HomeMy WebLinkAboutPermit Electrical 2009-4-23
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Electrical Permit Application
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us l'11th Stnrt.Sprin::fkkJ. OR 97477.PII(S41)72.6--J75l+ FA.X(S4t)72'J689
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I~ ~., . Penmt no.:
Date: '(It- 31> .,
Thh: permit ill issued under OAR 9J8-309-0000. Pcnnits arc nontranderable. Pennits expire if work is not started within 180
days ofi5suantt or if work is suspended for 180 da)'$.
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\;z~nmg:':p"P~~\~~~;;,~~RNMEONT::'P'P'ROVOAL:~~":< ,.:" /) :;.~."1:.:FEE:SCHEDULEi,. '
: N~'~~i~r i~;~ti;:~~._-~~ it~'~{)~".'~'IQf.ll': '-.~~os~ ;';..I;~~"~. ~~,~I
I ':.,CATEGORY OF ,.CONSTRUCTION'" ' ,,' ,... - " . .... ell.
I J I Residenti:d,'per unit, sprvice included:
o Residential 0 Government, 0 Commercial .
I " JOB SITE' INFORMATION ,AND: LOCATION' 1.000 sq. fL m\",. (4) $134,00 $
. BOO C , Q+C,../ . Each additional 500 sG.iuJr,9t(tt;;b I
Jobs,teaddress _ 0" 'SoT t~~Of\'aW(e~llIrc:~~\I\ilit\l__ $25.00 S
City' S?F~ I StatcOIL I ZIP. C; ~1'r 0 MroiJ>ldla,RV~,,~~v;'e set lortn $ 32.00 $
I Subdivision: 1803010 0 I Lot ~o.: O:ff$.',97t ~rl!b-JIili..!.Io~~@jl;\i\~.Il!.\-I. $ 63 00 $
I' - DESCRIPTION OF WORK" . ~o'-'i'.R 9~ 2_hl1~llil\Q~ ~v ,~s~~lru\es bY ,
~ o.fs ~ ~M\o 'S:\..~O, YCJI~~\l,~ffS\Iife"J\.e.a(Qll.Q![~raliO/l,re/QCalioll
_,I-. .t;~^,r. U~l'l / '.i' 11- ....1llI~~.t\1l;@\j~alfiW~<il8ft~~iWNOll\lV"I.vl , 1$81,00 $
......- ,... '1' [T.! 1./1'~ \1""" - It' I\.. - ^~~"_",..~,-t.,,..l,).
I ...,. '. ROPER'rY .OWNER "'.'. . ,::;: \ll". r ~:;q,t,.~qulJU'P"'<"r $ 95.00 $
I Name: !It1()(l,.-Sf;; d~ .PvL 401 10600 amps (2) $158.00 $
I Address: :3ZZ6D OL~ ttVY 3'1 !60ttoLooOomps(2) $205.00 $
I City.IANC~JVr I StalCdL I ZIP: <; 7.3 cr i I Ovor 1,000 amp' m volls (2) $469.00 $ I
I Phone. I Fax:' I Recounect only (2) S 63.00 , S \
I E-mail: ITemporary..rvi!....u.feede.....inslallation.olteralio/l.relocalio/l I
This installation is being made on residential or farm property \ 200 amps OJ 1= (2) , , $ j
owned bv mcora memhcrofrny immediate tamil\'. This nn~o I
Y' oy_,;~ 'is not intended for sale: exchange. lease, (;r rent. OAR t I 0 J:Uil,' .. , amps (2) \F11'I" ,00 S
479.540(1) and 479560(1). ,"\H ~<PflPl~IWT"GHrmt._EXPlt1t: . ~\S 1\~6.00 S I
Signarure^ulr~~~~01a\~ ~t~~ ~c~s section above \
I '. CONTRACTOR;INSTALLATION ..'., 'CO~i!~,~)I},I,U,lli;nslO/lperponel 1
I Rusinessuamc: ,}Kb ?,-jl)r+v,j <! ("(in ( , ANya100l\?}ftl'f.uli\lr.l;\lUu"with pmcb.""ofa ",rviceor feeder fcc: j
I Addross: ZJ'51 . 1)0 fl. ~ fill f I Each br.mch circuit I I $ 8.00 ! S 1
I City: ~r1~r,QJrf I Sta..: Ov-rZIP: q-r4-11 I lb. Fccfo.br.mch ci=itswithout purcb:1seofa servicc or teeder fcc:
_ Phme: ~ I _ 14b-%~ I Fax:'StH -1%-:? ~S5 ! I First br.mch circuil (2) I' I $ 55,001 $
E-mail: 1P,~ 0K"-E\l::L.o~ 1 Each additirntal branch circuit $ 6.00 $
I CCI3 license no.: 4'5 I Let I BCD license no.: 2.0. 2.1,L 1 Miscdlan.ous r...: service Qrfeeder 1101 included
. Signing supervisor's license no.: ~og''5S ! I Each pump OT irrigation circle (2) $ 63.00
Print name of signing 5upervisor:~IJ./WD Lf bur ..un~~ Each sign Of outline lighting (2) $ 63.00
I Signature of signing. supervisor: ~ _ -----..:.71 I Slgnal.l..1.funt ur a 11~11Itcd-cnergy panel, S 63 00 $
c _ ~. ~ J alteration. or cx1enStOfl (2) .
