2009
APPLIED: 04/2312009
EXPIRES: 10/23/2009
VALUE:
SITE ADDRESS: 1505 MOHA WK BLVD
ASSESSOR'S PARCEL NO.: 1703253404101
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Low volt voice and data
Owner: CUDDEBACK COMMERCIAL PROPERTIES INC
Address: 22395 WHITE PEAKS DR
BEND OR 97702
Contractor License
NORTHWEST.COMT~Q!tIN~nM ,_ 179040
IUIIU"" ~._. . - . . ~....,"",-.... "uu to
Notifiel ; BUILD INUINF0RMA'TION:IJtilit
in OAR 952-0'0-; ';';-~'1 ~ ~~u'e rUles are set folh
0090. You ~~ofStorii~s:rough OAR 952-001_
nHv.Qh"t~fS'nn't'- fth
calling the ,elg to truc ur~ e rules by
T,"e,oler. _lMnte' th t I
number for oIY8t~~H~~t: '. e e ephone
CentiYra,'Sr1 !y'p'e: Utlltty Notification
Range ffJIi,332-2344).
Energy Path:
Sprinkled Building:
Contractor Type
Low Voltage Electrical
# of Units:
Primary Occupancy Group:
Secondary OccuP'lIIcy Group:
Primary Construction Type
Secondary Construction Type:
# of Bed rooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
DescriPtion
Type of Construction
I CONTRACTOR INFORMATION I
Expiration Date
10/29/2011
Phone
503- 729-888 I
nla
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Nn""",~
~\
THIS Jiti'rUaLlC IMPROVEMENTS'
AUTHO ", oHAL
CO" RIZED U " L EXPIR Sidewalk Type:
w,MEN NDER ElF T,H
ANy 18 CED OR / THIS PER E WD~rnspoutslDrains:
o DAY PERlgDABANDONE~/T IS NOT
. . FOR
I Valuation Descrintion J
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I 01"2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00546
ISSUED: 04/2312009
APPLIED: 04/23/2009
. EXPIRES: 10/2312009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees P~id .1
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$6.96
$2.90
$58.00
4/23/09
4/23/09
4123/09
Receipt Nnmber
2200900000000000427
2200900000000000427
2200900000000000427
Total Amount Paid
$67.86
I Plan Reviews ~
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 Reouired Insnections 1
Low Voltage: Prior to cover.
By signature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 further 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 without permission of the Community Services Division, Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will he 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 rem:,;n on the site at all
times during construction.
Owner or Contractors Signature
Dafe
Page 2 of2
225 Fifth Street
Sprlngfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00S46
COM2009-00S46
COM2009-00S46
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200900000000000427
Date: 04/23/2009
Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
RANDY KELLEMS
Item Total:
Check Number Authorization
Received By Batch Number Number' How Received
djb
140208 In Person
Payment Total:
Page I of I
2:02:39PM
Amount Due
58.00
2.90
6.96
$67.86
Amount Paid
$67.86
$67.86
4/23/2009