HomeMy WebLinkAboutPermit Electrical 2009-9-8
225 Fifth Street+Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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I Date: 9-i-o ,j I
Electrical Permit Application
This permit is i~sued under OAR918~309-0000. Permits are nontransferable. Permits expire if work is'~otstarted within 180
days of issuance or if work is suspended for 180 days. '
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1!i:7IJl!i!~!lir,li!Ic:MEG,08Y;~.0F,~t0Nsr8UCjlTl()N_14.li!Iil!fif1!l I Residential, per nnit, service includ:ed: ' I
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I c.ty:~r\t-.<:, 1h'''.L1> I State: (".,f2.. I ZIPG7tf /7,U Limited energy (2) I $ 32,00 $ I "
I Reference: /702- 3.00 c::. I Taxlot.:OeIO~1 I Each manufactured home or modular I ' I $ I
I '.It('!11.li!I~,Hlll!!ii'OESCRI~rI0Nii;0F,;~W0RKf~''iI!1!Ylliillll!1iEii!!j!iJll'1 dwelling service or feeder (2) 63,00 $
~ej(\c...\I\.~__ D~IAfJ-l a..1'.~ AJ..~ lSrA-f"ooct.... J I Services,~rf~eders: InstallatlOn, alteratIOn, re/ocatlOn I
.fC\J'> So I I 200 anips or less (2) \ $81,00 $<;?f,~
I 201 to 400 amps (2) , $ 95,00 $ I
1(',11e.c..,+IM.~"''\-s, 1"40it0600amps(2) $158,00 $ I
""Iy~ -r "---1' ,-I, I 60Ito,I,000amps(2) , $205,00 $ I
L/ '~(> 1 ~ "'" //)' " , ..
I City: c.,1i>.\f\c:.r,~L\) I State: fit?- I ZIP:97{i7si?I.,):~~~r.l,~60~~sorvolts(2) $469,00 $ I
I PhoneSqJ -7'17 -91/3> IFax:9fl-q9B -o5:q;~ o~ljJSC;ryry~:y)~:,(~~, _ . . $ 63,00 $. 'I' "
I E-mail:. '-/)6 '{/ it- '..I~mp~~ary s~r:v~es;?[ feeders: installatIOn, alteratIOn, ~elocatlOn
I Th" II' 'b' d 'd' I f: @'/( 0 c2OOanips'orless (?ji'" r@r.
I IS msta, attOo IS emg ma e on resl entia or arm property C "', N...' v,. ,'-" h -,\ ': "It::> VI., $ 63.00 $ I
owned b~ me o~a member afmy immediate family, This e..,( '''!&20fCi9 4'00 ~ps,(2;i/;.; U;; '~G~ $ 87,00 $ I
property IS not mtended for sale, exchange, lease, or rent. OAR 9;-'1[') '-; <' f ;..l.-,:/} ,.......-?r1 ..<:l,; l$l..;-u _'~ I
479,540(1) and 479,560(1)" ) 10~to(!iOO;,'!!PP's:(2) Q~~I'@. '7 h<:-'r. $126,00 $
I 'Signature: ove~6",q9-'~~{(LG '009/~~oli,~e.~~~~ces or feeders section above I
:~PI;fu1~d!C0NTRAPTc:)R1tINSrAl!IlATION~~;~~~. Branch ~i7,f_~((s~~~w.lg{ereJ[&lo~~ns'ion per panel I
Business name: c'1\ 'M.D c..z.'?: <(JL c; \, c...~' ,c:.. I a, Fee/or bran't~d{fdi<W)JIi ~chase ofa service or feeder fee: I
Address: ~O. Rc,'.f, L\.\SI::lG I Eachbranchcireuit .'o/) lJDI $ 6,001 $\dDI
I City: t;...:>"i eNi I State6 ~ li'lb;:;IP:'=t 7 If 0 <f I b, Feefor branch circuits without purchase or a service or feeder ree: I
I, Phone:,<;L{C '74 {/,> - 1'17 ( I Fax:q!i?"I:if4f,fio,1... 2a '8 I . Firsl branch circuit (2) I ,. $ 55.00 I $ I
I E-mail:\,.,.;.....,~(!'J.rA~CIYri~~~r ,c:..c",,1 I Each addi'ional brnnchcircUl' $ 6,00 I $ I
I CCB license no,:\t......\( rt71 I B6P.~IL~e'n~~66~;~ ~ I I Mlscellaneous.fe.es: service or.fteder not inciuded I
I Signing supervisor's license no.: 302 % :C'f'j) Ul/!!>~!.I.,d I Each pump or lITIgatIOn C1fc1e (2) $ 63,00 $ I
I Print name of signing supervisor:i)II.. e. ~ e 'i'-ir~~~1]' l'J;.; ~.1'ch sign or outline lighting (2) $ 63,00 $ I
I' f ' -<..f - /.% {;'~v~~ . '15', )Si6'al,circuit or a limlted.energy panel. I
Slgnatureo slgningsupervisor: ~ _lJ"n",'(t41j~ ~)<la(4Jt"'rextenslOn(2) $ 63,00 $
, (IV>>"" 'va). 1,,/
'Iv"'tfn"'nifr6J1J\Y~spectjon: (I) $58,00 $ I
1&W';W:f~@~li!IARRl!iCANff8iJSEi:li!Ig~lill!H~[pt'!'.ar~ilri~rl .
