HomeMy WebLinkAboutPermit Electrical 2009-9-16
225 Fifth Stree"Springfield. OR 97477+PH(541)726-375HFAX(541)726-3689
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Date:
9 -16 .0'7
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are uontransferable. Permils expire if work is not started withiu 180
days of issuance or if work is suspended for 180 days.
~\y., 1');; '''(({OCAL;~GO\i'ERNMEN;rr,AP,I''~0VA8;'!\'t\l1-I,i~'i!f;;\4!;.1 1'};iJ~r,~ij'~&"!l"~'.~~~g>l,ITEE~.Sc;HE[j,UJ.\jEi[il!tiJlit1f{i~?"1i~'!!:~~31
I Zoning approval verified? DYes D No I 1~;~,~,~~:~~~f~-~~1~~~~lg:fi]J-~~:~i.~~~~~:!~~~f;~~18,1Y~;[i.:.it~~~,~a.~~rE1%t~~~~:1~;
i~~~;::~::~~~r;EG,Rb~~~:~~~;;r:RO~T~O~;::~:;~~;";<;:: 'II ~~~~::ti:I,:~::n(:; service included: '. II
~Jli(ii.:tOI3,lS ITElllN I;;ORMAq;IONfiAN[jllI!Qc'NTrloNmit~1r'tlj~1 $134.00, $
I Job site address: 1::l.\D t<Af:~~ ~J I I ~~~~oaritional 500 sq ft. or portion $ 25.00 $ I
I City: <;Drf n. c:, Ir\ State: 0 It I ZIP: 1''7'/ 7 '7 I' I Limited energy (2) ./ $ 32.00 $ 5' Z I
I ReferenC'~':";:<DESCRIP'tION'iOF:,,^,J;~:~~~;''i:?;<i'\f('.'j:;g;"i;;ll J~~~I~:ns~~~~~~r~~ Fe~~:r (;)'odular $ 63.00 $ I
7>~.... ~ / c:lr6LF / 'i\IA " l ~ . Services or feeders: installation, alteration, relocation I
I ' . I I ,. f:;~~.~~T.lm : dl,2Jlg~~~~.~r,I:~,~~?"" $ 81.00 $ I
L . ;P R' . . y' 'OW": . . ..-', .~.~" ,d )20,], to'400 amRs (2) YOlltO $ 95.00 $ I
I~am~: ' C-vv ,,_~~,\~;E~: ,;...... ;~R" .' . j~'~J;~~i2~~1:1n ~{g~~~~d'~:i:.~;fZ~e~;~:;rh $158.00 $ I
I Address 3Zto (~! !........e.o.J::u:"~;;~;0~,~~'~,~Ii:.~2,rr!q:j;9R2'g~i!~:~~~~~~~Oo1- $205.00 $ I
I City: t^.. r,.l I State: 0 (l... I ZIIllu1i'iZ<Jnf7 , ,!0ve(II:Ooo. ~ft)RslVi,';?,l,tM~l- Y $459.00 $ I
.'XN "'-,,~~ L - IL'V( tI P. ..I' ~uon "tilib, .. .". - I
I Phone: '-' I Fax: Cente' j. ~!'S?~r~c~2n1:C~!tlflcalion I $ 53.00 $
I E-mail: Temporary servic~~ or fee_ders: installation, alteration, relocation I
Th" II' . b . d 'd' I ' I 200 amps or less (2) $ $ I
IS msta atlOTI IS emg ma e on resl entIa or larm property 63.00
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, lease, or rent. OAR I' I
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see seryices or feeders section above I
I . ::'",,:',:,;::rCONTRAC1;OFf' INSTAI.!.l.!ATION.i ..1 I Branch circuits: new. al/era/ron. extension per panel ' I
I Business namel)tl',~ \\.y=t: r '10 c..~ Io""\b )o'~'\ c... <:.. I I a. Fee for branch circuits with purchase of a se'rvice o~ feeder fee: I
I Address: e ib i3~ 4 cS3 (p - I I Each branch circuit I I $ 6.00 I $ I
I City: -r: ):l~""'- I State: 0 (l I ZIP: ~~Tlr E.I b. Feefor branch circuits without purchase ofa service or feeder fee: I
I Phone:.)4{ - 913-1..fl/?7 - I FaxSV/ -?1r-SI)'O THI,~ .p~ R' p F~st branch circuit (2) I $ 55,00 I $ I
I E-mail: AUTHOI!I{~~~Ej~~~jlcklitilirlili.Ji.!i!l<IFcjr~ "'''f'l.j $ 6.00 I $ I
I I ..W:! Ivi -~ .UI"f IrK 'I ",,- .\..;, I"
CCB license no.: ItI'lS8' BCD license no.:)o-Y?;l.MME (~i)'I,IS0~a'.!,eous f...:f?[rYlMPr .f"lio/.rrM' included I
I I-1IVY 18 I -~" I", Mp."'~nf)~'r '_'1. I
Signing supervisor's license no.: 3~" 3 Lf A C D ~fiial!h:TP.'lIJbo ,rng""'n..,@lfGR - $ 63.00 $
I Print name of signing supervisor: C'y,.,>, hnll(V" D .~..t?1 Each sign oroudine lighting (2) $ 63.00 $ I
I Signature of signing supervisor: (wS~ t \ - I I S.ignal. circuit or a limited-energy panel, I $ 63.00 $ I
> ~ alteratIOn, or extensIOn (2)
I Each additional inspection: (1) I $ I
1~\f4i~"1ft1~lQq~tE!'~;AR~i]icgN'[~ti5
I (A) Enter subtotal ofabo~
(Minimum Permit FP$58.00f.-/
,I (B) Enter 12% surcha~'rf2x [A])
, (C) Technology Fee (5% of[A])
I TOTAL fees aud surcharges (A through C):
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~
C\. \~ .aC\
~~~
~
~
1\t..Q, ~ 0
D--V A,. ~
~~
$55
674
7*1>
-b7~
$
$
$
440-2584,J (9/08/COM)
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-0I365
ISSUED: 09/16/2009
APPLIED: 09/16/2009
EXPIRES: 03/16/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769Inspectiou Liue
SITE ADDRESS: 3210 RALEIGHWOOD AVE
ASSESSOR'S PARCEL NO.: 1703221318300
Spriugfield TYPE OF WORK: Electrical Work Ouly
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Low volt - phone, cable aud audio
Owner:
Address:
Contractor Type
Low Voltage Eleclrical
BURNETT GARY R & NANCY A
PO BOX 7547 . . you to
EUGENE OR 97401 ' ON' Oreqoll laW reqUIreS Il Utility
,,-r.,-r:MT\ . ........ ,j.l.-."" ('lIP-OO .
