HomeMy WebLinkAboutPermit Electrical 2009-5-15
j!
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~ork is suspended fOf 180 days.
II
liW''''ib\!i!!"iI!ll!i!1l1!:0CA'''1!G'Q"V' ERN. ME N;>:WiA""'?RQ.V A"'Wi14~Wi0:"0!!C!'.
Y0lli;?L.~,,,,~,N. .... L;;.,~ M .,__ ,_ __ _.ilb., liir::.._, , _~ _ ,L;;iL:t\B!d;~<Q9!?:fd!r
1~;:~~;~~~~~~i~~;~Q~[[q~N~~RtJ~mICl~~;'~Yf~II1!lJ~ I
I D Residential I [] Government I D Commercial
IliHIl!!f:JClBj[SITEibHN'=()Rl'IIA'fI()f\I;IiAN()i'I!QCA'f10111i1~~,3!;i 1,000 sq ft. or less (4) $134.00 $ I
I Job site address: I/).J) :S S77ZI!t'7 I ~~~~;?ditionaI500 sq. ft. or portion $ 25.00 $ I
I City: Sff!I/V&fit:U~ I State: ();(.... I ZIP: 97'f77 I I Limited energy (2) $ 32.00 $ I
i=~~:;.~lc~i~f\li!()~,iWJ~~~~~~~1 I ~~~11~:nS~~~:r~~ re~~:r '(;)"odular $ 63.00 $ I
0-1 - ~ -r.. Ii / c:::.-U A I f' _ 0 _....... , I Services or feeders: installation, alteration. relocation I
~(..,(.r1Xo I ,n,er .'\lj"J3;'.JoU'~ VJr"...L-1YJ~
L,~-,j^!"", G: V1& :'tJ~vrt-1 - I 200 amps or less (2) $ 81.00 $ I
1fu:&02Zili'.Illifi1;~;~&~ilii&n-RQ' "E R~iJ;Q.W NE R' ;~l'ji&iI!ll!:m[!:"!~:Jl;~:P))i:,"!C, Ltjl\(Io 400 amps (2) $ 95.00 $ I
'_~""~"~_"_'_"~,"'_H""";;o~,"""~"",r,;;",, ,,1';, ",'lItH?'^-, ",,' ""__,=01f"'!1k1'tih'i,~,G!_,,,'!m~'e..,rP ~ 'f.J
I Name: ..JA#.~v /11/1 Mlto.tJ.~6T ,e,Ml~:-r;~:t(e~ orl ~6~1~l!{&oo amps (2) $158.00 $ I
I Address: "J.O <; II <;rf'k1:',~:;,;;S adopte~:~s~ tule: ~~~e~~1I\1'000 amps (2) $205.00 $ I
I City: 51'.eOJlit'/f,,1:!it) ~~I;:Si~te:<(!).~'~&~~~';f.j\; r\1r&Git;OJJo amps or volts (2) $469.00 $ I
I Phone:o;tl/-1'1& - Oeo 8S in oll\F~'?:"'Uv ~ optain CU\"~t\ie .Iel lReaTh~~ct only (2) $ 63.00 $ I
\3-"n"lR (t1o""'\p. " \~,,"I.l....r. I
I E-mail: . ]~ OOIdU.. tne cef\tel. \. ~ Ut\\\W I ~O 'temporary services or feeders: installatIOn, alteratIOn, relocatIOn .
