HomeMy WebLinkAboutPermit Electrical 2009-9-21
Electrical Permit Application
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225 Fifth Streett Springfield, OR 97477 t PH(541)726-3753t FAX(541)726-3689
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Pennit no,: t! 9- / J"1~
Date: '7/J-{ /0'1
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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.
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Zoning approval verified? DYes D No
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I 0 Residential I 0 Government 1 '[] Commercial
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I lob site address: IlfKtJ /,,~ .Ir #-c::.
1 City: ~h 1 State: t:J1t--1 ZIP: cnlf)'l
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I Address: I J' .2-/ ~5 tllA~t1J I
I City:A'k:.-, ~.Nf~b:I,1 State:!!#1- I ZIP:~.;n2-
'Phone: '- 1 Fax: ..
I E-mail:
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),
Signature:
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I BllSiness name: J[ LA.{ fle:i;-r
I Address: 3'i?~t.{ \~.L:'\,hJ Qcc I 1
I City: ;:::;0\:). -II State: Or I ZIP: q7'-17~
I Phone: / -S-qf 7Aq-/6741 Fax:, / 6'11- ]lIb o7}.,)
I E-mail:
I CCBlicenseno,: 1~/.?1~S-1 BCD license no,: 'dn627c..
I Signing supervisor's license no,: t-/70('..5 I
I Print name of signing supervisor: .. _ J JAr' Y f:2J;:" I
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440-2584-) (9/08/COM)
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I Residential, per unit, service include.d: I
11,000 sq, ft, orless (4)$134,00 $ I
I Each additional 500 sq, ft, or portion $ I
thereof $ 25,00
I Limited energy (2) $ 32.00 $ 1
I Each manufactured home or modular $ 63.00 $ I
dwelling service or feeder (2)
Services or fee~ers: installation, alteration. relocation I
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1
1
1
Temporary services or feeders: installation, alteration, relocation I
200 amps or less (2)' / $ 63,00 $& "f 'I
1 201 to 400 amps (2) $ 87,00 $ 1
1 401 to 600 amps (2) $126,00 $ 1
I Over 600 amps or 1,000 volts, see services or feeders s~ction above I
I Branch cir~uits: new, alteration, extension per pane! J
I a. Fee for branch circuits with purchase of a service or feeder fee: I
I (I $ 6.00 I $ u~1
I b. Fee for branch circuits without purchase ~t a service or feeder fee: I
1 First branch circuit (2) $ 55,00 $ I
I Each additional branch circuit $ 6.00 $ I
I Miscellaneous fees: service or feeder not included I
1 Each pump or irrigation circle (2) , 1 $ 63,00 $ I
1 Each sign or outline lighting (2) 1 I, $ 63,00 $ 1
I Sign~l circuit or a limited-energy panel, $ 63.00 ,$ I
alteration, or extension (2)
Each additinnal inspection: (1) $58,00 I $ I
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200 amps or less (2)
$ 81,00
$ 95,00
$158,00
$205,00
$469,00
$ 63,00
$
$
$
$
$
$
20 J to 400 amps (2)
40 I to 600 amps (2)
60 I to 1,000 amps (2)
lOver 1,000 amps or volts (2)
1 Reconnect only (2)
Each branch circuit
(A) Enter subtotal of above fees
(Minimum, Permit Fee $58.00),
1 (B) Enter 12%surcharge,(.12 x [A])
I (C) Technology Fee (5% of [All
1 TOTAL fees and surcharges (A througb C):
$~"-
$'Q~
$ ) 't5-
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009"01394
ISSUED: 09/21/2009
APPLIED: 09/2112009
EXPIRES: 0312112010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR '
541-726-3753 Phone' '
541-726-3676 Fax;'
541-726-3769 Inspection Line
SITE ADDRESS: 1480 16TH ST APT 6
ASSESSOR'S PARCEL NO.: 1703253102200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Fire damage repair
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Owner: NORTH GATE VILLA'LLC
Address: 1328 LAS PULGAS RD , '
'PACIFIC PALISADES CA 90272
I, C,ONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
JEM ELECTRIC INC.
