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HomeMy WebLinkAboutPermit Electrical 2009-4-23 -) Electrical Permit Application ~~~~t,_m11~~i~1 us l'11th Stnrt.Sprin::fkkJ. OR 97477.PII(S41)72.6--J75l+ FA.X(S4t)72'J689 r~lco;::::M::i::~'O I 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)'$. . ,; ~ . j 1 j I I 1 j g /1 \;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 $ $ S 7 I~ L.( O~ . 9lI 7~ 440-2584-J (9/0l:lfCOM) -SLk~F.'t'IriI"."."< li,'.. WIr....,., , ; II ~ ,:, _H. _. ......'.' H..'''''......,_, '. _"J' ' 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..,' '.. ;. ..h.. - 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