. \ s aautllv........1 resellUIUI
loHoW rll a, r _'- _-:'"' ..Hip!=; a. , . - I.
NotilickC0N.'fRi\CT.OR.INFORMATlON".
. OAR 8~"~-Uv' .v~ . ~ ies 01 tne ,VOV~ ' Y
III Y obtalll cop 1..~hMe
Contractor 0090.. You ma t (Note: the \llilcense
, , ~\,-" ,..an p.r., . . Nr-t"i,,....QUOn
DEVLOGIC TEeHNOI\pG.I):;~(I.\'!~OIl UtilitY _' 19,1458
flUII" "-,, .-. . "'...." .... "'J_~ u-, . ,.
,I BUIIJDING INFORMA nON,
Expiration Date
09/16/2010
Phone
541-913-4487
VB
# of Stories:
Height of Slructure
Type of Heat:
Water Type:
Rauge Type:
Euergy Palh:
Sprinkled BuHdiug:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basemeut:
Sq Ft Garage/Carporl
Sq Ft Olher:
Occupaul Load:
# of Uuits:
Primary Occupancy Group:
Secoudary Occupaucy Group:
Primary Coustruclion Type
Secondary Coustrucliou Type:
# of Bedrooms:
R-3
uta
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Selback:
Rearyard Selback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
OlGaved Drive Rqd:
N o/~JWi>oIH1'eragetXP\RE \F 1HE WORK
THIS t IVII UN';ER 1HIS PERM" IS NOT
^ I'TI-lnPI7FD ,. ._~ rn"
- "':.::' n: '~."."''lJUUI'tL-1.J . _.-
I PIQ:I!I\\I0ILMIlROVEM.I!;~TS'
ANY l'tlu 01'\\ fL,.J-, Sidewalk Type:
Downspouts/Drains:
Total:
Handicapped:
Compact:
Street Improvemeuls:
Storm Sewer A va Hable:
Special Instructiou:
Noles:
I Valuation Descriotion .1
Description.
Type of Coustructiou
$ Per Sq FI
or multiplier
Square Footage
or Bid Amouut
Value
Date Calculated
Page 1 of2
Status
Issued
225 Fifth Streel, Spriugfield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769 Iuspectiou Liue
Fee Description
+ 12% State Surcharge
+ 5% Techuology Fee
Low Voltage - Resideutial
Miuimum/Adjustment Electrical
Total Amount Paid
Amouut Paid
$6.96
$2.90
$32.00
$26.00
$67.86
Total Value of Projecl
Fee.s Paid I
Plan Reviews I
Date Paid
9/16/09
9/16/09
9/16/09
9/16/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01365
ISSUED: 09/16/2009
APPLIED: 09/16/2009
EXPIRES: 03/16/2010
VALUE:
Receipt Number
1200900000000001066
1200900000000001066
1200900000000001066
1200900000000001066
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.
Low V ollage: Prior 10 cover.
I Re(]lJir~d Insn~c~io~,~ I
By signature, I state and agree, Ihat I have carefully examiued the compl~ted applicatiou and do hereby certify that all
iuformation hereou is true and correct, aud I furlher cert,ify that any and all work performed shall be done in accordauce witb
the Ordiuances of the City of Spriugfield and Ihe Laws of the State of Oregon pe~laiuing to tbe work described hereiu, and
that NO OCCUPANCY will be made of any structure without permissiou of the Community Services Division, Buildiug Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I furlher agree to eusure Ihal all required iuspectious are requesled al the proper.time, that each address is readable from Ihe
street, tbat the permit card is located attbe front ofthe property, aud the approved sel of plaus will remaiu ou the site al all
time.s during construction.
Owuer or Coutractors Signature
Pa2e 2 of 2
Date
225 Fiftli Street
Springfield, Oregon 97477
541-7'26-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1365
COM2009-0 136'5
COM2009-0 1365
COM2009-0 1365
Payments:
Type of Payment
CreditCard
cReceintl
RE<;EIPT #:
1200900000000001066
Date: 09/16/2009
Description
Low V ollage - Residential
Minimum! Adjustment Electrical
+ 5% Technology Fee
+ 12% State Surcharge
Item Total:
Check Number Authorization
Paid By Received By Batch Number Number How Received
DEVLOGlC TECHNOLOGIES djb 051495 In Person
Paymenl Total:
Page I of I
9:25:48AM
Amount Due
32.00
26.00
2.90
6.96'
$67.H6
Amount Paid
$67.86
$67.H6
9/16/2009