HomeMy WebLinkAboutPermit Electrical 2009-7-28
225 Fifth SlreeUSpringficld, OR 97477. PH(541)726.3753. FAX(541)726-3689
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PermIt nO.:'1
I Date: 7- 2%-0 (
Electrical Permit Application
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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,
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~~~~I~EfIN~~B~;~;~~AN"Ol~~G~m~~;~J I ~~~~::ti;I':'~:s:n(:; service included: $134,00 $ :
I Job site address: /(oti) J <:f I I ~~~~:fditional 500 sq ft, or portion $ 25,00 $ I
I City: Sfl'ill,~ [,'ell I Stale: 0;( I ZIP: 17'177 I Limited energy (2) $ ,32,00 $ I
Subdivision: I 70 J Z'5 ~ Lf I Lot no,6200 I Each manufactured home or modular I
~~QI'::S:CRIl?ITi!C!lNlf0f;,~W9,B.K~1 dwelling service or feeder (2) $ 63,00 $
--;em P Po kJe/ I~b. e.- I Services or feeders: installation, alteration, relocation I
I I 200 amps or less (2) , $ 81,00 $ I
1~~?"i~':'''-~''I?ROHER;JlI(,.w0VVNER1i!1'P!~~''''~'~i';;;''''~i~~1 201 to 400 amps (2) $ 95,00 $ I
~~:'.=:,,^~":(\~_-.-. _." _,-,-<0..'''''''. J__" , _____~JI~.~~kv;!t....w,..,.".
Name: 1J1! {j( ey S~OO I( _~.oMo 600 amps (2) $158,00 $ I
I Address: 1/ ~() J 5f- \a'<'J laCJ.\.\I'c 'O"I-'20JiilJ 1,000 amps (2) $205,00 $ I
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I City: sPf' kJ. I^Stal~:',e~'~';:I\~II~! c,&'.'l}as ,Ira 1:~l~J~I\QOO amps or volts (2) $469,00 I $ I
I Phone: _ _ \'~\\j)FaJt~\"~;a(\\"(. \ '\\~-IO\Jg\1 ultl~, ,1l-\"so_nheJ;t only (2) , ' $ 63,00 $ I
..,..,nv ...olf'l II ..... L\I' , p
I E-mail: ~ot" \LrV.~> 52-00, ,_vv' \n co?\t::,;l - Ite' ~~emP'<!rAJry services or feeders: insta,llation, alteration, relocation ~
^,\'\9 ..."I'l\a ,.~,\\1a 'h='''-'
Th" II' 'b' d '" - 'd"-'" 'l"~" ' - ,''v' '\'\" NC \2vu amps or less (2), I $ 6300 $ /
IS msta atlOll IS emg ma e qJ?;J~~l. e~~a ,.o\:.~~ P:?.P~%t\ \, , . ," b
owned b~ me or a member of my lIp1!!"d,-"tOlf~IIH!YCTliIS0 (\ 3,,>2-'2,4 '201 to 400 amps (2) $ 87,00 $ I
property IS not mtended for sale, excliange; lease, or,renvi()"R
,479,540(1) and 479560(1), (\UI'" ' ca(\\"\ .. I 401 to 600 amps (2) I I $126,00 $ I
Signature: lOver 600 amps or 1,000 volts, see serVices or feeders s~ction above I
~C.(;jNmMcmQ~~INSm~~~illIPN~~t-~ll~gm'1 I Branch eircnits: new. alteration, extension per panel I
I 'Business name: S[ LA..{ F./ ~:...L;.. -.r. I I a. Fee for branch circuits with purchase ofa service or feeder fee: I
I Address: 3<iSS:Y '1;...1......,,,).9.5 ,QJ I I Each branch circuit _,,;, I I $ 6,00 I $ I
I City: ,<:::;,01:'-\ -II State: Or I ZIP: Q7cJ7'fJ I b,Feeforbranch~r\~~flbUtl~~haseofaserviceorfeederfee: I
Phone: I-sell //N-/D7{1 Fax: 1 8f1- FI6 ;t'7&1 I F~r~r~rlt\"e'i1.t~\.J\~' \'~;. $ 55,00 $ I
E-mail: ' \\\)_\);~~~ ~tt.'/l'l'!i!j\;\l,\j~~&~M\' $ 6,00 $ I
I CCB license no,: I~/;),~ 51 BCD license no,: dB,~~,fz;r!\l\'~~~~"If5Jl,\I~\\: service or feeder not included I
I Signing supervisor's license no,: '7' 700..5 '" (\1I~~~~~'E\lr~lmgal1On CIrcle (2) $ 63,00 $ I
I Print name of signing supervisor: ~(", _ ().Ai'" t~"','\ ~\) ~1h' sign o~ outlin~ lighting (2), $ 63,00 $ I
I Signature of signing supervisor' 'I. +--1 Slgnal C!fcull or a hmlled-encrgy panel, $ 63,00 I $ I
. II\....-- alteration, or extensIOn (2)
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~ I (8) Enter 12% surcharge (,12 x [A]) :' $ 75'bl
~ I (C) Technology Fee (5%0f[A]) $ :5"- I
I TOTAL fees and surcbarges (A Ibrnugb C): $ 7'S l!...1
440-2584-) (9108/COM)
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Status
Iss u ed
CITY OF SPRINGFIELD
Building/COrhbination Permit
PERMIT NO: COM2009-01093
ISSUED: 07/28/2009
APPLIED: 07i28/2009
EXPIRES: 01/28/2010
VALUE: '
225 Fiflh Slreet, Springfield, OR
541-726-3753 Phone
54'1-726-3676 Fax
541"726-3769 Inspec1ion ,Line
SITE ADDRESS: 1660 J ST
ASSESSOR'S PARCEL NO,: 1703253405200
Springfield TYPE OF WORK: Use lriilials
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Temp power only
Owner:
Address:
MICKEY SNOOK
1660 J ST
SPRINGFIELD OR 97477
Contractor Type
Eleclrical
T. ,)I\[; uregon law reqUIres you to
, ,',": ;>)s,ad?pt,:clt(i]ONTAACif0RtINFORMATION.
