HomeMy WebLinkAboutPermit Electrical 2009-5-1
225 Fifth Street+Spdngfield, OR 97477+P~(541)726-3753+FAX(541)726-3689
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Electrical ~ermit Application
I P~rmitno" {1C; - s-'7 f
!I I ,Date: 5/1/ () '/
This permit is issued under OAR 918-309-0000. Permits are nontransferahlJ Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days. II,
~~[QQ~!-!11:GO\l.ERNIIiIEN1f1lf~RP'R(;WA!!:~~~
Zoning approval verified? 0 Yes ~ No ' ~
1'&~0t<mEGiRX4IOF;;lllC~()rII$5r:I:l.l!JlmIOrll~l!l\!\ii~1 I Residentiil, per unit, service included: I
~;~~~~~lmEWJlrIIF.~B~i;:~;ANDlil!:C~;';N;~~!~1 /1,000 sq, ~, or less (4) $134,00 $ I
I Job site address: '3o~( rKMJkL;j Blvd I '1 ~':,';~:ldit!onaI500Sq,ft,orportion $ 25,00 $ I
I City: :JPJ::A,>-, ,c,_'/d I State: O/'l.. I ZlP9} '10:" I I Limited eri6rgy (2) $ 32.00 $ I
1~;=~~~'lQE$_QRIe,TiONIQFJlWJ~~~~L~~ I ~~~71~:"si~~~~~~~ ~e~~:r (~)odular 1 1 $ 63.00 $ I
('l _ __.J.t 3' ~ b. -t":. 1 Services or feeders: installati?n, alteration, relocation !
~'V.elA,.~"J,O'~ ,If') Ill.., J--LA '
- -- . I 200 amps ?,r less (2) $ 81.00 $ I
~'l~~P.ROP,E;R'Ii\l'llir().vv:NE8l1-~~~ii!,~i'iI,~! I 201 to 400::amps (2) $ 95,00 $ I
I Name: anD' :t-5 w,ll"...df, 1(.,~ BL 1401 to 60diamps (2) $158.00 $ ,I
/ Address: "B....t:>.d I.:: 1.'0.0 I 601 to 1 ;oqo amps (2) $205,00 $ I
I City: I State: I ZIP: I Overl,OOq amps or volts (2) $469,00 $ I
I Phone: I Fax: I Reconnect::only (2) $ 63,00 $ I
\ E~mail: I Tempora~y services or feeders: installation, alteration, relocation I
This installation is being made on residential or farm property I 200 amps pr less (2) , $ 63,00 $ I
owned by me or a member of my immediate family, This I 201to 40Q:amps (2) / $ 87,00 f2 7 I
' property is not intended for sale, exchange, lease, or rent OAR
479.540(1) and 479,560(1), I 401 to 60Q:amps (2) $126,00 $ \
Signature: Over 600 ~mps or 1,000 volts, see services or feeders section above I
f~=:::~~N~~~~~!~;~~;~~:7:~~!\~~rJ: I :r;::~o:i~::~~~ ~i::~~:t:~~::r:~:s:s~~~:~::e~r feeder fee :
I Address: PO, B.:.)c / Z'l -, I I Each bri;nch circuit / I $ 6,00 / $ I
City: Pt'>/ZCSt ~ IZ"V,._ I State: 0 IL I ZIP: ~ 7 J J b. I I b, Fee for ~ranch circuits without purchase. of a service or feeder fee: I
Phone:5;.;-~7 -060'1- 1 Fax~;J-~5-7-0Zo<;. I I Firstbra!ochcircuit(2) $ 55,00 $ I
I E-mail: C\ehe.. &, S...",rl~....el~c.+':';c. _ C^AJ\ I Each ad~itional branch circuit $ 6,00 $ I
I CCB lice~se no,: A7 442- I BCD license no,: I Miscellan~ous fees: service: or feeder not included I
I Signing supervisor's license no,: t3Tf::J..7 - !.S I Each pump or irrigation circle (2) $ 63,00 $ I
I Print name of signing supervisor: Ge. he. l_ ....\e.1s oU I lEach sign ?r outline lighting (2) $ 63,00 $
I Signature of signing supervisor: }w{ I"?_ v? n P. _ I' 1 Signal circhit or a limited-energy panel, $ $
I~ l _ ~ _ a]teration,~r extension (2) 63.00
11~~~~~=~::~tio_~:I(:~Y:#T:__~_:~~_,,1
WfXtlTi"'f!iS!l,~IAFmI!IC-AN;r/!J\l'J,SEIiJi!?~rl!&,",ill ",~,,--~l
I (A), Enter:rubtotal ofabovdees $
(MlllImu'l' Permit Fee $58.00)
I (B) Enter 1'2% surcharge (,12 x [A])
I (C) Techn~logy Fee (5% of [A])
/ TOTAL (ees and surcbarges (A tbrough C):
I
I
~
~t~ /h\.,6^-
/\,;"J
\~\v
~~ rf'-
~~
$;0 s&' J
$ 1(:JSl
I!O/'Z'1 I
440-2584-) (9/08/COM)
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T!~PE OF WORK: Electrical Work Only
Ii
l1i\'PE OF USE:' New
Temporary elect for 15 hridge project trailers
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 3001 Franklin Blvd
ASSESSOR'S PARCEL NO.: 1703334402600
PROJECT DESCRIPTION:
Owner:
Address:
