HomeMy WebLinkAboutPermit Electrical 2009-7-22
Eiec'tfical Permit Application
225 Fifth Stree'. Springfield, OR 97477+ PH(541 )726-3753 oFAX(54 J )726-3689
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Date:
7-ZZ-c)~
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This p~rmit is issued under OAR 918-309-0000, Permits are nontransferable. Permits e.pire if work is not started within 180
days of issuance or if work is suspended for 180 days.
1~[0:c~LI1(GQ\lI:B~N1ENifi'~E&BQVA~~~~1 1~~~~I;:I;E!IS_C8.E(jJ!l!E~~.i~1
I Zoning approval verified? 0 Yes 0 No 1 i!"'N'.,"Ii'Jh'~,"'.~~f':,,,~'!lll',,0t'~,.lhIlS"~t'!it""'("'~')'-';i,t,'1'.::i~,'I~COsiJJ!,' il!llffiota~'W'1
.... .." '. ii~,:\!m.~~r~,?, \msp~c,,!ol)s'Reri~~eml ? - ,*'"J0~::J/ jml.~--'a'\;lf'0s~ ~'';''''''t~~-'
1_;~li'~~mEJ30R.y..iQfJ!iCPNSjJjBl'Jci1110N~~"1 f""..,,,,,,.,,,_._~\\:m""~""_' ."f; .I,<,,>? ='-~..""""", gOSh~
1~~~~;~lmE~IN~~im;~;ANDJ~~C~;~Nj~11 ~~~:::tt:I,:~:;'~:; servIce mclu~ed: $134,00 $ :
1 '.' r"-J / _r- / / -'- / ......r J _, 1 I Each additional 500 sq, It, or portion $ 25,00 $ I
Job SIte address: '-...J /' e:c ') f'( /1 / M /'L ~' thereof
1 City:,,<;.PTd 1 State: e?~ 1 ZIP: "77~/~ 1 Limited energy (2) $ 32.00 $ 1
i;=il,g~ic~li~~N[~~IW.J~~~~= I ~~~~I~~s6~~~6r~~ re~T:r (~)OdU]~ $ 63.00 $ I.
I &. ;:;ke .#1c;::.~ A~ >t-~ I Services-or feeders: installation, alteration, relocation I
~ --,,' _~ _ r 1 200 amps or less (2) $ 81.00 $ 1
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i!li!'~~'!i!i~~!ZriR'O'~,E Rlo/4'k"0.' 'W'N'E.R. 'i'lF,'1-IA, ,'''''~f;;;':',~,\\!,;''.''j 1 20] to 400 amps (2) , ' $ 95.00 $ 1
$V'/I..ltt'jf~~"__=,",_",=,,,I~, _ ,r; ___-'litIL<&:__'u _ ,_ .____'ii'f:,z!'"~~_~r4~~i.>~.......,,~
[Name: c:;/'t:C/. 6F-.sf3AiAV~--j7;e/d. /40Ito600amps(2) $158,00 $ I
1 Address: S ?-:&s /(;+1- M ; f L. t..?, 1 I 60] to ],000 amps (2) $205,00 $ I
1 City:uprrf. 1 State: off I ZIP: 977'/8' I Over 1,000 amps orvo]ts (2) $469.00 $ J
1 PhonI5Y/-~&- f?.t.:3(' 1 Pax: 1 I Reconnect only (2) $ 63.00 $b3,~
I E-mail: I Temporary services or feeders: installation, alteration, relocation .1
T.hiS installat,'on .is being m~':h9l\" r~id e,lltial.,qr f~~l1), , llrol'.erlv res \ OL _,~OO amps or less (2) $ 63.00 $ 1
db b ~I"'" "d' OI<"!1il"TI\'"~4'" 'v I
owne y me or a mem er tm)lle tate ,am , IS 12~1 to 400 amps (2) $ 87,00 $
property is not intended fof.cs~1e exena1lie'1\fua~eadt~fen~6AR'Jon U1 "
479,540(1) and 479,560(ll)lotification Genter. Ihose rules are S 3t C40,I to 600 amps (2) $126,00 $ I
Signature' in OAR 952-001-001 0 through OjAthR 9! ';'1' )O~er 600 amps or 1,000 volts, see services or feeders section above 1
. nno.n Vru r rnQ\f "hh:un r"nr'llPC:: () .. P r J E.f 1"\\1 .
i/l,~~C:ONiI1RP.:CJTlGR1IilNS]I1Al!l!&1iIQN~~lfi!iZf&fe'O 10 1 !!r~nch circuits: new, alteration, extension per panel I
I Business name: Y=;'~, </6tl~'~-.. . 'he 'Qo@jb;~"'J'!j!l i!::ltca1Fee for branch circuits with porch:"" e of a service or feeder fee: 1
1 /ft~1 '-o'1-'-vv<.-<.)(....[. I I I 1
Address: ~fjv97 ~M) c- ,;( OVr' Each branch circuit .' $ 6.00 $ 1
I City~".(;e-z- ;J:;.'d-('I State:o'< r ZIP: 9" 7</), ~ I b, Fee for branch circuits without purchase ofa service or feeder fee: I
IPhonOY/<rr-.b--t'z;:>,-'3'YI'F~r9'fAib"-d96/ I First branch circuit (2) 1 $55,001 $ 1
I E-mail:o/h%'J?~,_....~.;~-t3!~~,C&>M Each additiona] branch circuit , 1 $ 6.001$ 1
I CCB license no,: I? 'j''Y/'(' I BCD license no,: C '-.,:?h; It I Miscellaneous fees: service or feeder not included 1
I Signing supervisor's license no,: L,171.yo -S 1 I. Each pump or irrigation circle (2) $ .63.00 $ 1
I Print name of signing supervisor: t;.-?9Y"h"e A'7 . ..s-qk~ ..J.J;:ysign or outline lighting (2) $ 63,00 $ J
I Signature of signing supervisor: ~ /~~0;-/ SignaI circUlt or a limIted-energy pa~el. $ 6300 $ I
. 7;" ~. .:.... . - '/.? ~ratlOn, or extensIOn (2) .
