HomeMy WebLinkAboutPermit Electrical 2009-5-26
Electrical Permit Application
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225 Fifth Streett Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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Permit no.:
I Date: 'S- Z b . c..:> '7
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~C~fLEGGB;YLG>~CQNs.mR.!!!~iTIQ~~\l1(g~1
't!Residential 1 0 Government I 0 Commercial
~jj!lt~ElllSlifj:;iiINIil:5.BM:AmIGN1l'AJ:JJ:)l{I11QcP..ill[('H:jW~4lli 1,000 sq ft. or less (4) $134.00 $
Job site address: K'SO :s -) 0 (1...- 1 ~~~~:lditional 500 sq. ft. or portion $ 25.00 $
I City: ,<;r(2,.i, ~ .1 State: 0(' I ZIP: C17if7Z I Limited energy (2) . $ 32.00 $
f~~~~~~R~i~~Qt~wJ~i~~~ I ~~~~I~~S~~~~r~~ ;e~~:r (~)odular $ 63.00 $
I c:::::-. _ r..../ I Services or feeders: installation, alteration, relocation
1 (wn f,;(?p l '-II;~"".' '1 1 200 amps or less (2) / $ 81'.00 $ 8/
1~~~~eRQ~!;Rffi1i'ci[~Y{NIZR-jj{Wlit~~im,~%'f:;.,~1 I 201 toAOO amps (2) . $ 95.00 $ I
I Name: L';;~,I+ ,'r;:,,oL,1/I,Jt9. 1 I 401 to 600 amps (2) . $158.00 $ I
1 Address: bo7b 1"Er...:"'-.jf' Lt' I 1 601 to 1,000 amps (2) $205.00 $ I
I City: <;(>rh. 1 State:o/L.. I ZTP:77f(?O,. ",1,,'r\~I,OOOampsorvolts(2) 1 $469.00 $ 1
I Phone: _ D/7 _ I? ~ I { 1 Fax: _ _ \'I la'IJ \e4U" ~1-oJ E.e~il~tect only (2) 1 $ 63.00 $ 1
rIG ~, . l"'\~onO "_,, n{e ...:'i \UI~r.
IE-mail' '''1E\'.\IIU''' d- O?led \l~ ""ules ~ \elot~'1'Pl'rJlry services or feeders: mstallatlOn. alteration, relocaNon 1
t\\ 1....C.::\ .....v.nc..A{ - ~t\::J"- ,
"Mo" I' .. "~"'d' v"al -t.O< ,. ,," V" 200.ampj or less (2) $ 6300 $ 1
l'uIS msta latlOTI IS bemg made on .~~Sl~f~R-, ':01> 'l~ p'rl~?p'ertyJ ~ \\"\ . '(~'~'"' .
owned bJ: me or a member ofllJYOmm~~1.\'~~lf!J.rrul~~,ThisvO?les Oe Ie' z~Ol:I~~!lO amps (2) $ 87.00 $ 1
property IS not mtended for sale,(exchange, Iease,<o, rent.,ptc.R 1\'1 " t""i~"- 1
479.540(1) and 479.560(1). '0'090. '(00 ~"u~e"le\. " ~ utili\'! ,.1 ',40 to 600 amps (2) $126.00 $ I
I. g,,,e OlegO" 1/1''''
Signature' Gall\'l 101 tne 000-332- uver 600 amps or 1,000 vnlts, see services or feeders section above 1
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1~1iiC0NmRA'CmGfB.l\iINslt~J~I!!'P"!DljDl\I~{,;~;~; 1 Branch circuits: new, alteratIOn. extension per panel I
I Business name: J[ L<< FIe:- _l; ---(? I a Fee for branch circUits with purchase of a service or feeder fee. I
I Address: 8ZSY \T;:-.L~,h)" 12ct 1 1 Each branch cii-cuit 1 1 $ 6.00 1 $ I
I City: ,C:;Or~. ,IState: nr I ZIP: Q7L/7'f: 1 b.. Feefor branch circuits without purchase ofaservice orfeederfe e: 1
I Phone: / -:::,.q{ 711-/0741 Fax:.; oil- 7f./6 07').) 1 First branch circuit (2) 1 $ 5500 $ 1
I E-mail: 1 Each additional branch circuit . I $ 6.00 $
I CCB license no.: 1t:,1;}'~ s-I BCD license no.: 'dn ,Cj(}.7c:. 1 Miscellaneous fees: service or feeder not mc'ft4fd
1 Signing supervisor's license no.: t{ 700..5' . 1 Each pump or irrigatiOn circ~e C,l: \\\t~~\~1' 63.00 $ I
1 Print name of signing supervisor: A6e ( M/" j-'2J~'> 1_~I"4l~lgn or !'.Pl\l~'\1.1~'{,'fi~t:?'~\\ I~ $ 63.00 $ 1
-/.IO'/'/I HQ~.- MilHl'''' ;Utth"~J>.1i) FV\\ ,
I Signature of signing supervisor: If /II!) i1 _ \\'~~I~W~ut\h1~k",f!\)\J'~~~ I $ 63.00 $
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~iln/ . NA) g;t~rsubtotalofabovefees $ 8-t'
rt~ 1 (Minimum Permit Fee $58.00)
. ~ \ f1.... I (B) Enter 12% surcharge (.12 x [A]) $ 7' 71
\. \ ~\- I (C) Technology Fee (5% of [A]) $ if o~
