HomeMy WebLinkAboutPermit Electrical 2009-10-2
E,lectrical Permit Application
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ns Fifth Strftt. Springf"H'ld, OR 97477. PH(54l)7tO:-3753. .F.~X(5" )7~6.36S9
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~ c:,.DEPjl.RTMENT, USE.ONI.; Y:D~,
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~:~, \ Pennilno Cc:7 -O\~p.
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Date: U ,..- U .c-- ,,--,. \
This permit b hsued under OAR 9J8-309-0000. Permits arc nontran~ferable- Pennits expire: ifw,o,"" is not started within 180
days ofissuance or ir\\'ork is. suspended for 180 days.
\ '. ,., '." .... fEE"SCHEDUL.E'. '0'...'..
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" . ~,"'>';!:. __"',,>, ~:;.~/.'::'''~'':';~_'_>'_' .". _ - 0"<" ,',',(,
1"";-" c.. ":.; ::,;,,:.,",,',,"'."."'. ~:*''''''<''I' -'}':I"~Go.6;:1 :"TotaL:
:;Numbcir.OrllU~ctions'IM:Htem(~):::i::'~ Qn'~' -r-;,,---- -/",0, ~-~t-. - -.:.;"
-/>, ,-s- "l",- ", -~_ >~""C, ;;f~":~ ~ '~"__;';' .''':,-/.- .~, '''~,:''''-'::'.~, ~< _ "_e~P -:;'I"',eaL; ";n~'f~2'j C().5:t.~>.~;
I Residmtial; pe-r unit, srrvice included:
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',,}Y:o;,:LOCAL:.GOVERNMENl';:A~J>ROVAL!:1,:,:'~:J(":r;1'-
Zoning approval verilicd'l 0 Yes '0 No
'.~,'ii';:::;:'_'2;:C.CATEGORy.:'Of.['CONSTRUCTION)li:'~J'J.;t"~.;fj
I 0 Residential J 0 Gmrenunent I g'lCommercial'
t;~~:lt~~::~\I~~R~:IOt:'AN~CATION:;";'>:':::~ ~7~i~:;:::(:~' ft or portion :1:::::
lcitR{\!;::l~L(;>~(J. I State:Of".l I ZIP:Clf'-i71 I Limited energy (2) $ 32,00 $
U~~:;~'~~~;;:"~;D~~~Jr~'l~~~~:~~;n{Q~;; I ~~~lrn:S;;:'~~~:;:r(~)ooUlar $ 63,00. $
I I I " h -t-' \-: (, I mO I S."-i",,, or feeMrs: it/slallatiot/. alteratiot/.:relocatioft
V'Jpf1C1/ } 1(..\. -\ IX r,lV.i'~',. (/ (;( I I 200 amp" orless(2) 1 $ 81,0.0. $
\u(';:llV;.r.l it-~_
.",:';,<:::'Y:;'" "c,,:I>ROPERTY,:OWNER 5':t;:,;'~,::.!',::,;/::: ::::':'11 20.110400 amps (2) I $ 95,00 $
I Name: ..InL.L.-J. 1Y\VBff'Y\;E~, [L<.> 401 to 600 amp" (2) $158,00 $
I Address: .J 60 I to 1.000 amps (2) \ $205,00. $
I City: I State: I ZIP: 1 Overl,OOO amp" or volts (2) I $469,00. $
I j I Reconneci,onl.y (2) I S 63,00' S
Phone: Fax:
E-mail: 1 Temporary servi!';eS or feeders: ins/allatioll alteration, relocation
This installation is being made on rcsidemialor.farm Y'''t'.;..~:j 200 amps or les".:l (2) $ 63.00 $ .
owned by me or a member of my inunediate nUllBv. This 20 1 t~ 40Q amps (2) $ 87;00 S
propcrty'is not intended for sale; exchange, lease, or rent, OAR I
479.540(1) and 479.560(1), ' . I 401 10 600 amps (2) $126,0.0. $
Signature: " lOver 600 ,""ps or 1,000 \'olls, see services or feeders scetion abo\'e 'I
1>;,'..,'t>i'.:CONTRACTOR :INSTAI.LATION;;;::'.,~j,':.:i:."'~. ;':0,; I Branch eiremls, tie". allemtiot/, exlensicmperpanel 1
I Business ~me: ..J K~ 1----1 n (+V-,_t---"'" ~t.--' . . 1 1 a. Fee for~ronch ci~uit.<; ~>ithpurcha.<re ofa service or feeder,fee:
Address: 2.1"51 ~(\ ~JlQ::f I I Each br.meh circnit 'I $ 6,00. I $ .