I "'....I\H'(1 ,.......onOll 2.'1 ^ '11 I
This installation is being made 'I1\~~i1!Allnlii!1 W1i"'l rn6PeftY"- -. "200 amps or less (2) $ 63.00 $
owned b~ me or a mem~er ofmY'fmmed@te1fa1hi'IY. This I 201 to 400 amps (2) $ 87.00 $ I
property IS not mtended .for sale, exchange, lease, or rent. OAR I
1:~~~;~:;;l~~~MI0f\1l~I!II1!lJ~B.t; I ~::::~:::~::~~:.O:/~:'I:;::~e::::j:::e~:::~;::[iOn :bove i
.1 Business ~ame: i: I a. Fce for branch circuits with purchase of a service or feeder fee: I
I Address: 11 I Each branch circuit I $ 6.00 I $ I
City: ,. IIIU,State: I ZIP: I b. Fee for branch circults without purchase ofa service or feeder fee: 1
Phone: \ ~ l:- I Fax: I I First branch circuit (2) II I $ 55.00 I $ S S I
I E-mail: () Vj: I Each additional branch c\rculll/1QI( { $ 6.00 $ b I
I CCB license no.: 'I I BCD license no.: MOi\Ct: I. _ "~\SeNI,n'l!'l(~}J-rvl?r1~lot mcluded I
I Signing supervisor's Iic~nse no.: 1\1\S I'H\~~\ Ii'a.~i;Wlit\\fig~leln{}clf~h I I $ 63.00 $ I
I Print name of signing su~ervisor: j:>.U1\-1U~\ .\:1 Jjl~Il:i'I~ <fli'il1/llll>\J_Ji (2) I $ 63.00 $ I
1 Signature of signing sup'e,', rvisor: CONlWIC.r C~~iiW!b;iG'iJ1.or a hmltcd-energy panel_I I $ 63.00 $ I
. "~I . Q Q. D ~'lI1t.rIrt13h, or extensIOn (2)
:1 t\1'i . "'"
I Each additional inspection: (1) I I $58.00 $ I
Electrical petmit Application
\j
225 Fifth StreettSpringfield"IOR 97477tPH(541)726~3753t FAX(541)726-3689
I,
'I
~-l^.
'D.\~'\J(i.
~c5<.
\P
440.2584.J (9/08/COM)
pe~~~ZOO?-OO 67]1
I Date: Sf r/o <} I
I (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 X [AD
I (C) Technology Fee (5% of [AD
I TOTAL fees and surcharges (A 'through C):
6(1
$ 7..JZ.1
$ .,?oq
$ 7t1 71
$
Status
Issued
CITY OF ~rKlj~vFIELD
Building/Combination Permit
PERMIT NO: COM2009-00673
ISSUED: 05/15/2009
APPLIED: 05/1512009
EXPIRES: 11/1512009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54]-726-3676 Fax
541-726-3769 Inspection Line
,.
.,
SITE ADDRESS: 1120iS ST
ASSESSOR'S PARCEL N0.: 1703261400603
. il
PROJECT DESCRII'TlOI'i: Bath remodel
ii
Springfield TYPE OF WORK: Bathroom
TYPE OF USE: Remodel
Residential
Owner:
Address: ,
II
JARRED GIBSON
1120 S ST II
SPRINGFIELD OR 97477
Ji
Phone Number:
541-746-0683
I. CONTRACTOR INFORMATION I
CII "., \1).
. ontractor , w requireS ""Icense
" . 0 gon a n UI\I\W
O,WNER ._.-"T'o~t re d by lhe orego Ilorll1
O'WNER .' dople \ ate se
." ....'.\e& a "'h,,~e ru es _ ~c~-"n.j-
','I \ ..,".8\li::BuiLDINmNFORMA;il@N<[bY
. - I' ~r\' I I \e
hi U,-" ,. '100\(;1.\11 v_,- \.-, te\eplIUI
I_gO You me (Nole: Ille .1. lion
# of Units; . i Ou.. Il1e .tI,-oIlSjori~s: Ulility Noll Ica
Primary Occupancy Group: R-};a'\I~gr lot fJeigi\rtE'~n~cuctU!ll44).
Secondary Occupancy Group; num e centnypij df'ffela~"~
.,
Primary Construction Typ~ VB Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: I! Energy Path:
Sprinkled Building:
Contractor Type
Electrical
Plumbing
Expiration Date . Phone
Lot Size:
Sq Ft J'st Floor:
Sq Ft 2nd Floor;
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
FrontYllrd Setbllck:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks;
Overlay Dist: . Total:
# Street Trees Rqd; Handicapped:
Paved .Drive Rqd: Compact:
% of Lot Coverage: .. il-l\: \NO?'\\.