'\}\ I TOTAL fees and surcharges (A through C): $ 9if~'
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~~mtier.;Qfdnlpeciio~1p."!~ilFm!(')1~ QiYl, . ~~s~ ~otat~
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I Residential, per unit, service included: I
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440,2584-) (9/08/COM)
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00726
ISSUED: OS/26/2009
APPLIED: OS/26/2009
EXPIRES: 11/26/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 850 S 70TH ST
ASSESSOR'S PARCEL NO.: 1802022304101
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: ,Repair
Residential
PROJECT DESCRIPTION: Service change
Contractor Type
Electrical
LISA JAEHNIG
6076 FERNHILL LOOP
SPRINGFIELD OR 9747!jJ.,TTENTION' ()'M~_ '_
IUIIUW rUles 8rl()nt~,...j L....-::., 'v'jUIl es you to
NotificatIC(5ti).NiI1RAGT?:R'T~fORMI\1;~(l)!'t .
, In OAR 9""'-UU1-0010 th-- ~.~ O"'lOrrn
0090. You . rough OAR PC-,l.ll!"
Contractor /I' may obtain copies of th L~t:t",se
JEM ELEC;&\~y1't.ce center. (Note: thA tal~J~!~3!;1Y
,. ...... ",,-:, "'-l"'"'~ 'H"'" . -......
qeRBIjuDIN~.IN~~~~~~IONjln
# of Stories:
Height of Structure
Type of Heat:
Water Type:
. Range Type:
Energy Path:
Sprinkled Building:
Phone Number: 541-912-1334
Owner:
Address:
Expiration Date
09/07/20 I 0
Phone
541-729-1074
VB
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupaucy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: .
R-3
nla
Froutyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Sctback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
N QJ:J.t;Uif Dist: .
THIS~'r~t
AU7lt~~WifJ!~v . EXPIRE IF THE W
CO/i;'Y.o/fI!rvY!Etj OR IS R: THIS PERMIT IS ~~~
ANy 180 fMVD;r:'.~lf:~BANDONED /'no
I PUBLIC IMPROVEMENTS I
REQUIRED PARKING
Total:
Handicapped:
Compact: .
Street Improvements:
Stol'm Sewer,Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
, ' I Yaluation Descriotion I
Description
Tvpe of Coustruction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I' of 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
Perm ServlFdr 200 amps or less
Total Amount Paid
Amount Paid
$9.72
$4.05
$81.00
$94.77
Total Value of Project
Fees Paid.'
Date Paid
I Plan Reviews I
5/26/09
5/26/09
5/26/09
CITY OF SPRINGFIELD
. Building/Combination Permit
PERMIT NO: COM2009-00726
ISSUED: OS/26/2009
APPLIED: OS/26/2009
EXPIRES: 11/26/2009
VALUE:
Receipt Nnmber
1200900000000000530
1200900000000000530
1200900000000000530
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 R~~uiJ'ed T nsn~~tiJlDs .
Electric Service: Approval required prior to utility company energizing service.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that an}'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 Communit}' 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 requested at the proper time, that each address is readable from the
street, that the 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 Signatu~e
Paee 2 of 2
Date
225 Fifth Street
SpringfieJd, Oregon 97477
541~ 726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00726
COM2009-00726
COM2009-00726
Payments:
Type of Payment
Cred itCard
cRcccintl
RECEIPT #:
Date: OS/26/2009
1200900000000000530
Description
Perm ServlFdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JEM ELECTRIC
Item Total:
Check Number Authorization
Received By 8..tcl1 Number Number How Received
djb
203761 In Person
Payment Total:
Page 1 of I
8:21 :08AM
Amount Due
81.00
4.05
9.72
$94.77
Amount Paid
$94.77
$94.77
5/26/2009