HomeMy WebLinkAboutPermit Electrical 2009-9-16
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Electrical Permit Application
225 F;!th Street< Springfield, OR 97477+PH(541)726,3753t FAX(541)726,3689
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I permit~ol~--o/~YI
I Date: 9//0?/09 I
This permit is issued under OAR 918-309-0000. Permils are nontransferable. Permits expire if work is uot started within 180
days of issuance or if work is suspended for 180 days.
I \'\'L10CAL::GO\lER~MENThfAI?RR.0YAG~,1!;,*,'i'Wtm7\;li;,1
I Zoning approval verified? DYes D No
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I Job site address: 7 I g 1'1,7/-1 S T
I City: SN!IIv'7 TN!(...O I State: 0 R. I ZIP:i 74;')
I ~~~;:~?ce~:~"DESCR'If''''ION 'O~ "'Wol RTKa~'~~~:'~;:"i'''''~''J''i!i'''';'1<!
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I ". ;" ;PRORERTY:"OWNER,;"
I Name: J<o A Ai /VI <:- L.A lAI 's
IAddress:(Jx- /e7-r4 Sr-- I
I City: 5/~.t...o I State:o,O I ZIP:7'77-'7 '7 I
.1 Phone~'7-/ -7c;r- 6'.- YY?91 Fax I
I E-mail: I
This installation is being made on residential or farm property
owned' by me or a member of my immediate family. This
property is not intended for sale. exchange, lease,or rent. OAR
479.540(1) and 479.560(1).
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I Bu~s name:
I Address~
ICity ~
I Phone: ~ _.I~Fa;
IE-mail: ......~
I CCB license n~...-/ I Bb:p license no.:
I Signing,.stlpe;visor's license no.: '"
I Pri~ame of signing supervisor:
I Signature of signing supervisor:
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I State:
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.~ZIP:
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440,2584.) (9/08/COM)
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1:;_;~~,~~~~~~f;'~f~;~~~iJ~?l.te~,H,j~~:~~;(j$1~~,~19t.~'~I':~l_:(;.:~~~rt~'i'I:Jf;~~t~,~,~~~
'I Residential, per unit, service included: I .
.1 t,OOO sq. it or less (4) $134.00 $ I
I Each additional 500 sq. ft. or portion $ '1
thereof $ 25.00
I Limited energy (2) j $ 32.00 $ I
I Each manufactured home or modular 1 $ I'
dwelling service or feeder (2) i $ 63.00
I Services or feeders: installation, c:lter~lion, relocation. .1...
1 200 amps or less (2) / $ 81.00 $0/. '-'
I 201 to 400 amps (2) $ 95.00 $
I 40 t to 600 amps (2) $158.00 $
I 60 I to t ,000 amps (2) $205.00' $
lOver 1,000 amps or volts (2) $469.00 $
I Reconnect only (2) $ 63.00 $
j Temporary services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 63.00 $
I 201 to 400 amps (2) $ 87.00 $
I 401 to 600 amps (2) $126.00 $
1 Ove~ 600 amps or 1,000 volts, see services or feeders section above
1 Branch circuits: new, alteration, extension per panel'
I' 1 a. Fee for branch circuits with purchase of a service or feeder fee:
I 1 Each branch circuit I $ 6.00 1 $
I 'I b. Fee for branch circuits without purchase of a service or feeder fee:
I I First branch circuit (2) $ 55.00 $
I 1 Each additional branch circuit $ 6.00 $
I f Miscellaneous fees: service or fteder'l}ot included
I I' Each pump or irrigation circle (2) $ 63.00 $
I I Each sign or outline lighting (2) $ 63.00 $
I I Signal circuit or a limited-energy panel, $ I
alteration, or extension (2) $ 63.00
1~~;;;;;;~~~;g~~~~";Nt~~SE~&Ji~;~;'~'f~~~i)!~~i!f;1
(A) Enter subtotal of above fees $ f:) I ~ .
.(Minimnm Permit Fee $58.00) 0 .
