HomeMy WebLinkAboutPermit Electrical 2009-7-31
01/14/09 WED 11:06 FAX 5417263689
CITY OF SPRINGFIELD
G!J002
Electrical Permit Application
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-..~ Permit no.:
ZZSFdlIllilroolts,..:'.!""""\Ollnmtl'll(541)7Z6:3753tl'AX(S41)7u.JQ!I I 7 / . i I
-1I5Z- " Date: 7/ sy 09
;(:r]~~:OF.:siR1N_GFbiLlho.REG_6k::.; .:
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This permit is issued oDder OAR 918-309-0000. Permits are nontransferable. Permits ellJlire if work is oot StDrted within 180
days oC issunnce or ifworlit is su.pended Cor 180 days. ,
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_ZoniDgapprovalverified? Dyes DNa, I
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~;W~)?;~~_3 ~~~ ~1 ~;z~B. '~:~-;:::=%~~ ;. / I :: 1 ~3 I
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I et:-"'f>ul-ct: ~ ;/11 If f=i=:-eAt"tL. I S.....i... Or r..d.,,: ilutallatton. alluafion. relocation
I I 200 llIIIp9 orles9 (2) I - I S 81.U0 S
~~~~~IJ1~~..~'iS~~~J;~* I 201 to 400 amps (2) Is 9$.00 S
I Name:oML-eT vlu.A~E MAfic.. 'LLC- 401 10 600 llIIIjlS(2) , IS{58.00 S
'Address: l.f SO Hm,ooltT ~ ML .#'s'J" 60110 I.OOOmnps(2) I I S2II5.00 I S
I City:!lWl'b(l.,\ B&Iaf I Slate: cA I ZfP:9Zbbo" Ower."OOOllllljlS....vol1s(2) I. 1$469-00 S
I Phone: I Fax: . Rc:oonnc<:l only (2) I: I S 63.00 j S
I E-mail: T~pOrDry senites or feeders: inttD.//ariim. aItuirtion, relocation
II This mstaUation is being IBllde 00 residential or lium propeny 200 amps or less (2) I. , S 63.00 S
owned by lnO or a member of my immediate family. This 20110400 """",(2) I S
propeny is not intended fur sale, excbaoge, lease, CO' Ienl. OAR S 87.00
479.540(1) and 479560(1). . 40110600 amps (2) I _ S128.00 S
Signature: Ova600llIIIjlSor I,OOO't01ts, :sc:c:=vicesor1Udus;..mon obov<:
~~~ir~~1i~~~~IPN'~i'.:~~i,~, B"'Deb eire.its: "<lV. alteration, "-"''''io;per panel i
' "I 1""";"/ "J ,84' (\ V"j'\ ,
I Ilusinessname:I/f'_11 ':J' t5 f'.r.,TrI2.<!~.,.~ ()\ego _. ,0\ \"a.Fccfurbnmdlcin:uits_.__~.or"","iCl:udi:ah:rr..: I
I Address: On J~W;o.~f\d~;(~~oP\e~,p.:c~.\u\e':~~~~~2l0(1,,:,Ucbbnnchcin:w1 i-I S 6.00 is j
I City: t-fu qPY1~o"0~ t~!;*i8!e:f,t1, ~,~';hZIPq'l<Aog~ ~O, ~b: fee rorbnndlcimrltswilhompurchase'oras<l"Vico or rccdcrCee: I
I Phone: 42!z; -~r6:'-05~,-~~~\:ai(\00?~~~\\e\e\el?,~ ~~IOl\First_oirarit(2) I I S 55.001 si
I E-mail: oJe/(5 e..1~~~f~'~;Vq.~$ ~':;rO'~',;,~" Eal:hadditiooaJblancbeirc:uit $ 6,00 S I
I CCB licellSe no_: Ji)Q '" i11~\~;LB\W:li~s'.;v@;;;)'~':-rq -c_ I MiscdlaDeo.H...".".;,;. OJ' ftedu "'" indud2d 'I
! Signing ..~- .' :'nr's 1ic:e.B~\i;;:'- &ett~\_l) I Eacb pump..- inigation circle (2) f $ 53.00 I: S I
Printnameofiigningsupervisor: ,~/f11(rJ. i2lr.nJ/r), _I E~~~e"!!Jo'llgll1iog(2) I $ 53.00 I)
Signal11re of signing supervisor: I~ ~~ .J I ~lgnaI- cm:wt or a h!"ited-energy pan.~ I S 63.00 I S
_._~.-'. or OXIC11Slou (2)
Each additiuual iL_. ...:._. (I) I I $58.00 I $
~~ . ~~;;~~SE~j~::~
l1J . ~o/' . I (B)~rr,,:l1i" ~%2j~~\ I S 756
~ '"b'<. ' NO\\C\~\llg~I1\_~j\,..slll-~~~(!\w, I S 3' r