I City ~n~, Q rrl I Stalte 0 U I ZIP Q-14-11 1 II b, Fee for brnnch circuits without PUlChase of a service or feeder fee: 11
I Ph<me: ~I ."..",_%~ Fax:,:,>ct-I -i4b-~~S5.1 First brnnch circuil(2) 1/ l S 55.00 I S
I E-mnil. ~p,~.jI("..e:~.c..oM ' '1 I Eaeh additional branch eilCnit 1/01 $ 6,00 $ I
I CCIl license no,: 4612.'1' I BCD license no,: 2.O-2..nC- 1 I Mueellaneousf...: service orjcedert/olincluded _11.
I Signing snpervisor's license no,: . 4'i1-SS j I Each pump or inigation circle (2) $ 63,0.0.1 $
I Print name uf signingsupcrvisor~-.Jn.fhrHJ ~f) lou~~ Eaeh siB'~ or outline lighting (2) $ 63,0.0. S I
I S'gnahleof" , " .' ~A "-'I I Stg.n.alcUcultorahmlted-cnergypanel, Is 63.00 -$ I
,I. r slg.mngsU~f\ISOr. <=-'~/'~ J .alteration,orex-rensiOl1(2) , .
"-J I Eaeh .d<titiona(;nspection: (I). .. I J $58,0.0 $ . I
1i:\f.'C~1!.,f,':/,,\:<j~":":~;;C{A~PlljCANJ.i,USEy';;~~d(';;'!;i,,':,;'"',;=<1
I (Al Enle"~ht~talof abovefee; ~ _.' .' . .'1
(I\tinim~m Permit Fee S58J)()) $ 115"-
I (B)EntCT 12% ",rcharge(,12 x [A]) h..-?:'751
I (el Technology Fee (5% of IA\) $ ,LJ.,f1J 1
I TOTAL fees and surcharges (A through C): $ /3'f. ~5-
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-I40.258~H (9i08/COl\.1)
Status
Issued
CITY OF ~rKINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01463
ISSUED: 10/02/2009
APPLIED: 10/02/2009
EXPIRES: 04/02/2010
VALUE: .
.
225 Fifth Street, Springfield, OR
541-726-3753 Phune,
541-726-3676 Fax
541-726-3769 Inspectiun Line
," ,
SITE ADDRESS: 188 W B ST
ASSESSOR'S PARCEL NO.: 1703352312401
Springfield TYPE OF WORK: Electrical Wurk Ouly
TYPE OF USE: New
PROJECT DESCRIPTION: Replace light fixtures and relucate six receptacles.
Commercial
Owner: JOLLY INVESTMENTS LLC
,Address: 175 W B ST BLDG L
SPRINGFIELD OR 97477
I ,CONTRACTOR INFOR~ATIOr:' I
Contractor Type
Electrical
Contractor
J K GUCKENBERGER ELECTRIC INC
License
45129
Expiration Date 'Phone
04/24/2010 541-746-4656
I , BUILDING INFORMATION I
# uf Units:
Primary Occupancy Gruup:
Secundary Occupancy Gruup:
Primary Cunstructiun Type
Secundary Cunstructiun Type:
# uf Bedruums:
# uf Sturies:
Height uf Structure
Type uf Heat:
Water Type:
Range Type:
Euergy Path:
Sprinkled Building:
Lut Size:
Sq Ft 1st Fluur:
Sq F:t 2nd Fluur:
Sq Ft Basement:
Sq Ft Garage/Carpurt
Sq Ft Other:
Occupant Luad:
uta
I DEVELOPMENT INFORMATION I
Fruntyard Sethack:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Sular Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% uf Lut Cuverage:
REQUIRED PARKING
TutaI:
Handicapped:
Cumpact:
I PUBLIC IMPROVEMENTS ..
