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HomeMy WebLinkAboutPermit Electrical 2009-10-2 E,lectrical Permit Application \~_tm~i~_m]rr~1l:!_l~1 ns Fifth Strftt. Springf"H'ld, OR 97477. PH(54l)7tO:-3753. .F.~X(5" )7~6.36S9 I', "" .... " ' .. " " .. '. .""", ~ c:,.DEPjl.RTMENT, USE.ONI.; Y:D~, Cl'l~ ~A'?'''<' ~". __~",' .-_ ..r_,{_....."'_,....: ~:~, \ Pennilno Cc:7 -O\~p. I \ ," .-'-) (>-,0. 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'...'.. ". ~". I .' _, _. ",,- ,.~...."" ...,.\,. '- _""c. .......-. " . ~,"'>';!:. __"',,>, ~:;.~/.'::'''~'':';~_'_>'_' .". _ - 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: j 1 I 1 j j I 1 1 1 j ',,}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- ~' ~ ~<> ~~ ,~ 6'- \\)~ ~~ -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