HomeMy WebLinkAboutPermit Mechanical 2009-9-10
Ele(;trical Permit Application
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I Date 9-/0-0' I
',225 Fifth S'mltSp,ingfield, OR 97477tPH(541)726,3753+FAX(541)726,3689
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,
,:ji~1.!0GALi:;G0VERNME/IIif\rAP,RR0YAlf'r.J~,f\'!lf'1~1 1@,1(n?i!;~4~'1~:j>1l!'it#!iI;"El:~SGI'lEJj.l:JI.!!E~~~~;';'~,~~.ill!\1I
Zoning approval verified? 0 Yes 0 No 1 1:~iJlri;;e~'of'i~i~~~ii~ri~:~~'r:it~~t)::II'Q{~;1 ';,S<i~C~i:\<;ro'tal,':'\
I:.r-M1Jfj:n3il'.i.~i~:cA'tE G.QRY;tr(jF,'~itGON5:t:RU.G-,tf(jN~1~';:-,j;~~~~,\}.'.~~~:, -,l:''i)~;~;.~~t""~,pgf;,:"~",,,'tt:;;,-(}:,'r;({,,W;rh'_'f.W'," ~:t~"... '___,:'<0 .. ;J.l;:~.
e.a. ;'~"';' ''\.-~' (:.ost_, :,~"
I Residential, per unit, service included: I .
1 $I Residential I D Government I D Commercial
11,000 sq, ft or less (4) $134,00 $ I
1~..t0!3jU$FrtE,j[NI:;0RMA;rtLON~r#./IIDilli()J::AiJiION~ei\iJ{jll
1 f;! 7 / ,/1 1 Each additional 500 sq, ft, or portion $ 25,00 $ I
Job site addre~' t' 0 L./1"'\. (~> 0 '. . thereof
I City: -..::p . ' 1_ Sta~ r ZIP77V7)( Limited energy (2) $ 32,00 $ 1
1,~,~t"::~~c~.:.I2,o,~S~R~~~J0F:.J;~~~;~~'! 1 ~~~~I~:nS~~~~~r~~ Pe~~:r (~)odular.1 $ 63,00 $ 1
I "/i S'-/ ;1'(. ~ ' 'DU' if ~"~''-'-''':';C1''''):''';'-' ':1:' \ I Services or feeders: installation, alteration, relocation
i, . . -J-( ~~'~R~~T~~ER,,21>$~/;" /'..:/ .,1 : ~:~ ::;00::;: ::: : ::::: :
I Name: GA 1?-/4 is y 0 0.,~i0.!f4;/::I1I' ,'1. ] 1 401 to 600 amps (2) $158,00 $
1 Address ~71 iY bA I rs;;!f'l9~~?{~~0'0;;YOI)I;, 601 to 1,000 amps (2) $205,00 $
I City, c:;P;Z-b I State~~J~)?.W;Z!0;7~~~QY9u~00ampsorvOItS(2) 1 $469,00 $
1 Phone, _ , 1 Fax~'f}bf},~ ll)f! y 06: 'U II} -0 ? 1/ ,~R<'c3Rnec!-?/)ly (2) 1 $ 63,00 $
~~.f~~..... ta,.., In. >':S' ....vn ... r.
I E-mail: ~b Yt!J)A.e ~r2- ~~~~:f, (T!~P'o~~~:~~I~rQices or feeders: Installation, alteratIOn, relocation
, , ' _ L ,> 10 ~,;- -,,,c' '/ 11200 amps or)loSs (2) $ 6300 1 $
ThIS inS lIatlOn IS bemw",ade On residential or farm Rtop.erty U. ' tie "n:; u~:; . 'n ' ,
owned by me or a member of my lmm dlate famIly, ThiPO'1o t!lt~ ,A,ijc201 '1{,'(400't\&,ps (2) $ 87,00 $
property is n~t I ded for sale, e nge, lease, or rent OXR?,<._ ]'l':' '":vn v "'y
479540(1) an 4 560(1). / ~ 7>{ 4QJ6\9600 amps (2) $126,00 $
Signature:, _" ,~'" .,. ,/c.---t-- rOver 6VdO amps or 1,000 volts, see services or feede~s section above
I' ,>' .";.c~NT~;r:'OR11I'3STA1;.i;lArlON.", .; 1 Branch circuits: new, alteration, extension per panel
Businesn"me: ~W .JJG""~- I a, Fee for branch circuits with purchase of a se'rvice or feeder fee:
I Addres's: Each branch circuit I I $ 6.00 I $ I
I City: I~jtte: 1 ZIP: b. Fee for branch circuits witho~t p.urchase of a service or feeder fee: J..