,".' )fl.lOnCemef. nIU;,t:IUlt:::iareSelTOnn
IIlC6riW~UiJ't1-001 0 through OAR 952-001- License
OOJEMYELECTRtC"iNC3pies of the rules by 161235
"'_,,,..,, ".., ....."r".....~ ,,\,_#~. AL._ ~~I_ ,
Expiration Date
09/07/2010
Phone
541-729-1074
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Ty'pe:
# of Bedrooms:
number for the Ore(lpIBUIJ!JDINGiiNF,ORMATlON I
Center IS 1-8uu-':'';''-'',j<i'l),' ,. ,
# of Stories:
Height of Struc1ure
Type of Heal:
Water Type:
Range Type:
Energy Palh:
Sprinkled Building:
"
Lot Size~
Sq Ft 1 sl Floor:
Sq F1 2nd Floor:
Sq F1 Basement:
Sq F1 GJrage/Carport
Sq F1 Olher: ,
Occupanl Load:
R-3
VB
nla
Frontyard Selback:
Side 1 Se1back:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION' 1<
NU \ (v!;.' EXPIRE \~ 1M!: ,JOR
1\-\\S PEP()~\1IS\-\th~ 1\-\\SPER!v\\1 IS N01
AU1\-\OR}7.SUeV1~~fes~mONED FOR
Co!v\!v\EIi'a~ld l}ri"~~:
, ANY 18U'.{JM'JJ6f-cU~~hge: ,
REQUIRED PARKING
;ro1al: '
Handicapped:
c:;ompacl:
I PUBLIC IMP~OVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
,
Downspouts/Drains:
Noles:
I Valuation Descriotion I
Description.
Tvpe of Construction
$ Per Sq F1
or mulliplier
Square Foolage
or Bid Amoun1
Value I
Date Calcnlated
Paee 1 of2
Status
Issued
225 Fifth Stree1, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
To1al Value of Projec1
Fees P~jd I
Fee Description
+ 12% Slate Surcharge
+ 5% Technology Fee
Temp Power 200 amps or less
Amount Paid
Date Paid
$7,56
$3,15
$63,00
, 7/28/09
7/28/09
7/28/09
Total Amount Paid
$73,71
I Plan Reviews I
CITY OF SPRINGFIELD
Building/COInbination Permit
"
PERMIT NO: COM2009-01093
ISSUED: 07/28/2009
APPLIED: 07/28/2009
EXPIRES: 0112812010
VALUE:
Receipl Number
i
2200900000000000854
2200900000000000854
2200900000000000854
I'
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.
I. Reguired Insnections I
Temporary Electric: Approval required prior to Utility Company energizing pole,
By signature, I state and agree, that I have carefully examined the completed applica1ion and do hereby certify 1hal all
information hereon is true and correct, and I further cerlify that any and all work performed shall be done in accordance wi1h
1he Ordinances of the City of Springfield and the Laws of the Slate of Oregon per1aining 10 1he work described herein, and
Ihat NO OCCUPANCY will be made of any structure without permission ofthe Community Servic~s Division, Building Safety,
I further cer1ify that only con1raclors and employees who are in compliance with ORS 701.005 will be used on this projec1, '
I fur1her agree 10 ensure that all required inspections are requested a1 the proper lime, thai each address is readable from Ihe
street, 1hat the permit card is localed a1 the fron1 of the property, and the approved set of plans will"remain on the site al all
times during construction.
Owner or Con1ractors Signa1ure
Page 2 of 2
Date
225 Fif~h Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 I 093
COM2009-0 I 093
COM2009-0 I 093
Paymenls:
Type of Payment
CreditCard
cReceintl
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2200900000000000854
Date: 07/28/2009
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JEM ELECTRIC
Item Tntal:
Check Number Authorization
Received By Batch Number Number How R,eceived
djb
331358 In Person
Payment To1al:
Pa,ge I of I
2:33:48PM
Amount Due
63.00
3,15
7,56
$73,71
Amount Paid
$73,71
$73,71
7/28/2009