.~ \\-IIS?~RI7.Ed'd'OT~~~~~arga(Alhruugllq: I S7,g7'I
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440-2584-] (9/08/COM)
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01105
ISSUED: 07/31/2009
APPLIED: 07/31/2009
EXPIRES: 01/31/2010
VALUE:
,
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 205 S 54TH ST SPACE 52
ASSESSOR'S PARCEL NO.: 1702330001200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Overlay Dist:
# Street Trees Rqd:
NOT/(j}/tved Drive Rqd:
THIS P'i:m!l!f~~overage:
~UTHORIZED II^,~~~ E~\!HE IF THE WORk'
Ar;p,0iii6iMPRf}~~k~~VI/' IS NOT
-" "1"\/ t"tl,/UD D FOR
N. Siilewalk Type:
PROJECT DESCRIPTION: Replace MH feeder
Owner: CHALET VILLAGE MHC LLC
Address: 450 NEWPORT BEACH DR #595
NEWPORT BEACH CA 92660
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
, ATTENTlu,~: Uregon law re '
In'low I qUires y'Q" t~
Contractor" ru es adopted by the Ore ~Icense
DELLS ~~l!g,TttG: :.enter, Those ruleR "~~~N9j&~
0090. Y~~I;Bui'LDiNG-iNFORMAHONIII.
calling the center. (Note' - .. ...~ 'u,,,, "y
number for the !t\>f.Stories; the telephone
_~V" u,illtv Nntificat'
R-3 Center i:Jitight'Qf Structure ,on
vi.) ,..."..u:.~t::v"+")
Type of Heat: .
Water Type:
Range Type:
Euergy Path:
Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
, Storm Sewer Available:
Special Instruction:
Notes:
I Valuation DescriDtion ,
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid,Amount
Page I of 2
Residential
Expiration Date
01114/2011
Phone
541-935-2154
n/a
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:'
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Downspouts/Drains:
Value
Date Calculated
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-0110S
ISSUED: 07/31/2009
APPLIED: 07/31/2009
EXPIRES: 01/31/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees PaidJ
Fee D~scription
+ 12% State Surcharge
+ 5% Technology Fee,
Manufactured Home Feeder
Amount Paid
Date Paid
Receipt Number
$7.56
$3.15
$63.00
7/31/09
7/31/09
7/31/09
2200900000000000862
,2200900000000000862
2200900000000000862
Total Amount Paid
$73.71
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. '
I Reouired Insoections I
,I ,I ,
MH 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 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 hereiu, and
that NO OCCUPANCY will be made of any structure without permission of the Community 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 iuspections 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 ou the site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
225 Fifth Str,eet
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2200900000000000862
Date: 07/31/2009
9:24:S7AM
Job/Journal Number
COM2009-0 11 05
COM2009-0 11 05
COM2009-0 1105
Description
Manufactured Home Feeder
. + 5% Technology Fee
+ 12% State Surcharge
Paid By
DELLS ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63,00
3.15
7.56
$73.71
Payments:
Type of Payment
CreditCard
Amount Paid
djb
416530 In Person
Payment Total:
$73,71
$73.71
cRcceinll
Page I of I, '
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