1 Phone, 7')jf fig,!::., , I First branch circuil (2) I'I $ 55.00 I $ S- f
1 E-mail, 4(j:~ PI:;;;:/, I Each additional branch circuit ' 1 $ 6,00 $
1 CCB license no (,,0') 'W6b)JjJn.Q,~. , 1 Miscellaneous fees: servIce or feeder not meluded
A. fJ//,P//li ~. rr ::>V7JfJ l.
1 Signing supervisor's licen~~VKoJ;9nIVCI:;) U/VDj:'~ f)(Plt5':.;:'e!"i~ ,;.1 Each pump or ImgatlOn circle (2) $ 63,00 $
I-VA 0"" l I LI ,~. ,,. 1 ' ,
Print name of signing supervisor, ,.,y PC''.; /s 'tis /:J~ ~ Each Sign or outlme IIghtmg (2) $ 63,00 $
I Signature of signing super\:lSor' ~'1(0D. 4,J'i/VDoA:!:f}!/l' ;/Ar(~U~I~~,c~;te~:nl~~~t(~i""ergy panel, $ 63,00 $
v FO/? I'liffch additional inspection: (I) $58,00 $ 1
~ '^- 1\~~S~~:~~7~~:~:;~~Nit~jJSE\~~~~;\'~!fi.l~Bi~~~;'i~1
(\ \'\,,0 <')./ (Minimum Permit F~ S-8 ,
V\.. cJ;J::-1 (B) Enter 12% surcharge (.12 x [A]) $ h [fe,'
~ (C)Technology Feo (5% of [A]) $ Z,.~
& TOTAL fees and surcharges (A through C): $ L 7 ~ b
\
-, -
440,2584,J (9/08/COM)
CITY VJ' ~rt<lNGFIELD
Building/Combination Permit
PERMIT NO:COM2009-01325
ISSUED: 09/08/2009
APPLIED: 09/08/2009
EXPIRES: 03/10/2010
VALUE: '
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 4710 DAISY ST
ASSESSOR'S PARCEL NO.: 1702324306601
Springfield TYPE OF WORK: Heating System
,
PROJECT DESCRIPTION: Install ductless heat pump
TYPE OF USE: New
Residential
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
NOTICE:
~:::: ~:-,'"";~,,::f ,~;;;;:. ~t"'nc Ir lnt VVUiH\
11t1!J'.IiLI€d.)W;P~QM"~~/iI;r,SclpERMIT IS NOT
COMMENCED OR IS ABANDON~!drnl'lk Type:
ANY 180 DAY PERIOD. . DownspoutslDrains:
Owner: BROUGHER GARY J & SUSAN J
Address: 4710 DAISY ST
SPRINGFIELD OR 97478
,., C~NTRA~TOR INFORMATION I
Contractor Type
Electrical
Mechanical
Contractor License
OWNER
Asso~B;WijlE'~ItING[&rAHMf~~!'l'.9~, I P.6275
,Notiticatio~rl~:Biii'LDINd:iNF0RM'A llI0N I
In OAR 952-001-0010 th I -'.- ~;'~ 0';' JOrin
0090. You may obt#od?o~,jl,~,oAR 952-001_
call: " h :.:1.1, I GVIJIH:-:: of thA rib
R13 t e centeftle!g~fEPfjStructure' es Y
number tor the Or;I:Y(l~ '1J'tff.r.rt,reJephone
, vwenter is 1\Ya!e!jfJ;}cIl~~~tltlcatJon
, " Range Type: :
Energy Path:
Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DE':ELOPMENT INFORMATION ,
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Paee 1 of 3
Phone Number: 541-741-0257
Expiration Date Phone
08/31/2010 541-683-2590
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
. Compact:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I V a.lu.~tio~ De~criDtion I
Description
Tvpe of Construction
$ Per SqFt
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Flr~~ f1id I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
+ 12% State Surcharge
+ 5% Technology Fee
Add,Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
$9.48
$3.95
$79.00
$6.96
$2,90
$55,00
$3,00
Total Amount Paid
$160,29
I Plan Reviews .1
Date Paid
9/8/09
9/8/09
9/8/09
9/10/09
9/10/09
9/10/09
9/10/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01325
ISSUED: 09/08/2009
APPLIED: 09/08/2009
EXPIRES: 03/10/2010
VALUE:
Value
Date Calculated
Receipt Number
2200900000000001019
2200900000000001019
2200900000000001019
2200900000000001027
2200900000000001027
2200900000000001027
2200900000000001027
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.
L.RfollirprlJnsnections I
Rough Mechanical: Prior to Cover
Final Mechanical: When alt'mechanical work is complete,
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete,
Pa2e 2 of 3
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01325
ISSUED: 09/0812009
APPLIED: 09/0812009
EXPIRES: 03/10/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signatnre, 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 shali 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, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 70] ,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
str. eet, t:~~~rmit card is located at the front of the property, and the approved set of plans will remain on the site at all
times d~ struction,
'y~___ / 00/ ~f'
r c~rs s~re V Date { . '
Pae.e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department,
Public Works Department
Job/Journal Number
COM2009-0 1325
COM2009-01325
COM2009-01325
COM2009-0 1325
Payments:
Type of Payrnent
Check
cReceinll
RECEIPT #:
Date: 09/1012009
2200900000000001027
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
GARY BROUGHER
Item Total:
Lheck Number Authorization
Received By Batch Number Number How Received
4001
In Person
Payment Total:
DJB
i
Page 1 of 1
I :33:5IPM
Amount Due
55,00
3,00
2,90
6,96
$67,86
Amount Paid
$67,86
$67,86
9/\0/2009