.1 (B)Enteri2%surcharge(.12x[A]) $ "'-/JJ5'
I (C) Technology Fee (5%0f[A]) $"'1' -, '2-
I TOTAL fees aud sorcharges (A through C): $ '1"'117
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-0I364
ISSUED: 09/16/2009
APPLIED: 09/1612009
EXPIRES: 03/16/2010
VALUE:
Status
Issued
225 Fifth Street, Spriugfield, OR
541-726-3753 Phone
541-726-3676 F.x
541-726-3769 Inspection Liue
SITE ADDRESS: 718 18TH ST
ASSESSOR'S PARCEL NO.: 1703362114400
Springfield TYPE OF WORK: Eleclric.1 Work Only
TYPE OF USE: Alle....tiou
PROJECT DESCRIPTION: Inst.n feeder from house to det.ched g.r.ge
Residenli.1
Owuer: ETTA JEAN MCLA WS REVOCABLE TRUST
Address: 2112 5TH ST
SPRINGFIELD OR 97477
I CONT~ACTOR INFORMATION I
Contractor Type
Electric.1
Contractor
OWNER
License
Expiration Date Phone
l BUILDING INFORMATION'
# of Units:
Prim.ry Occup.ncy Group:
Secoud.ry Occup.ucy Group:
Prim.ry Coustructiou Type
Secoud.ry Construcliou Type:
# of Bedrooms:
# of Stories:
Heighl of Structure
Type of He.t:
W.ler Type:
R.uge Type:
Energy P.th:
Spriukled Building:
Lot Size:
Sq Fllst Floor:
Sq Ft 2ud Floor:
Sq FI B.sement:
Sq FtG.r.ge/C.rport
Sq Ft Other:
Occup.nt Lo.d:
n/.
I DEVELO.~~1ENT INFORMATION I
Frouty.rd Setb.ck:
Side 1 Setb.ck:
Side 2 Setb.ck:
Re.ry.rd Setb.ck:
Sol.r Seth-.cks:
Overl.y Dist:
# Slreel Trees Rqd:
P.ved Drive Rqd:
% of Lot Cover.ge:
REQUIRED PARKING
Tot.l:
H.ndic.pped:
Comp.ct:
I PUBLIC IMPROVEMENTS I
Street Improvements: Sidew.lk Type:
Storm Sewer Av.i1.ble: N[D;o,'::,usl/outslDr.ihs:
Speci.IIustruction: _ . , THI c.
AnE~'llL)N:Ureoon iaY' i'c,-!u,,"'" you. ~J AU S PERMIT S
Notes: t'Jl\ow ;.~"il; adOpte.t by thli Ore~on Utl;~Y COI;HORIZED UNHALL EXPIRE IF
. '_""M"M "......t..r Those rules ilre 3tI9t ^ ,,,. fMENCf:n ^_ DER THf" n~_ THE WnDI/
~-6AR~2-001-0010~g~~--" .. I" IIJU DAY P-" Ii) ABAND ""VIIf IS NOT'
0090 You may <lbtail'l co~ ~IMltulltiVIii DescnDtIO~ ERIOD. ONED FOR
M;r the eentef (Note: the 131epl100tl
D . t' -':1 ~~. . ~ "'I'l'f;$.P-""\filllfilC(' Squ.re Foot.ge
escnp IOn y,ne.. 'Uti l'IUlI. I' B'd A
no. ror, os 1_800-::1:~2-2:!l.ll tIp ,er or I mouut
V.lue
D.le C.lcul.ted
P.ee I of 2
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Status
Issued'
225 Fifth Street, Springfield, OR
541-726-3753 Phoue .
541-726-3676 Fax
541-726-3769 Iuspection Liue
Fee Descriptiou
+ 12% Slate Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Total Amount Paid
Amount Paid
$9.72
$4.05
$81.00
$94.77
Total Value of Project
F~e~ Paid I
Plan Reviews I
Date Paid
9/16/09
9/16/09
9/16/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01364
ISSUED: 09/16/2009
APPLIED: 09/16/2009
EXPIRES: 03/16/2010
VALUE:
Receipt Number
2200900000000001044
2200900000000001044
2200900000000001044
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.
