HomeMy WebLinkAboutPermit Electrical 2009-5-11
225 Fifth Streot+Sp,ingfiold, OR 97477 +PH(541)726-3753 +FAX(541)726,3689
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I Date: S - (( ~ 0 7 I
Electris:al 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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I I Residenti~l, per unit, ser~iceincluded: I
t~~~~:~~;;E~~~~~i1N(~~1~~~~~~~j i i~;;01:i:~:~:~s;0(:~ ft. or portion :1:::::: \
1 City: .s p(-~ L State: tAL- 1 ZIP: ., 7c{ 2'~ I Limited energy (2) $ 32.00 $ I
Subdivision: ./ !:>OZD ~ 2 2 I Lot noD B.?()() I I Each maoufactured home or modular $
1~~7~;~~SC[{lf;~(O~W~B.~~1I~~~~: 1 ::~:~:: ~:r;~::Oo:S~ei::;~l~::ion alteration. relo:at::~OO
i~~~t~~~i.1 :::::':::::. i I ;,::: : ~(
1 Address:' z.. S-O s. '> Z.... ~ Sri 601 to 1,000 amps (2) 1 $205.00 $
I City: c;.T>,c~ I State: ()l..L-1 ZIP~I'5'74:1.?,':,leov~r.i\0~0'~p~ror,vO!tS.(i? I $469.00 $
or,II,...", l'U..'I~ lr-v.;.r;:u uy lilt:: '.JtJ:;:'jUII ULllllY
I Phone: I Fax: -. ,NoIiIicaIion Ce ntf,R~~qr,'<'iI't,?N!Yo\6)'o 00' fndh $ 63.00 $
E.mail: In UAK 902-UUII-( ure;rrli]o~ar.~lseEvic'i!s~orJ'e~~~r~: installation, alteration, relocation
. . ." .. ~~~~. ','::;~ ~::;,. 0 )QOOlamps 100i'less ~2)1 rules by
ThIs mstallatlOn IS bemg made on residential or farm1pr9p'eR:Yhe c' lnl,;:.. '''I_~_. ..1-_ .._1___1.. _._ _ $ 63.00 $
owned by me or a member of my immediate family. TiMb'\oJ ~ .. -;i01\i~406.';;;'p;i2V' .~.:~
property is not intended for sale, exchange, lease, or%\W OA)2r t~ e'): "9u'/ ~'~'~n,"u:lflcatlon $ 67.00 $
479.540(1) and 479.560(1). Gente' I~ 4OJCl/i1600.amps1(01), $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services orfeeders section above
RlI&~iIc5DNmR1(GffiQR~INSmlX~ll~~N~~$~~~ I Branch circuits: new, alteration, "extension per panel
Business nam..., 1,-) 1/ .y r y II 10 (0 S . 1 I a. Fee for branch circuits with purchase of a service or feeder fee: 1
1 Address: / fJ 0 ,n () '-J.. (PVJ 7 . j' [ Each hranch circuit I I I $ 6.00 \ $ b \
I City: \tV ~ 11 'f {If I II <..L, I State: () y'f I' ZIP: f.j 7 L/... (P-I 1 b. Fee for hranch circuits without purchase of a service or feeder fee: 1
I Phone: 7.Jf:J? 72-'-!- 1 Fax: ,-tfl.f J 0'4 -, I First branch circuit (2) $ 55.00 $
I E-~ail: I I , . j Each additional branch circuit $ 6.00 $
I CCB license 00./ jl,'f~LpI CD license no.: ~ O.-.:-~ ..;:;; II Miscellaneous fees: service or feeder not included
[ Signing supervisor's license no.: I 1 ::ach pump or irrigati9n, ci!,cI!'.(2). rk-' I $ 63.00 I $
I Print name of signing supervisor tach SIgn or outline h@.~tm~ ~l. " I $ 63.00 $
I . .' . \ I 1 ......; I 'al 1 !tlh~rs1frr!!i1:~- r I it I I I
SIgnature ofstgnmg supervlsor.0 AIITH() - tl.l>N@HhlrblMD ~ 'fVfiTp~ T $ 63.00 $
. -~ ~ If 7 )) ~~~8Effi:~~~~&..~1
n.l\ Qj ..IJ......[\ I I (8) Enter 12% surcharge (.12 x [A]) $ /0 C{q & C) \\;J':J . ~'V ~ [CC)TechnologyFee(5%of[A]) $ l{:sr
o t5 ~ 1 TOTAL fees and surcharges (A through C): $ /0 ( ~,
~~
440,2584-) (9/0S/COM)
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00646
ISSUED: 05/11/2009
APPLIED: 05iII/2009
EXPIRES: 1111 1/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 890 MOUNTAINGATE DR
ASSESSOR'S PARCEL NO,: 1802032208300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Public
PROJECT DESCRIPTION: Service and circuit for pump
Owner: WILLAMALANE PARK & RECREATION DISTR
Address: 250 S 32ND ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
BURRELL BROS ENTERPRISES 1NC
. License
136446
Expiration Date
08/20/2009
Phone
541-747-2724
# of Units:
Primary Occupancy Group:
Sccondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I BUILDING INFORMATION I
ATiliiStlRills:Oregon law requires you tnot Size:
follHeigiilPo'i' SfruciUfeby the Oregon UtilS'q Ft 1st Floor:
Not+yp~;'Of Heai:9r. Those rules are set fC$'<\1Ft 2nd Floor:
in OWaa,~:?r9~~:001 0 through OAR 952-0\5~-Ft Basement:
009RaX~~lfY,,'b:obtain copies of the rulesSlYFt GaragelCarport
C2EtnV tl)p:'ilioter, (Note: the telephonlS Ft Oth .
nUgJ'bVlidne"?J.8oon Utility N?tificatioaq . t"{' d
Pru~"'~lLer% t!1J\jO'332-23<?4t ccupan oa:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
I'aved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Notes:
I PUBLIC IMPROVEMENTS ~
NOTICE: Sidewalk Type:
THIS PERMIT SHAll EXP1REd~Jl~WOB\Cnins:
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD. .
Street Improvements:
Storm Sewer Available:
Special Instruction:
I Valuation Descri,otion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e I 01'2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
$10.44
$4,35
$6.00
$81.00
Total Amount Paid
$101.79
Total Value of Project
Fees Paid I
Date Paid
I Plan Reviews I
5/11109
5/11/09
5/11109
5/11109
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00646
ISSUED: 05/11/2009
APPLIED: 05/11/2009
EXPIRES: 11/11/2009
VALUE:
Receipt Number
2200900000000000509
2200900000000000509
2200900000000000509
2200900000000000509
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 Renllirerllnsnectinns'
Electric Service: Approval required prior to utility company energizing:service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, 1 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 thc work described herein, and
that NO OCCUPANCY will be made of any structurc 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.
] 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 locatcd at the frontofthe property, and the approved set of plans will remaiu on the site at all
times during construction.
Owner Of Contractors Signature
I
/
Page 2 of 2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00646
COM2009-00646
COM2009,00646
COM2009-00646
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000509
Datc: 05/11/2009
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
- + 12% State Surcharge
Paid By
JOSHUA BURRELL
Item Total:
Check Number Authorization
Received By Batch Number . Number How Received
djb
03560c In Person
Payment Total:
Page I of I
11 :36:56AM
Amount Due
81.00
6.00
4.35
10.44
$101.79
Amount Paid
$101.79
$]01.79
5/\ 1/2009