I (A) Enter Sllb,total of a~ove fees . . ' . ere .
(MinimnmPermitFee $58,00). $,)-0 \ I
I (B) Enter 12% surcharge (,12 x [AD $ ;).4.12. I
I (C) Technology Fee (5% of[AD ii $' 10, dS' I
I TOTAL rees and snrcharges (A through C): $)35,/71 ..
I Name: is,FD
I Address: S 77 I
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Status
I55 u ed
CITY OF :Snm"ld,.ELD
Building/Combination Permit
PERMIT NO: COM2009-01326
ISSUED: 09/0812009
APPLIED: 09/08/2009
EXPIRES: 03/0812010
VALUE:
225 Fifth Street, Springfield, OR
541.726-3753 Phone
541.726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3783 Olympic St
ASSESSOR'S PARCEL NO,: 1702300002105
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: ~ew
Commercial
PROJECT DESCRIPTION: Add service and circnits
Contractor Type
Electrical
} '.'-" -'0
BFD INVESTMENTS LL(\t ':':uv,. t '. ~IV: 0
5729 MAIN ST PMB 242, II] O'lftcq,/,US CirJore!lOI] I
SPRINGFIELD OR 9747~09~4~r)Sin~~nte~I;.~ 6/;;,;e!!Ulreo ,
calli 'vufh:;",' -uu1n~;'-';::,-erlil~-If:1.qoh"J~t..I fo
I]U/))6:~I\IC;:O~TRA:GTOR}INFORMATIONI'
'vr Ih '~', (IV -;v'es Of '" IJS2 'V'It)
Contractor cel]ter ~s Or~90I] oD~' Ihe t~7ebis~~e
CAMP CREEK ELECTRId:jIf0_aQ~llty IVn;'JI6_4~]7Y
Expiratiiln Date
06/09/2011
Phone
541-746-1471
Owner:
Address:
BUILDING INFORM/ATlON'1
A,__
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Rauge Type:
Energy Path:
Sprinkled Building:
Lot Siz~:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occup~nt Load:
# of Units:
Primary Occupaucy Group:
Secondary Occupancy Group:
Primary Coustruction Type
Secondary Construction Type:
# of Bedrooms:
nla
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
. rH~/~CE.: I DEVELOPMENT INFORMATION'
IIUrHO '[RM/r s
COMIv! RI2[D U HIILL E. Overlay Dist:
IINy 7 [NC[D ND[R rffPJR~:W!'~,!rees Rqd:
'< 80 Dlly OR IS II ISI;.3(E,d m'tvo/~:
P[RIOD BIINLt6AjlJZ41~olteW/(e:
.' 1';[D FOR VOr
I ~U~LIC IMPROVEMENTS'
REQUIRED PARKING
Total:
Haudicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction: '
Sidewalk Type:
DownspoutslDrains:
Notes:
I V~luation. Descri9tion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value,
Date Calculated
Page I of2
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01326
ISSUED: 09/0812009.
APPLIED: 09/08/2009
EXPIRES: 03/08/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541_726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees. Pai? I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$24.12
$10,05
$120,00
$81.00
9/8/09
9/8/09
9/8/09
9/8/09
2200900000000001018
2200900000000001018
2200900000000001018
2200900000000001018
Total Amount Paid
$235,}7
I Phm 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
workday.
I Renuirelllnsoections II
1,,101 VI. , III
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service,
Final Electric: When all electrical ,work is complete.
By signature, I state and agree, that I have carefully examined Ihe 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 tbe State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Commnnity 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 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 Ihe property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
225 Fifth Street
Sp'ringfleid, Oregon 97.477 .
541-726-3759 Phone
Job/Journal Number
COM2009-0 1326
COM2009-0 1326
COM2009-0 1326
COM2009-0 1326
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
City of Spri~gfield Official Receipt
Development Services Department
Public Works Department.
2200900000000001018
Date: 09/08/2009
Description
.Penn Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add,
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
CAMP CREEK ELECTRIC
Received By
Item Total:
Check Number Authorization
Batch Number Number How Received
djb
287190 In Person
i .
Payment Total:
Page 1 of 1
2:25:35PM
Amount Due'
81.00
120,00
10,05
24,12
$235,\7 '
Amount Paid
$235,17
$235,\7 .
9/8/2009