License
Expiration Date Phone
ATTENTION: CI"BBIL'DING<lNF0~MtTION I
fol!ow rules adopted tJy me v,"~v,' e~t'f'o"r"th
# fU 't" T# 'St"'''~ :3re s
o Dl s: Notification Center, ,0., Orl~~ 0 ~QQ1.
Primary Occupancy Group: 'In OAB 952-.0.01-.0.01 QHeiglif!6rStr'ilctrif1e b
S 0 G bt' ~~;j" 'H,ft~e ru es y
econdary ccupancy rouPiJ09Q, You may 0 ahType of' eat:I' h
.. "1....~,.,. .LL,o t8 ep one
Primary ConstructIOn Type calling the center. Water)'ype: t'f' t'lon
, h 0' ......... 11t'I'nl NO Ilea
Secondary ConstructIOn Type: number for t e le!\a".~e JYf;,e,14).
# of Bedrooms: , Center IS 1-'En'J,~'Pat\i: ,
Sprinkled Building:
.'
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
1 DEVELOPlh"n. .NFORMA nON I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
NOTICE' " Paved Drive Rqd:
, .!:4 .of..I,ot Cnveragl\DRK
THIS PERMIT SHALL tJ(nhc IP ",L " .
^' 'T' ,nrJJ7cn 11~ln~R THIS PERMIT IS NOT
"~ ... - ..- ~...--~-. ., ..,
COMM,ENC~D 1I RUBL"f0~IMPROVEMENTS I
ANY 180 DAY PthIUU.
Sidewalk Type:
Downspoutsffirains:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
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I Valuation DescriDtionl
Description
Tvpe of Construction'
$ Per SqFt
or, multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of 2
Status
Issued
225 Fifth Street, Springfield, OR"
541-726-3753 Phone
541-726-3676 Fax ~,
541-726-3769 Inspection Line
-:.;
Total Value of Project
~ees Pair! I
. .~.;
Amount Paid
Date Paid
Fee Description:
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Service Reconnect
$8.28
$3.45
$6.00
$63.00
Total Amount Paid
$80.73
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I Plan Reviews I
.. . ~, ..
9/21/09
9121/09
9121/09
9121/09
CITY OF ~rKll',,\.;JFIELD
Building/Combination Permit
, PERMIT NO: COM2009-01394
ISSUED: 09/21/2009
APPLIED: 09/21/2009
EXPIRES: 03/21/2010
VALUE:
Receipt Number
2200900000000001072
2200900000000001072
2200900000000001072
2200900000000001072
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 7:00a.m. will be made the following
work day.
RI~ouirer!lnspections I
II.... jl .
,
Electric Service: Approval required prior to utility company energizing service.
Rough Electric: Prior to Co~er ,
Final Electric: When all electrical work is complete.
By signature, 1 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 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 701.005 will be used on this project.
I further agree to e sure that all required inspections are requested at the proper time, that each address is readable from the
street, that the per it card is located at the front of the property, and the approved set of plans will remain on the site at all
times during cons ru tio .
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Page 2 of 2
q- /Xl ~ ()9
Date
225 Fifth Street "
.. . ,-,';'.,
Springfield, Oregon 97477
541-726"3759 Phone '
City of Springfield Official Receipt
Development Services Department
Public Works Department
',RECEIPT #:' 2200900000000001072
Date: 09/21/2009
2:05:16PM
.... .- .,-,
Job/Journal Numbe...::.:.... :Qescription . "{. -.-;:
COM2009-01394., :; i '+'5% Technology Fee
C0M2009-01394 "\+ 12% State Surcharge
COM2009~01394" ';"'"SeiViceRecoimect
COM2009-01394 Add, Alter, Extend Circ Ea Add
Payments:
Type of Payment Paid By
CreditCard )EMEI,~CTRIC '~'\
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 044358 In Person
Payment Total:
Amount Due
3.45
8.28
63,00
6,00
$80.73
Amount Paid
$80,73
$80.73
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cReceintl
Page I of I
9/2112009