R,>," ired II',sneetin 'IS I
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Uudergrouud Eleclric: Prior to cover
Fiual Electric: When all electrical work is complele.
By signature, I state aud agree, that r have carefully examined the completed application and do hereby certify Ihat all
iuformatiou bereou is true and correct, aud I further cerlify that auy aud all work performed shall be doue in accordance with
Ihe Ordinauces of the Cily of Springtield aud the Laws of the State of Oregou pertaiuiug to the work described hereiu, and
Ihal NO OCCUPANCY will be made of any structure without permission of Ihe Community Services Divisiou, Buildiug Safety.
I furlher cerlify that ouly coutractors aud employees who are iu compliauce with ORS 701.005 will be used on this project.
I furlber agree to eusure Ihal all required iuspectious are requested al the proper time, tbat each address is readable from the
street, thai the permit card is located at Ihe front of the property, and the approved sel of plaus will remaiu ou the site al all
times during construction.
'~~./n'/' a.- C...:?::-,
Owuer or Contractor~iguature ,
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Page 2 of2
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Date
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; GENERAL,POWER OF ATTORNEY
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I, ETT A JEAN McLAWS: of Springfield, Lane County, Oregon, hereby make, constitute
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and appoint MICHAEL EAT,QN, of Lane. County, Oregon,as my true and la~ful attorney-in-fact,
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for the purposes seto:ut belQw.' If Micha"IEaton is unablebr unwilling to act for any rea~on, then I
niake;constitute a.nd;appoirtROXY ANN EAT9N as my attorney-in"fact.
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. (I) . :To le~e;grai1t, bargain; ~ell, contract to sell, convey, exchange"release and dispose
. of any real or persona) prop~rtyof\yhichI am now or hereafter rp~y be possessed orin which Ihave
. . any right, title or interest: iridudingrights of homestead, forariyprice or'sun1,and upon such terms
and co~ditibns ,as my; attoniey"in-factilljly deem proper; .
, ," -," .
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(2) To take pos~~ssi~n of, manage, maintain, operate, repair <l!ld urtprove any and all real
.or persorialpr~peftyno~;or:hereaftei belonging tq me, to pay the ,expense thyreof, to insure and to
keepth~ same'iri'smeg a[id ofo'pay 'any and all taxes, charges and assessinents that may be levied or
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. imp6s~di1iere6n; . , . . . , . ~
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(3) . To buy,sell,}md generally deal with goods and merchandise of every description and
to hypothecate, pledge andencimlber the same;
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(4) . To'ouy,sell,'assign,.transfer, deliver andto appoint stock transfer agents therefore or
appoint attorn~ys to transfer all or any shares of stock in mynarI1~ i~ any corporation for any price
and upOI! suchteniis l!5Ip.y~ttorney'~inlfact may deem right and t9'receive payment therefore;
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(5) . ':ro b6rro~ ',any sunis of mOli.ey on such terms and rate of interest as my
attorriey-in-factmay'geem proper-and,to %ive security for tnerepayment of the same;
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(6) To ask for,.gewand,recover, collect and receive all moneys; debts, rents, dues,
accounts, interest~,div;derids and cl<}ims whatsoever which are no'w or which, hereafter may become
due, and payableluid,tiikeaIj)a;VfulIIle.fu:is.of n,covery, including aitachirient; 'levy or otherwise;
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(7). .:Top~~~al-e; ~~e~irteal!d'filti;anypr06fof d~bt:,andotheri~struments in an; court and
to ta1<:e arty pr6de:;dlngsuhd~r the Bankruptcy Act in connectibn'with:an:y sUrribfmoney or demand
due or payable to Irie; and;in;;aiJ.y such'proceedings to vote in my name for the election of any trustee
or trustees'and to demand; receive and accept any dividend or distribution whatsoever;
. , (8)' Toadjuit, settle, compromise or submit to arbitration any account, debt, claim,
demand or dispute as-\"'ella.:i'll1atters which hereafter may arise between me or my attorney-in-fact
and any other person or persons; .
