HomeMy WebLinkAboutPermit Electrical 2009-9-21
225 Fifth Street. Springfield, OR 97477+PH(541)726-J75J+FAX(541)726-J689
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I Date: 7-Z(~ 01 I
EI~ct..ical Permit Application
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 suspende~ for 180 days.
I ;;:1,.'",,!'1 "r~)L10GALi:;.G0VERIIIMENy\tA~ftROYA[?i!rf,1r.~1i;#'.1 1"~l~','lY;*m@\lE~~;!r(\J~~J,i;,EE!!S!>HE[j,UI1!E~~11!~~~~~~~l'
I Zoning approval verified? DYes' D No ,[ ,I ;~~'~he}1~f~i~;~~~!i~~;;~~1;if~,~~{n~;11'Qi~:;I;';;.Fo~~:i;lrIS$O'tliU,;j
i~~;~;:~:~~~~~T:EG~R~;;~~:~~:;mRur~O~o:~~::~:'!;:'~ii I" ~:;~::';i:;;'~;~::i';::~;~'i~~';~:;~'~:;; """"".,e~.,,,", .,,,CJlst""'I,,
~~-~:;~'sl1E~~iR~~OIll:~~[j~~o~Amlolll~~~~~lil ~~;~Oo~:i:~~:i~S;o(:~ [1, or portion :1:::::: i
I City: ':)U-1rJGi-lt::UD, I State: C It.. 1 ZIP: 1'7'1171, 1 Limited energy (2) $ 32,00 $ I
[)~~::;~,~,~c~ 1'~~~~~~~i~OF'tiWJ;K~~:~~i~~~~;~,11 J~~~I~;nS~~~~~r~~ Fe~~:r (~)odular $ 63,00 $ I
c/ ............f!~ ~ _.. l I 'Services or feeders: installation, alteration, relocation I
t::....."""lVLCA7_ ~=1>tV rv ,v.-Pv
r, I' 200 amps or less (2) $ 81,00 $ I
'-C(J\)ElJ$,"'G l.lNI1"" ,
'];. '. ,PROeERT;'(i:OwNER, ,i,,'_:..i..; ;:.,,;, 1J2,~I"t~~Q,OJilmps'(2)',j':~'1 $ 95,00 $ I
\ ':1\ t.N \IV>"' - C I" ,,'-r Olonol' "'''''1 I
Name: An Avv'\ Ai\ A-,vG 1../ GH ."" _." ",IAS ado~ leI I ~ql,to 6. OaJ11.PJ: Wi torth $158,00 $
I Address~ S""1'L STt-1 ~ T ~-;;;~i~atiOn C:~t~ ',;,~~~JJ.q~';(lQo91~P..s'(2)QOi- $205,00 $ 1
1 I I ~,w,,,c-vu' - II 0 1 OOOl"hn "IIP.SI W(') $ 1
City: ,'n," NC--;',aA) 'State: t'1i:' i lZII':""1-7'-" 77 0' lte r, ~sr;: amps ~r~v.?}", L $469,00
YrH _ (- __~ ,l"IIf-t.tV I , i'lDe)';:;I'-""'''--
1 Phone:9{I- iJi:z.:i "in? I Fax: u:';~;\i~q the cen'le~. ,,~~~o~n:~~!';~!y'-,<t!,cation $ 63,00 $ I
I E-mail: number 10r lIlc.l? i 'J:~~J.>Rri!n:~e/V)ces or'feeders: installation, alteration, relocation I
. . .'.. .. ,::::~to.r b 200 amps or less (2) 1
ThiS mslallatlOn tS bemg made on reSidential or farm property $ 63,00 $
owned by me or a member tifmy immediate family, This I 201 to 400 amps (2) $ 8700 $
, property is not intenqed f(,{ sale, exchange, lease, or rent. OAR I" '
479.540(1) an!!.19i56q~l} 401 to 600 amps (2) $126,00 $
~SignaturCj~ /~, " ,lover 600 amps or 1,000 volts, see services orfeederssection above
I. " ,,:';).cOiilTRAC'I'QR'i' INSTAtl'A'I'IQN;", ,'" ''';:1 I Branch circuits: new, alferafion, exfension per panel I
! Business name: t!:> c..,.,!NC-"-. I I a. Fee for branch circuits with purchase of a se.rvice,or feeder fee: I
I Address: 1 I Each branch circuit 1 $ 6,00 1 $ 1
I City: 1 State: I ZIP: 1 I b. Fee for branch circuits without purchase of ~ service ~r feeder fee: I _
I Phone: 1 Fax: I I First branch circuit (2) I $ 55,00 $ g ~
I E-mail: I I Each additional branch circuit / $ 6.00 $ , i-J
1 CCB license no.: I BCD license no,:NOTICE: I ~isce~xf~:~t:~:t"'I'm"i~"JeAA~dernot included 1
I Signing supervisor's license no,: THIS PERIVllj S1fa\oIr.p~l/'ijerI'fP~JAlfdif5:IW(2T $ 63,00 $ 1
1 -4l!''l..CJLi' ,I. - "0 I
Print name of signing supervisor: AUT~~!:,.I:;;r_h .,~a\e S:i~~8f\\qw~~e::.JllIiiUJg\(2) $ 63.00 $
1. Signature of signing supervisor: L;U\V,1I1V~cn,w[)':"r~ f .s,it~~l~~CUif ort-a li~it,e(d2-)energy panel, $ 63.00 . $ I
~~!\ ,~_ PN fla le'l1lt;Un, or ex ens IOn
I Each additional inspection: (1) , $58,00 $ 1
1!11~1k~~1~,~~~;~k~~~s~rA-R:eJHG:~N[~)USCEi~*;.~~~ZYfit~f~~~[i~~:j~1
I (A) Enter subtotal ,Of above fees $ I ( I
(Minimum Permit Fee $S8.00) t:?