"\Oi\C~:..,,.,-::- ~\.l~\ L.. \:~?lr~~~M" IS ~Oi.
I PUBL1fl,IMtiBQ~~l\\I'W1:S'I\rI~~DOW~D rOt'
1'\\ \I ,e . . OK Iv "-\)t'\
. 'A\oJ\E~CED 100. Sidewalk Type:
COWl Df\'1 PER .
. i\~'1180 Downspouts/Drains;
Street Improvements: '
Storm Sewer Available;
Special Instruction:
Notes:
Paee I of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726~3753 Phone
541-726-3676 Fax "
541-726-3769 Inspectio~ [Ape
Description
,
"
J!
Tvpe of ~onstruction
II
I Valuatinn Oescriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project I
I F"", p~;..J .
_ /. ,'''
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
"
Add, Alter, Extend Circ Ea Add
Fixture "
Minimum/Adjustment Pluinbing
Amount Paid
Date Paid
.,
II.
$14.28
$5.95
$55.00
$6.00
$57.00
$1.00
5/15/09
5/15/09
5/15/09
5/15/09
5/15/09
5/15/09
Total Amount Paid
;/
$\39.23
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00673
ISSUED: 05/15/2009
APPLIED: 05/15/2009
EXPIRES: 11/15/2009
VALUE:
Value
Date Calculated
Receipt Number
1200900000000000457
1200900000000000457
1200900000000000457
1200900000000000457
1200900000000000457
1200900000000000457
To Request an inspecti'hn call the 24 hour. recording at 726-3769, All inspections requested before 7:00
a.m. will be made the skme working day, inspections requested after 7:00 a.m, will be made the following
work day.
\
'1J;>"n'~
'I
, .
Rough 1)lumbing: Prior to cover and including required testing.
j!
Final Plumbing: When all plumbing work is complete.
R I EI . P .II C
oug 1 eetnc: nor to over
Filial Electric: Wheh all electrical work is complete.
. '
Paee 2 00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone "
541-726-3676 Fax ii
541-726-3769 Inspection Li.ne
J~
CITY OF SPRINGHIi,LD
Building/Combination Permit
PERMIT NO: COM2009-00673
ISSUED: 05/15/2009
APPLIED: 05/15/2009
EXPIRES: 11/15/2009
VALUE:
By signature, I state and ag'ree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true ~nd correct, and I further certify that any and all work performed shalj be done in accordance with
the Ordinances of the City I;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 strncture without permission of the Community Services Division, Building Safety.
Uurther certify thannly c~ntractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure thiat all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card lis located at the front of the property, and the approved setof plans will remain on the site at all
times during construction. !! .
k",///~A
/1 II ."
woer or Contractors Sign:~ture
. ,
I
!I
II
!~ .
Page 3 of3
cr/;r-/t} 9
Dale I
I
225 Fifth Streeti
Springfield, Oregon 9747~
541-726-3759 Phone
,:.,~AINa. FIECO.iij..' . .......'
-~A - .'
IlL.' ..'.
_. -
,""~' '-""",.. .,. .......... "
Job/Journal Number
COM2009-00673
COM2009-00673
COM2009-00673
COM2009-00673
COM2009-00673
COM2009-00673
Payments:
Type of Payment
CreditCard
cRcccintl
Ii
RECEIPT #:
.,
1200900000000000457
"
Description
Add, Alter, Extend Circ
,
Add, A,lter, Extend Circ Ea Add
Fixtur~'
Minimtm/Adjustment Plumbing
" .
+ 5% Technology Fee
+ 12%!'State Surcharge
!i
]1
Paid By il Received By
JARRED G!BSON djb
,
Check Number
Batch Number
Page I of I
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 05/15/2009
Item Total:
Authorization
Number How Received
033822 In Person
Payment Total:
9:41:49AM
Amount Due
55.00
6.00
57.00
LOO
5.95
14.28
$139.23
Amount Paid
$139.23
$139.23
5/15/2009