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" (9)" To sell; dis<:9ur1t, endorse, negotiate and deliver any check, draft, order, bill of
'., . " ,,', . J ", -' " - -,
exchang~, pronliss9ry:note or o~h~r negoti~blepaper payabl" to.me,and,t()collect; receiye and apply
the proce'eclsthereqff9r my'~sdoi' ''!fly purposes;, to pay. t() or deBosit the ~ame ot any other 'sum of
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1-' GENERAL POWER OFATrORI!EY mrr AjEAJ:I McLA ws) (171019)
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money coniing into !4e ha~ds.of myariorney-in"fact in any fqrm of b<inking account in my name
with 'any bank; savings anploari' a~sociati6iJ, credit ~nioll,or- brokerage house, and to draw out
moneys depo'slted toimy cr~dit with any such instituticin,-arid'to applythesa~~ for any purposes as
my attorney-in-fact ~ay de!~mexpedient;topurchase and sellcertificatesof deposit; to appoint any
ballk, stock or trust C9.mpany as escrow agent; generally to conduct any and allbariking and financial
trarisactions.mrmy:b,~h<lif;:~ .' .
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. (10) ,:Toin'ake,eJcecuteand d~liver any and ail manner of contracts with reference to
mirterals, oilimd:gas tights~re~{s alldroyalties, including agreements facilitating exploration for and
discoveryc)f oil;ri1in'eral:S:~q;depositS; '. .
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. (11)' To cdhmieti'ge aiid prosecute and to defend against"answer and.opposeall actions,
suits, and proceedings; ..'
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;(I?LT()c;yote any'stock-inmy name as proxy;
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. .(13) . ., TOhaye accJss}6iinY:sa~~tY deposit ~ox which li~ been brImjy be rented in my name
or in the name ofmYiseJfand <Ui.yother person or persons;
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(14) ~co~nection with 'any of'the powers herein granted, to sign, make, execute,
acknowledge iilld deliver inlmy name any and all deeds, mortgages, pledges, satisfactions, releases,
acquittances, receipts; bond,~; writs and any and ~ll other instruments whatsoe\!er; with such general
or special agreements,andc9venants; including those ofwarrilllty, asIiIyattomey-in-fact may deem
right; . ., i ..~. . . .
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(15) To .~ti1ploy,;'p'ay' and discharge clerks, workmen, brokers and others, including
accountants and attorneys in' connection with the .exercise of any of the foregoing powers;
.; - ,', *, " .
(16) Genermly to condust, manage and control all my busiriess and my property,
wheresoever situated:asmyittt6mey~in-fact may deem in my best interests, hereby releasing all third
persons from responsibilityZfor the acts and omissions ofmy'attomey-in-fact; .
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. (17).' .T6.~ri4~r~~,'.~eg:otiat'6. imic~,sh IIlYiSotiaj..S.~cUrity, V etc~an{Administration and
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RailroadRetit,iim~nf\'i;li~c\C~;JJ:S,; 'Savings!3ouds, ane! anY other 9hecks, Donds or negotiable
instruments frorrt'the' government,'and any other person or institution;' . .
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(18) To make wh~tever arrangements are necessary to establish the automatic deposit of
my Social Security, Veterans' Adniinistration, Railroad Retirement, pension and annuity checks or
payments, or to change the account and location therefore; .'
(19) . To I1,1~egift~'tomy spouse and to my lineal d~scendants and the ~pouses of my lineal
descendants (including myattofuey-iii-facts and their spouses) and to any charitable organizations to
which I have contributed, in the' pasi: Gjfts made under this paragraph shall be consistent with my
estate'plan inexistenc~ att~~ time'ofthe gift, to the extent'reasonabiY'possible; . .
,
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2. GENERAL POWER OFA'rrORNEY (ErrA JEAN MCLAWS)
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(171019)
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(20) To r~prese* q-tebe'foreany office of the Intern~l Revenue, ServiCe and Oregon
Department ofReven\leconc~rning anY cif my tax returns artd'imy tax matteraffecting me, to receive
any confidbitialinfd'riiJati('mcon~e'rning. the same, and to endorse any income tax returns on my
behalf::- "', .. ,
. ,
(21) To execute ~n Income Cap Trust on my behalfforthe purpose of, qualifying me for
Medicaid assistance and ahY otherdocuriJ.entation necessary to qualify me fo'rMedicaidassistance;
. .
