HomeMy WebLinkAboutPermit Electrical 2009-9-23
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1 Zoning approval verified? 0 Ves ' .0 No. .
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1 Job site address: :;"0 if 7 MA i' IV 5'1 - .1
I City:'~,)"':_,; (,'" leI I State: Dk... I ZIP:(i7'17V I
1 Refere~ce: r:(o Z s:~!. ~ , 1 Ta~~~t :<?~?~~
, ',~ DESCRIRTI0N,,0F ,WORK' i[~"r""~~~.!,,,"';:'i'i,~1
1 j \ ..L- Services or feeders: installation, alteration, relocation
1 i 0 ~, If +>~ .1 ;, e.,,~ \ p '" ~:P 1200 amps or less (2) $ 81.00
I.. iPROeERTV,OWNER;'.", cc; <,.:. 1201 to 400 amps (2) $ 95.00
IN I ~ \) + ~ 1401 to 600 amps (2) $158.00
ame: h,C,,-vv1 rs- '\ eo '<.-01>"'--
I Address: <; (; L( I M f>r: ""'- ;; t ' 1 601 to 1,000 amps (2)
1 City: ') Q [;... i J ' ,l State: C> 4...J I ZIP: lOver 1,000 amps or volts (2)
I Phone:>'..I! -1 )fo"'~'f~'~- ~nx~NTION:-Ofegon law rRn .1 Reconnect only (2)
~ " . I! ~'" VOII tf"l
I E-mail: IVll.~VV I Ules aaopted by the C ~ej ;;r~~P.~,r~ary services or feeders: installatIOn, alteratLOn, relocatIOn
NOtlfr('~f1nn (''''....~_.. ......, 'I -","v
. . l '.-... --:-:-..~,. IlJU':-'l"::!IUle a 200 amps or Jess (2) $
ThIS mstallatlOnlls bemg, made ~1.resldeI?t}(!1-9D\~r:.w. p,~opeI1Y . ,t;,.,:C;l Iv],n 63.00 $
owned by me or a member ofm:;;lIl]l!))e<!La.!.err.aJIJ'ty,',im~s'IfGugh CAli' 201?t61400 amps (2) $ 87.00 $
property IS not Intended for s~' exchange/rlease, or rent ro'A'RlS 0 tf'lo ",;", ""
479 540(1)~ 479.560(1) "~"b" '" '" ~bmef. (Note: the tel ,4, Olrto 600 amps (2) $12600 $
'~erf""th 0 )lI'"Cl .
Signature: , C~ r - i" fl< e 1'e~on Utility 'OIIOye(,Q.QQ amps or 1,000 volts, see serv.ces orfeeders section above
" ~' ~ . r IS - .0n-~'J~ ~~ 14
1 .' ,', L CONl'RJl/C[OR\INSJALLA'I'ION',' , II' Branch circuits: /Jew, alterallOn ntenslOnper panel
1 Business name: ' , rr-> I Y NH\.. I I a. Fee for branch circuits with purchase of a service or feeder fee:
Address: I I Each branch circuit I I $ 6.00 I $
City: I State: I ZIP: I I b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: I Fax: I First branch circuit (2) (I $ 55.00 I $ 5' ~
E-mail: I Each additional branch circuit $ 6.00 I $ J
CCB license no.: j BCD license no.: I Miscellaneous fees: service or feeder not included I
I Signing supervisor's license r/;}!:JT!C1=. .1 Each pump or irrigation circle (2) $ 63,00 $ 1
I Printnameofsigningstiperv{s~lS' PER~dl"'~. I Each sign or outline lighting (2) $ 63.00 $ I
I Signature of signing s,upervis'~:' NORIZED" "'rtAL[ EXp ~ Signal circuit or a limited,energy pa~el. $ 63.00 $ I
L. d.nA ~_ II^/,.,...._ IRr: ,,.. ~ alteratIon, or extensIOn (2)
"""C/VCE' 'vel'! rH -" I H
A/Vy 180 D D OR ISA8 IS PERMIT );~a~l?l(d:i,~~:~.i:~~~ction:,~~, ',..Lc....~.:8:~~." ,~",I
A y PERIOD A/VDO/VED Fe 1?1s,!YJJli1:.'<tf>,'g,~i,.<I1{'~ReI.!ICA/IlT;\\,l:JsEl!i!1i>J,illk~!irW-iM1,lii;!ir!1
. . 1
(A) Enter subtotal of above fees ' "'-e>t
~ ...c..... (Minimum Permit Fee $58.00) $ S
(\ ~b.. ~/ ,I (B) Enter ]2% surcharge (,12 x [AD $ b 'f
'1\ tJ<'- I (C) Technology Fee (5% of[AD I $ Z 7f
~ I TOTAL fees and surcharges (A through C): $ t:.. 7 S6
"
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t .
Electrical Pelimit Application
It\~")'9E~~,R:fM,E"N:tU~E,oN,lYi~;:i;: I
c.o-t~oo 1 - IIJD1 I
PermIt no.:
I
'.225 Fifth Street+Springfield,:.OR 97477+PH(541)726,37S3+FAX(541)726,3689
9~L ~ ~ 0 <]
Date:
This permit is issued u~der OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started. within 180
days of issuance or if w'ork is suspended for 180 days.
