HomeMy WebLinkAboutPermit Electrical 2009-7-22
225 Fifth Streett Springfleid,.OR 97477 + PH(54t)726-3753+ FAX(541)726-3689
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Electrical Permit Application
I C0W1~LlOi-O/04~
Penmt no.:
I Date: ][7 - 2 Z -0 <]
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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. II
li\fr~I[~Q-e;l!(~0S(,l:gt'lMl:tiI;fjf~geR.<;iMA~~ I:l{S:QIil.e:~J!J"H
[~;~i~~~~;;C[<;iF,i9:~N~~:~~'il\'Qi~~~J I Res:ential, per unit, servic~:;:~ed: ..A'" I
_",..",:sidential .. 0 Government ...0 Commercial . _ 11,000 sq. ft. or less (4) I,;,' $134.00 $ I
1~=~,~:~i~Eliit7Ci5t5~i1lj~f.l;~N+~~:Q*rr~~J;P~~ I ~~~~;ritional 500 sq. It or portionii $ 25.00 $ I
I City: s;p~~ I State: ofL I ZIP: i7471 I Limited energy (2) Ii $ 32.00 $ I
"~~~~J~~e~JlIiF.iW~~~~~i~ I J~~71:;::"S~~~~~:~~ Fe~~:r (~)OdUli $ 63.00 $ I
\ ---rt:1-'V\.f', (/ c)L./ IE:. t1... I I Services or feeders: installation, alt~ration, relocation I
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I Address:' _I 3Z-g 1, L-irs -P""\,,As' ~.J I 1601 to 1,000 amps (2) ,II I $205.00 $ I
I ci~.L f/~I.~~I State: cA. I ZIP: 9'D27zJ I Over 1,000 amps or volts (2) .11 $469.00 $ I
I Phone: . I Fax: '. .1 I Reconnect only (2) II $ 63.00 $ I
I E-mail: ,I .I ie'mp~r:~9't~,~rYl~~s or feeders~ ins?allation, alteration, relocation I
Th. . ... .. I iOO'amps1odesi(2) ~ "'Ill/res you "t f I
tS mstallatlOn IS bemg made on restdentJaI or farm property . U, ,- (.,... . - v, 'dA ()__ _ :.0 $ 63.00 $
owned by me or a member of my immediate family. This' J. Iii )E'I)20i]i~4bo !J!.ps(2)Ules -"VII U[/Illy $ 8700 $ I
Property is not intended for sale exchange lease or rent OAR) \' . - - "". (,... am Oct d .. .
, " .IJ. JUlm- . ""V"-:rnOAR .....11/ I
479.540(1) and 479.560(1). cal/inc It ,401'toI6QQ.'!'1':P1,<:?L _,.. 952-001_ $126.00 $
Signature: nUmbe. fcl;9xff;~P~ aITlPSlbr:i!Plib'tt9~IEe/@Sef,:vjces or feeders s~ction above I
~~=~~;t'lm~[i~NSJfl:~{:?~i~~g~tfil;e. 1.:r;:~~o~i~~~~i~~~~]~;~~:g:J;t~::na~:~::e:r feeder fee. I
I Address: 3'i?f;Y \~.L:::r.h r I2c4 . I I Each branch circuit Ii I I $ 6.00 I $ I
I City: ,'SOt'.--\. "I'State: Or .1 ZIP: q7r.j7~ I b. Feefor branch circuits witbout pu(chase ofaservice orfeederfee. I
I Phone' 1-5~{ 7!lQ-!074 I Fax:. I 5i/- JC/f:,.07,;(.7 I I First branch circuit (2) II $ 55.00 $ I
I E-mail:' I I Each additional branch circuit II $ 6.00 $ I.