Street Improvements:
Sidewalk Type:
Sturm Sewer Available:
Speciallnstructiuu:
Downsp.:outslDrains:
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forlh
, in OAR 952.001-0010 through OAR 952.001-
trrtT'Cf'E:. ('Innn v....,. ~~,. """'..._:_ ___~__ _lJl__ ....1__..
.~_._.--- --"'. J ...- -.,. -- _...._.~.._--J
THIS 'PERMIT SHALL EXPIRI:Jr J nt ,vvunf\ ,. I;alling the center. (Note: the telephone
AUTHORIZED UNDER THIS ~.vca~uatlo~lI?escnp,tlOn umber for the Oregon Utility Notification
CO M M EW~ ~D 0 R IS. ABAN D~ pfr'=SllQJ? Sq Dare Fuutage Center IS 1-800'332-2344).
NyTYjl/,eOufDco,nstructrun. It' I' B'd A t Value Date Calculated
A u A) r'tt'lIUU. urmu Ip ler ur I mUDn
Nutes:
Description
Paee 1 uf 2
_S.~I!'I!,!rv~~,2!
~~. 'p. ":.;'
Status
Issued
225 Fifth Street; Springfield, OR
541-726-3753 Phune
541-726-3676 Fax
541-726-37691nspectiun Line
"'
...
Fee Descriptiun
+ 12% State Surcharge
+ 5% Technulugy Fee
Add, Alter, Extend Circ
. Add, Alter, Extend Circ Ea Add
Amuunt Paid
$13.80
$5.75
$55.00
$60.00
Tutal Amuunt Paid
$134.55
Tutal Value uf Pruject
Fees P~irl I
I Plan Reviews ~
Date Paid
10/2/09
10/2/09
10/2/09
10/2/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01463
ISSUED: 10/02/2009
APPLIED: 10/02/2009
EXPIRES: 04/0212010
VALUE:
Receipt Number
2200900000000001131
2200900000000001131
2200900000000001131
2200900000000001131
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.
I Rec/,",irerll nsnections I
Ruugh Electric: Priur to. Cuver
Final Electric: When all electrical wurk is cumplete.
By signature, I state and agree, that I have carefully examined the cumpleted applicatiun and do. hereby certify that all
iufurmatiun hereun is true and currect, and I further certify that any and all wurk perfurmed shall be, dune in accurdance with
the Ordinances uf the City uf Springfield and the Laws uf the State uf Oreguu pertaining to. the wurk described herein, and
that NO OCCUPANCY will be made uf any structure withuut permissiuu uf the Cummunity Services Division, Buildiug Safety.
I further certify that unly contracturs and empluyees who. are iu cumpliance with ORS 701.005 will be used un this pruject.
I further agree to ensure that aU "required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is lucated at the frunt ufthe pruperty, and the appruved set ufplaus will remain un the site at all
times during construction.
Owner ur Cuntracturs Signature
"
Pa2e 2 uf 2
Date
225,Fifth Street:' .,H
Springfield, Onigon'97477
541-726-375? PIlon,~i.:
Job/Journal Number
COM2009-0 1463
COM2009-0 1463
COM2009-0 1463
COM2009-0 1463;"
Paymeuts:.
Type of Payment
CreditCard
cReceintl
,-.;
RECEIPT#:
Description
Add, Alter, Extend Circ
, ; ,Add, Alter, Ext~nd Clrc Ea Add
" ,:,+5% Technology "Fee
. + 12% State Surcharge
'I,.
Paid By
JEFFREY GUCKENBERGER
:~...
J
l
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001131
Date: 10/02/2009
8:41:23AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
55.00
60,00
5,75
13,80
$134.55
Amount Paid
nJm
045020 Phune
Payment Tutal:
$134,55
$134.55
Page 1 of1
10/2/2009