~ ~
[.PU"~
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~
iCITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00598
ISSUED: : 05/01/2009
APPLIED: 05/01/2009
EXPIRES.: 11/01/2009
V ALUE: .~
Engene
Puhlic
ORECON DEPT OF TRANS HWY COMMISSION
355 CAPITOL ST RM 119.
SALEM OR 97310
Owner: STATE LAND BOARD
Address:, 355 CAPITOL ST RM 119
SALEM OR 97310
Contractor Type
Electrical
Contractor
CENE NELSON
# of Units:
Primary Occupancy Croup:
Secoudary Occupancy Group:
Primary Construction Type
Secoudary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Sethack:
Rearyard Sethack:
Solar Setbacks:
Street Improvements:
Storm Sewer Availahle:
Special Instruction:
Noles:
,
ATTENTION: 9regon law requires you to
follow 'rules ad.opled by the Oregon Utility
"I_..:.t~__...:__ .....___'''-_.. ......,_ _ _ _ I ., ..
I CONTRA2ibk~FQ~~fAoN~I--O-U9h:OAR- 9-52-00 i' ~
. , . ... . 'pies ,of the rules by
calling the center. (Note: the telephonj1.
number for t~Mi~[l~~n UtiliifP'j5!!~ll!.Q;Mlate
Cente157!14iZ-800-332-23,0i71.3l/2009
. BUILDINC I:"FORMA nON I
11
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq'Ft 2nd Floor:
Water Type:' Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
''''~:''r"~~E
Energy.Path: :,' Sq Ft Otber:
Spri~1fl~g 1l~\t!t!~1f SHhL f?)(fI'IRE IF<m~~M{ad:
I DEVELOPMENT.iN'EOR,J\'iiif[6~~IilI" t-'tliIVIII I:::> I~U I
. ---- - " - .~J,NDONED FOR REQUIRED PARKING
ANY 180 DAY PERIOD.: ~
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage: '
Phone
I.PUBLlC IMPROVEMENTS I
II
Sidewalk Type:
Downspouts/Drains:
Page 1 of2
-':l!O~RINGI'1I,~~1
i '-
l~
Status
Issued
CITY OF SPRINGFIELD
BuildiJ)g/Combination Permit
PERMIT NO: COM2009-00598
ISSUED: 05/0112009
APPLIED: 05/01/2009
EXPIRES: 11101/2009
VALUE:
225 Fiflh Slreet, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726'3769 Inspection Line
Description
Type of Construction
:1
I Valuation Descriotion 111
"
!I
$ Per Sq Ft Square Footage
or multiplier or Bid Ari\ount
!I
II
Total Value of Project
',I
Value
Date Calculated
Fees Paid'
ii
I;
II
Date Paid
il
5/1/09
5/1I0~
5/1109
Receipt Numher
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Temp Power 201 - 400 amps
Amount Paid
$10.44 '
$4.35
$87.00
2200900000000000466
2200900000000000466
2200900000000000466
Total Amount Paid
$101.79
I, Plan Reviews I
To Request an inspection call the 24 hour recording at 726-376~. 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 Insuee\'o 1S -il
I I .....;1
Temporary Electric: Approval required prior to Utility Compauy energizing pole.'
II
II
By signature, 1 state and agree, that 1 have carefully examined the completed application and do herehv certify that all
information hereon is true and correct, and I further certify that any-and al'. work perfonried shall be done in accorda'nce 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 o[the Community Services Division, Building Safety.
I further certify that only contractors and employees who are io eomplianc~:with ORS 701'.005 will be used ou this project.
1 further agree to ensure that all required inspections are requested al the proper time, that each address is readahle from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain 00 the site at all
times during construction. :1
~~ e. JILUl---
5 - I - 00;
Owner or Contractors Signature
Date
Page 2 01'2
229 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00598
COM2009-00598
COM2009-00598
Payments:
Type of Payment
Check
. cReceintl
RECEIPT #:
.~ji:
Wii:.........
:1
II
II
I
II
il
II
Check Number
Batch Numb~r
"
2200900000000000466
Description
Temp Power 201 - 400 amps
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SUNDOWN ELECTRIC
Received By
cjc
Page 1 of 1
22,m
City of Springfield Official Receipt
Development Services Department
Public Works Department
Da,te: 05/0112009
Item Total:
Authorization
Number How Received
In Person
Payment Total:
1l:02:13AM
Amount Due
87,00
4.15
10.44
$101.79
Amount Paid
$101.79
$101.79
511 /2009