1'll'>"''''''''''&'''''''"'''''-''''"EEi''S'C H EDU' "E"""",",'u......) 'L"~"'"$T"''"I
L. i,1In;lg;;:;~"'~'.)1t:1",M~t:iZ.f~i'l 1";";.. ,~ _ . . ,.' ,.' L;: __:m2-;:~~:~~'Jt'j;~viL1J:;;14%EIHf,,:~',~-ii~ .
I :~~m~e;'Jf:i~;~~~!i~'~;;~;t;t;~i~;ri)c~':i..IQiy:1 ,;;P~~':~;:I ';:;rOfar;1
'9 'H~v".,.,,,..i,,~.a.~,,~d;,~..,'"<.'."''''rl'i:..,,'-,, ",' ,.I\!". -: ,>';".,~,: ,:,;.'0:' ..oJ,.J.' .,.~a"'~;":"'i' '\ ,.,;.C9,S(.,,;,,,:
I Residential, per unit, service included:-
I 1,000 sq, ft, or less (4)
I Each additional 500 sq. ft. or portion'
thereof
.I Limited energy (2)
Each manufactured home or modular.,
dwelling service or feeder (2) ,
$134.00
$ 25,00
$ 32.00
$ 63.00
$205.00
$469.00
$ 63.00
440,2584,) (9/08/COM)
$
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01409
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/23/2010
VALUE:
225 Fifth Street; Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Springfield TYPE OF WORK: Heating System
SITE ADDRESS: 5047 MAIN ST
ASSESSOR'S PARCEL NO.: 1702333204700
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install heat pnmp
Phone Number: 541-726-6485
Owner: PETERSON LARRY A
Address: 5047 MAIN ST
SPRINGFIELD OR 97478
Contractor Type"
Electrical
Mechanical "
# of Units:
Primary Occupancy Group:
"
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback: '
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
oI""'III::A..
I CONTRACTOKINFORMATION I
II) O""CCitl '''S qCi -'ego .
, Contractor 0090 'A./i 9o~1) Cel)t OPte(j LiCense Expiration Date Phone
OWNER Oft!/.: YOlJ ;'OOt'o~1: It/OOy tl]~l9qi!ires
MONTGOMERY HEA'FI.I)i!:ir&'!AJ!.i':QQ.I>'J?i17,.{r200,(ere90,,~OlJ ,f)?/08/201 0
BU ILDIl;'~GIINF.()RM;{m)NIO-'1R ~ sei;~/fty
'~r is i ~901) U~:' tl]e-ftl]e ;;2'Oo~rtl]
# of Stories: -800'3 tlltry te!epl] les 6)>t Size:
Height of Structure '32-234lvObIiOq Ol)e q Ft 1st Floor:
Type of Heat: 4). bOI) Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
541-998-9423
R-3
VB
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
A/
Ilig~CC.'
AU.,.,., t:RAA,_
A (,'OfJ1/~;r.fi!?l:/J 'pbB''''If:: J,l)1PROVEMENTS .
/Vy J 11 /Veto '''''l::R !. lI1f
o D..qy OR IS IIiIS P IF llit
PtRIOD A8..q/VDO;frll4lll/VORI(
. '.tD FOR /VOl
Sidewalk Type:
Downspouts/Drains:
Pa2e 1 of 3
Status
Iss u ed
225 Fifth Street; Springfield; OR
541-726-3753 Phone.:' (
541-726-36761'ax
541-726-3769 Inspection Line
I V aluation De~crintion I
. Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Total.Value of Project
F",,< P~irl I
,1:.
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee' ,
Ist Appliance
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$16.44
$6.85
$79.00
$55.00
$3.00
9/23/09
9/23/09
9/23/09
9/23/09
9/23/09
Total Amount Paid
$160.29
Plan Reviews I
CITY OF SPRINGl'l~LD
Building/Combination Permit
PERMIT NO: COM2009-01409
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/23/2010
VALUE:
Value
Date Calculated
Receipt Number
2200900000000001080
2200900000000001080
2200900000000001080
2200900000000001080
2200900000000001080
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"~ 'wwl'lirll*l
Rough Mechanical: Prior to Cover
"
Final Mechani~al: When all mecbanical work is complete.
"
Rough Electric; Prior to Cover
Final Electric: When all electrical work is complete.
j,.
Pa2e 2 of 3
_lii~~!l!I!i!iI',t!lI~; , .
~k ]. . .;N;, .^
CITY OF SPRINGFIELD
Building/Combination Permit
. Status Issued
~: . '. i
225 Fifth Slreet; 'Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2009-01409
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/23/2010
VALUE:
I
I
By signature, lstate'ahd ag~ee, that I have carefully examined the com~leted application and do herehy certify that all
information hereon is 'true and correct, and I further certify thai any and all work performed shail be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of 9regon pertaining 10 the work described herein, and
that NO OCCUPANCY will be mad~ of any structure without permissi,on 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 ensJre 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 the property, and the approved set of plans will remain on the site at all
ti~e\)dUring constructionQ .' I
~CM4-- c..~ _~. I 9 -),,3 -I) 9
Owner or 6';ntra';:;>or~ Signature Date.
:i
Paee 3 of3
225 Fiftl1 Street
Springfield, Ot;,~g~n_97417__ ____
541-726-3759 Phone .
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1409
COM2009-0 1409
COM2009-0 1409
COM2009-01409
COM2009-0 1409
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200900000000001080
Date: 09/23/2009
,.,
D,escription
l.st Appliance < ,
Add, Alter, Extend Circ'
. Minimum! Adju~tment Electrical
. ~ ".
'-1;,5% Technology Fee
+ 12% State Surcharge
. ;1
[tern Total:
t:heck N umber Authorization
Received By Batch Number Number How Received
Paid By
LARRY PETERSON
djb
363792 In Person
Payment Total:
:" ~~
Page I of I
8:36:57 AM
Amount Due
.79<00
55.00
3.00
6.85
16M
$160.29
Amount Paid
$160.29
$[60.29
9/23/2009