. (22). To seek revie\V of my medical records, and execute releases of confidential
information from m~dical providers and insurers or other third partY payors, and consult with my
physiciarts,.insure,rs or thirq party payoi~, and care providers to the same extent as my health care
represenfutiv~.ai1d:'sllall be considered.my personal representative (along. with my health care
representative) for pUrpose's ofpfotected. health information (PHI) disclosure under 2003 federal
'HIP AA reglllliHons ap.dOtegon litw, and may sign authorizations'comiJ!iant~ith such federal and
state law authorizing!disclbsUfe Milly PHI; however, I leave deci~ions about my' health care to my
heaithcaIehjpre~~ht!,ltiye m:ider Oregon law.
.- ",. "".
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(23) '. This' i~a. Durable Power of. Attorney and shall not terminate by reason of my
incapacity or iri.;:omphency;: I'hereby give!)I1d grant t!J my a1!orney-in-fac(full power and authority
to do and p~rf61TIi ev~fya.d:andihiI\.gwhatsoever requisite and nec~ssary to be done, as fully to all
intentsandpw-poses" ~In}ig~t, it personally present, hereby ratifying and confirming all that my
attorney~in-factshall:laWfuI}yclo or.calise to be do'ne by virtue hereof.
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DATEDthis / 'I- ;'
dai of. ..~
,2008.
"
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Etta Jean MfLaws
"
STATE OF OREGON' ),
.) ss.
County ofLane, ),
. Personaiiy aP;6;;;:ed\hi~ab6ve-ri~ed ETT A mAN M,.cLA WS; who is known to me to be
. the same pers~n who bxecuf~d the foregoing aiid acknowledged thefci~go;nginstIl.lment to be her
voluntary act and deed,this:' \ lj. '6 day of August, 2008.
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.- - - - --;-ciFICI..\t SEAL~:'-- -1'
PAULAD I'ETERMAH
\. /NOTARY. PUBUC~ ClREGON .'
. . COMMISSION NO: 406630
MY COMMISSION EXPIRES~'Y..!oj~~
Notary Public for Oregon
My Cominission Expires: '/,/ ( () ,/ (()
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3 - GENERAL POWER oiA ITORNd (ETTA JEAN McLA ws)
. ~ -. . ,
(171019)
.~ ..
REVOCATION OF DURABLE POWER OF ATTORNEY
I, ETTA JEAN McLAWS,also known as JEAN E. McLAWS, of Springfield, Oregon,
hereby revoke the DUrable Power of Attomey dated December 30, 2004, in which I named
MARILYN K. ENGLEHARDT as my agent and attorney-in-fact. This Revocation shall take
effect immediately. .
DATED. this / Lj , day of August, 2008.
~~M~ 'n~~
STATE OF OREGON )
. ) ss.
County of Lane )
On this /L/-t:!20.ay of August, 2008, personally appeared Etta Jean McLaws before me
and acknowledged that she signed the foregoing instrument as her voluntary act and deed.
~-OFFICIAtSEAl. ,.,.. ~;
, PAULAD rc.u::nllllAN I
\. /' NOTARYPUBU. C-OREGON I
'.. COMMISSION NO. 406630 i'
, __MY. ~~lp~~E~J~':.'f .!O_20~D_:9
f2ea;J~
Notary Public for Oregon
My Commission Expires:? -(0 - (0
Revocation of Durable Power ofAtlomey - 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
'COM2009-01364
COM2009-0 1364
COM2009-0 1364
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001044
Date: 09/16/2009
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid'By
JEAN MCLA WS
Item Total:
t:heck Number Authorization
Received By Batch Number Number How Received
njm
2367
In Person
Payment Total:
Page I of I
8:56:3IAM
Amount Due
81.00
4.05
9.72
$94.77
Amount Paid
$94.77
$94.77
9/16/2009