~~\ . x~,~ 0.- jIE3,eb3dilltiOnalinsJ>KtiOn,(I) $58,00 $
,~~ ,..'. ' APPLICANT USE
A~ ,.......". J.~ (A) Enter subtotal of above fees }
~,~~~\)J (~ ~.f'M.~~bo.t~~~~ ' (Minimum PnmhFeeS58.oo) S 8"
c, ~ ~\}' ~ (B) EntL"T 12% surcharge(.12 x [A]) $
I (C)Techlll.l'ogyf'ee(S%of~AD ,$
'-S:- I TOTAL r... and surcharges (A through C): I $
$
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7 I~
L.( O~ .
9lI 7~
440-2584-J (9/0l:lfCOM)
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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: COM2009-00540
ISSUED: 04/23/2009
APPLIED: 04/23/2009
EXPIRES: 10123/2009
VALUE:
SITE ADDRESS: 800 S 18TH ST
ASSESSOR'S PARCEL NO.: 1803010001100
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Add service to existing radio shack
I CONTRACTOR INFORM,~nON I
I ~e(\\J.\'- n \)\'\\~l
Contractor . 01e90\\ \~~\\\e 01e91~ ~~~j}~f
.. ......t..\ ,-1.'\1 , ~ _'" ~\
J K GUCKF;~\l;D~(';EI{~kIf0T@!;;dNC'53~l>.'" (45~tl!, b'l
\~IIo'-N t'i~Jimt!DINGlINj!ofuw,A~{d~l\\e
.,'ce.-, I Ill' '01\
"0\1 I g""CV-' '"'\801" - . . II'''''' "'ica.\1
I~ p.."''' >J au INO\e., ~O,I
i\\ 0 '(aU tfif.pJ(~tories:\\ \)\\\1\'1 AA).
0090. , \\\EHe' bllof'Sfr ~i?-3
80111\\9 '" "W! ?,\JiJI
c ~el 'vl);lJf '1B"H~at:
I\utl' GE\\later Type:
Range Type:
Energy Path:
Sprinkled Building:
Owner: MORSE BROS INC
Address: 32260 OLD HWY 34
TANGENT OR 97389
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Sctback:
Rearyard Setback:
Solar Sctbacks:
Street Improvements: .
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
I DEVELOPMENT INFORMATION I
TYPE OF USE: New
Commercial
Expiration Date
04/24/20 I 0
Phone
541-746-4656
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: -'jandicapped:
Paved Drive Rqd: ~t \NO~mpact:
% of \f{ee~erage: \. ~?\"'t \f i\ \S ~O't
~~,c PE\l,W\\i S\\-\\\,~~~ i\'\\S ?;~~~ fO"
I PUBLIC lM~~ .:; s P,\lJ>-IWv,"
'coN\I~,~ll ~~o\)
~'i '\'00 U j:\'i ?ti\ ~idewalk Type:
JI, DownspoutslDrains:
I Valuation. Descrintion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Pa2e I of 2
Value
Date Calculated
-iiE-
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: COM2009-00540
ISSUED: 04/23/2009
APPLIED: 04/23/2009
EXPIRES: 10/23/2009
VALUE:
Total Value of Project
Fees Paid I
IIIII
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$9.72
$4.05
$81.00
4/23/09
4123/09
4123/09
2200900000000000422
2200900000000000422
2200900000000000422
Total Amount Paid
$94.77
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 made the following
work day.
I ~(>O\ "-ed Insnedions ,
..11..1111
Electric Service: Approval required prior to utility company energizing service.
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.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are re(IUested at the proper time, that each address is readable from the
street. tlIl.t thc 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
Date
Paee 2 of 2
225. Fifth Street
Springficld, Oregon 97477
541-726-3759 Phonc
.. ,!...N,,~IEL ,0 "14'" I..,' '..
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IflIi: ., ..,
City of Springfield Official Receipt
Developmcnt Serviccs Dcpartment
Publie Works Department
Job/Journal Number
COM2009-00540
COM2009-00540
COM2009-00540
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200900000000000422
Date: 04/23/2009
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JKG ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 05576d In Person
Payment Total:
Page I of I
9:58:07 AM
Amount Due
81.00
4,05
9.72
$94.77
Amount Paid
$94.77
$94.77
4/23/2009