I CCB license no.: 10/~?:Js-1 BCD license no.: 'In -6J.7c. I Miscellaneous fees: service orJeede'!:notincluded I
I Signing supervisor's license no.: "i 700..5 . ~ Fj:;r>l'lump or irrigation circle (2) Ii $ 63.00 $ I
I Print name of signing supervisor: .Ji.dt" . f JAr" :/-'?J'::" . H ~rl:~lt,;;_~r outlindighting (2)!i $ 63.00 $ I
I Signature of signing supervisor: . ....., if~lt~ltb~t~In~~P~E WO 1~ 63.00 $ I
I (;01'.' P? c rrr;.. "1- -
/ AN :~~~:~=~;~%~ir~~~~J
(AJ Enter subtotal of above fees Ii
(Minimum Per~it Fee $58.00) '1
I (B) Enter 12% surcharge (.12 x [AD Ii
I (C) Technology Fee (5% of [AD ][
I TOTAL fees and surcharges (A \/,rough C):
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$ b3
$ [sr;
$ 31 :r
$737/
440-2584-J (9/08/COM)
Status
Iss u ed
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CITi OF SPRINGFIELD'
Building/Combination Permit
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PERMIT NO: COM2009-01048
ISSUED: 07/22/2009
APPLIED: 07/20/2009
EXPIRES: 01122/2010
VALUE: $ ::25,000.00
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 1480 16TH ST APT 3
ASSESSOR'S PARCEL NO.: 1703253102200
Springfield TYPE OF WORK: Apaitment Building
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TYPE OF USE: Remodel
Commercial
PROJECT DESCRIPTION: fire damage
Owner:
Address:
NORTHGATE VILLA LLC
1328 LAS PULGAS RD
PACIFIC PALISADES CA 90272
Contractor Type
Electrical
Contractor
JEM ELECTRIC INC
License
161235
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Expirati~n Date
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09/07/2010
Phone
541-729-1074
I CONTRACTOR I,NFO,RMATION I
.' BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Rl
A""#~ofIStories:) Lot Size:
! _' -: . . ......1":' rOr-,...... j~
o'!cHelght of.Structurelaw reqli,.r Sq Ft 1st Floor:
, ',.. .... "UC>I)' db es Y II
, J"t''fypeiof,Heat: Ie y the 0" ou tCSq Ft 2nd Floor:
In 0 ^, - '. . VCO/le( Th egon Ut."t, 'I
, ",Water.(TJl~e:. ose rUles II .Sq Ft Basement:
C000 ., - " -uOl0 th are Set! t' '
~ ;. Ra~~ei!rpJ'~tai rough OAR 952. or Sq Ft qarage/Carport
ca/"Eiiergytl'ath: n copies Ofth 00lSq Ft Other:
numt. - -. Her IN,,! ' e rUles b . II
Sptinkled Building: e. the te/Non JOccupant Load:
('on..../.- .... ......'c::!:jOJI Uti/it,,~! ::!-' One II
-. 'L> '~,""J '" "'- - .~."'! :dllOn
, DEVELOPM~r,l 11~ruKM;Vr.10N I
VB
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Oist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
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I! REQUIRED PARKING
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ilTotal:
II Handicapped:
': Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
NOTICE: Sidewalk Type:
THIS PERMIT SHALL PRl"m~~~t~RrW6RK
~UTHORIZED UNDER THIS PERMIT IS NOT
OMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation Descr,iotioiI I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value]l
Date Calculated
Pa2e I of 2
. cIn11 OF SPRlNlJl'l~LD
Building/Cdlm binationPermit
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Status
Issued
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PERMIT NO: COM2009-01048
ISSUED: 07/22/2009
APPLIED: 07/20/2009
EXPIRES: 0112212010
VALVE: $ '25,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769'lnspection Line
Total Value of Project
Fees Paid ~
$7.56
$3.15
$63.00
7/22/09
7/22/09 ,
7/22/09
Receipt Number
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1200900000000000826
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1200900000000000826
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1200900000000000826
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Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Temp Power 200 amps or less
Amount Paid
Date Paid
Total Amount Paid
$73.71
Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections rJquested before 7:00
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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 1 nsnections .
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Temp~rary Electric: Approval required prior to Utility Company energizing pole.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hJrehY certify that all
information hereon is true and correct, and 1 further certify that any and all work performed shall'lbe done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the w6rk described herein, and
that NO OCCUPANCY will be made of any structure without permission ofthe Community Servi~es Division, Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will!be used on this project.
1 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 sit~ at all
times during,construction. Jr
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3'(59 Phone
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City of Springfield Official Receipt
Developme1ht Services Department
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Public Works Department
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Date: 07/22/2009 2:42:06PM
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RECEIPT #:
1200900000000000826
Paid By
JEM ELECTRIC
Received By
Item Total:
Check Number Authorization
Batch Number Number How Received
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Amount Due
63.00
3.15,
7,56
$73.7]
Job/Journal Number
COM2009-0 I 048
COM2009-0 I 048
COM2009-0 I 048
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Payments:
Type of Paymeot
Cred itCard
Amount Paid
djb
392797 In Ijerson
Payment Total:
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$73,71
$73.7]
cReceint I
Page I of I
7/22/2009