(B) Enter 12% surcharge (,12 x [A]) '$ 7:?2j
(C) Technology Fee (5% of [A]) $ Y OJT
1 TOTAL fees and surcharges (A through C): $ 7/ J>7
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'v0-
440-2584-J (9/08/COM)
Status
Issued
CITY OF SrKll~l.t<lELD
Building/Combination Permit
PERMIT NO: COM2009-01391
ISSUED: 09/21/2009
APPLIED: 09/21/2009
EXPIRES: 03/21/2010
VALUE:
225 Fifth.8treet, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax. ,
541-726-3769 Inspection Line
SITE ADDRESS: 532 5TH ST
ASSESSOR'S PARCEL NO.: 1703352405600
Springfield TYPE OF WORK: Heating System
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: ' Install He condensing unit
Owner:
Address:
MANGRICH ADAM E
532 5TH ST '
SPRINGFIELD OR 97477
. 'yoU to
on laW reqUiteS n Dti\iW
.. .~.n"\' Greg " '''0 OreQO , ,~,'h '
. .. . doti\.t:u....] I are ;:IV'.
r . '" '. -.('.::1 t' _, __.....r\\ eS .,_n ('\(l\.~
; ."'~':';ll.GONTRACTOR,INEORMATION, .
t~Ot\h.lc...~ "O'O\~\JVi- .esOlll......
,- ' R 95,-' t in coP\ \ _nl:\one
Contractor u~' 'Iou may ob a 'Note', the te ~r;lt~!!se
OWNER .009 " t'ne center. \ Dti\\ty No \I
'1"'~\\mQ _, _ r\rpdOn _ ^nAA\
'nu",L'I>Buii,;DING~iNFORMA TION I
Expiration Date Phone
Contractor Type
Electrical
VB
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Fl 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
# of Units:
'Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R"3
nla
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
, , REQUIRED PARKING
Ove~I~~!>isl: II' 1\-1E \)'JOI'\\\ Total:
l~~r~et~~~e~ ~~$.LL E1?II'\E R~\1 IS ~01 Handicapped:
:r~rf,d?Qnv~~q~~\DER T\1\S?'<- EO 1'01'\ Compact:
~\J"{W8nQ.o:ve;&:( IS I\BI\~DO~
('nl\lt,,!,~~C~:.:: \,CQ\()\).
I PUBLI(lIIMPROV'EMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
.,
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 on
Status
,
Issued
" ,
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,..'
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
$7.32
$3.05
$55.00
$6.00
Total Amount Paid
$71.37
;;
Total Value oj' Project
Fees Paid I
Date Paid
I Plan Reviews I
9/21/09
9/21/09
9/21/09
9/21/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01391
ISSUED: 09/21/2009
APPLIED: 09/21/2009
EXPIRES: 03/21/2010
VALUE:
Receipt Number
1200900000000001083
120090000000000]083
1200900000000001083
1200900000000001083
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. '
Rl'('u';"ed I n,oection"
III.. IIIII . I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, 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 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 ensure;that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit,{,,{d is located at the front ofthe property, and the approved set of plans will remain on the site at all
timesa;during cJ.,ryfc,ti~n. .
'/ I t
,,;.1; ~
Owner or Coltiactors Signature
Page 2 of2
9/z1109
Date
"~';- -,' .. ,-; " .
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street:', ' ..
Springfield; Or~~(}n:'97477 ,"
541-726-3759 Ph,i!iui'
Job/Journal Number
COM2009-0139 I
COM2009-01391
COM2009-01391
COM2009~01391
Payments:
Type of Payment
CreditCard
cReceintl
'RECEIPT #:
1200900000000001083
Date: 09/21/2009
Description
Add, Alter, Extend Circ '
;Add, Alter; Ext~nd Circ Ea Add
,!. -'. . .,-, .,..-
;,+5% TechriolosY Fee
')+ 1,2% State Surcharge
'{: . '~,; .,;,-,:
,',
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
'Paid By ,
J ADAM MANGRICH
233925 In Person
Payment Total:
djb
,
Page 1 of 1
11 :24:09AM
Amount Due
55,00
6,00
3,05
7,32
$71.37
Amount Paid
$71.3 7
$71.37
9/2112009