NOTICE: J,~~c\'C<!d~~~tHi1R~ct~on:~(!~,.! _=, . $~~:OO I. $ _
<. . THIS PER S\-\JI,LL EX l~",~~li~if!'A~RIEICANffiJl'\iJSE~~~"il
"_l\l~ Jl,UTHORIZED UNDER TH Tt15dtii~;p~~a] ofabovefees . J 71
~ 9Jt'\ COMM~~R IS ABI,IWmimum PermitFee$58.00) , $ D'-::>
, . /\" ~ ANY ~~~\OD.. 1 (B) Enter 12% surcharge (,12 x lAD, $ 75<=1
\\{f,{\J1}V;;\2-- 1 (C) Technology Fee (5% of [AD , $ 51.>1
, . \~ "8< 1 TOTAL fees and surcbarges (A through C): $ 7 S 71[
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440.2584.) (9108/COM)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01053
ISSUED: 07/22/2009
APPLIED: 07/22/2009
EXPIRES: 01/22/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54]-726-3769 Inspection Line
SITE ADDRESS:, 5765 KALMIA LN
ASSESSOR'S PARCEL NO.: 180204]403400
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair Public
PROJECT DESCRIPTION: **Ioc** MWMC sewer pump station adjacent to 5765 Kalmia - access Mt Vernon RD
Owner:
Address:
SA V AGE WILLIAM A & VEDA E
5765 KALMIA ST
SPRINGFIELD OR 97478
CITY OF SPRiNGFIELD
201 SOUTH'18TH STREET
SPRINGFIELD OR
Phone Number: 541-726-3761
Owner:
Address:
h_
Contractor Type
Electrical
fOI/~""/V /tON: C '
Not", W 'Ules ad I' C0'I'fIMCTOR INFORMATION I
II/C~tl t , ' ,
ino "one '-"uuyth '-'''''~Yo
AR 0<: enter rh e Ore U to
C(jn~!)~Il:..t!,r2-001-0oi oSe rUles 90n Utility License
FIRSmi,qG!flf~/qI);~t.d.~C9I~G Ojja;,e^~et forth 179416
Humber fo; th:n~[, BULLDIN-ci INF~MNfION'
Center is /i3un Utility N~:';p'none 1
OO-Jto{StorteS:ICatio~
- ""''f<!J .,
HeighloPStructure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Expiration Date
11/27/2009
Phone
541-726-2961
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft ~asement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
ri/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
NOTICE: # Street Trees Rqd:
THIS PERMIT~ij~1~;~~e~tf, THE WORI<
AUTHORIZED UNDER THIS Pl:RMIT IS NOT
f'lnlllllll1rf..li"'rn nn 1(' ^D^l'dnnr.lr:n enD
Total:
Handicapped:
Compact:
ANY 1 ~ROV~MEN.TS I.
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type,
DownspoutslDrains:
Notes:
Paee I 012
_~fiill'ill,N!Iilli;IIili',Qi
... -'
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CITY OF SPRINGFIELD
Building/Combination Permit
I,
Status
Issued
, .
PERMIT NO: COM2009-0IOS3
ISSUED: 07/22/2009
APPLIED: 07/22/2009
EXPIRES: 01122/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa.
541-726-3769Inspection Line
I Valuation DescriDtio? I'
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated '
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
$7,56
$3.15
$63,00
7/22/09
7/22/09
7/22/09
Receipt Number
1200900000000000819
]200900000000000819
1200900000000000819
Total Amount Paid
$73,71
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.
Reotliretllnsn~ctinl1s I
Electric Service: Approval required prior to utility company energizing service.
By signature, ] state and agree, that I have carefully examined the com~leted application and do hereb~ 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, Bnilding Safety,
I further certify that only contractors and employees who are in compliance witb ORS 701.005 will:be ~sed on this project.
I further agree to ensure that all required inspe,ctions 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 reinain on the site at all
times during construction. J
Owner or Contractors Signat.!lre
Date
Paee 2 of 2
,
225 Fiftb Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 I 053
COM2009-0 I 053
COM2009_0 I 053
Payments:
Type of Payment
CreditCard
cReceihtl
RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
WAYNE SYLLIAASEN
1200900000000000819
Received By
djb
Check Number
Batch Number
Page I of I
City of Springfield Official Receipt
" ,
Development Services Department
,. , ..
, Publici Works Department
I
,
,
Date: 07/22/2009
,
Item Total:
Authorization
Number
8:22:37AM
Amount Due
63,00
3,15
7,56
$73,71
i
How Received
Amount Paid
r5608z In Pers~n
Payment Total:
I
I
,
,
I
$73,71
$73,71
7/22/2009