HomeMy WebLinkAboutPermit Easement 2009-10-7
,) .
, '
Electrical Permit Application
r~:tiY':pF, ~PJp~~If.I,E LP~~QRE'GON
22S Fifth Streett Springfield, OR 97477tPH(541)726-3753t FAX(54 1)726.3689
1jJfl1.l'ifeEiU1Rmr;r!N''lf.tf.tsEI0N~~'ii1
*!?~~,4ktftiJ;il:tmJ7j;iW2,fDN#,*~;;;@;EilW.~/V.,.~ij
I CO~ZOO 'I' v IObG I
Permit no.:
I Date: 10 -7-0'1 I
This permit is issued under OAR 918-309-0000, Permits are nontransferable, Permits expire if work is not started within 180
days of issuan~e or if work is suspended for 180 days.
~~1IIiliJ'6li110,~~Wi~o~~RNMEN[~~aPxR(1)~~I1~"~':I1MI
I Zoning approval verified? 0 Yes 0 No I
It'~~.Jt:Ji!i!C~mE~OR~J!:'{i)F,~JeON$mRl!JcmIONl1'!!tilil!~Jijlf&:!JjJI
I~sidential I 0 Government ) 0 Commercial r
1f:i~il't.!l'i:J0B1';SIi1'E'!!INFi.oR~ml!JN~:I,iNEl]~l1oC;6,'l:I.eN.e,';'_1
I Job site address: S 2 3. 3. cr +l." st :fI L{ I
I City: <;~fd I State:(JIL I ZIP: '7 7f{7;;l
I Subdivision: 1702 :JIlL{ I Lot no.: 0]/001
1""!MIQ'i''''''''''l''-'''E'S''RI'''''I'''N~'''''l'jW'' "'R' "'if----"
.~'Nd~~'"c,~l::;~";;' "'i::~-i
I I
, . "I'; ;~. ~.'C,,,,,,,.,.... . . .. "," ''''. ,'<', ........., ~";'f '''''',!m'"'''.;"'~ ",."" "'" '"
~rllfi\~df4~iil1';~F!R(1)ijER'I';Y&!.0WNE:R1!iiIi~!~~4!~.1
I Name:~~ "JA-A1s>st:7\.I I
I Address: :5ZL:J g LIt~s,~e- 'hit I
I CityJ:'::U..6--t::NL- I State: oIL I ZIP, 77qIJ\ I
I Phone: I Fax: I
I E-mail: I
This installation is being made on residential or fann property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, Or rent. OAR
479.540(1) and 479.560(1),
,.eE:il'$!::1BE:ll!l:II!E~~1I
Imll.~;JI.~~1
I Residential; per unit, service included:
11,000 sq, ft or less (4)
I Each additional 500 sq. ft. or porti9n
thereof
I Limited energy (2)
I Each manufactured home or modular
dwelling service or feeder (2)
I Services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 81,00 $
I 20 I to 400 amps (2) $ 95,00 $
I 40Ito 600 amps (2) $158,00 $
I 60 I to 1,000 amps (2) $205.00 $
lOver 1,000 amps Or volts (2) $469.00 $
I Reconnect only (2) $ 63,00 $
I Temporary services or feeders: installation, alterafion, relocation
I 200 amps or less (2) I $ 63.00 I $
I 201 t0400 amps (2) I $ 87.00 $
401 to 600 amps (2) I $126.00 $
$134.00
$
$ 25,00
$
$ 32.00
$
$ 63,00
$
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
1~~ij!l:;"'i1lIeO~G;rL0RlIIINSm~l!~ml(1)NI.!~ I Branch circuits: new, alteration, ~xtensian per panel
I Business name: [) U yy~ II n Y1J5. I I a.Feeforbranchcircuitswithpurchaseofaserviceorfeederfee:
I Address'''] 0 h 0 )( ( It!:li ." _ I I Each branch circuit I $ 6.00 I $ I
I CIty .WI1 / tJ r V II J If I State~ 6 y f I ZIPf1 v ' I b Fee for branch circuits without purchase of a service or feeder fee I
Phone, l~ l Fax: , 0 I First branch circUll (2) I' I $ 55,00 I $ S 5 I
E-mali'hvy-ytl1bY"oS(;/nNtlr~On l'n-(,(U-h Each addll10nal branch circuit 1 $ 6,00 $ h I
I CCB license no :/(;1 ()~ I ~e no,:~jj ~ tJ-LJ.;;:{~ I Miscellancousfees: serVIce or feeder not ~~~d , I
I Signing supervisor's license no,: 'tf 7;1 , 5 I Each pump or Irrigation clrcle'2.i~~~~~"\LOO ~ i
\... CE: E IF THE ~'8Iitb\-.fYille:<<r~lke fees $ II I
~ >-- NO~ PERMIT SHALL EXP~R THIS ., ({4iiIIl!lA~'IS Wl!mit Fec $58.00) t?
~ f\~ ~ORKAUTHO~~~~~~NCED~OR\E~ '0"': I (Bl1!~ierI2%surCharge(.I2X[Ai.) $ 77't. I
0..: V peRMJnS NO, Y 181) DAY p.. ' \.Po- I
1J ,sP,NOONEDFORA."l . ,p. (C) Technology Fee (6% of[A]) $ 30r J
, ~{Y:e..o/ I TOTAL fees and surcharges (A through C): $ 7/77 I
~\;0
440,2584-) (9/08/COM)
>'
c.
Status
Issued
.:.
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01066
ISSUED: 10/08/2009
APPLIED: 07/23/2009
EXPIRES: 04/08/2010
VALUE:
:,? .".'
... J'.~.,
225 Fifth Street, Springfield,ORX
541-726-3753 Phone;',':, ,; ,':!
541-726-3676 Fax' ;: .
.541-726-37691nspecHon,Line
SITE ADDRESS:, ,523 39TH STAPT 4 ,
ASSESSOR'S PARCEL NO.: 1702311403100
Springfield TYPE OF WORK: Electrical Work Only
.;;l
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTlpN:, Add Circnits to unit
.,;;. ,--~, '~f:1 . .::~, -~,;."
Owner:
! Address:
JANSSEN DEBORAH K & DWIGHT A
'320~L4KF;SlDE D~
EUGENE OR 97401
I .CONTRACTOR INFORMA TlON I
Contractor Type Contractor
Electrical ,,: ',.; BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date
08120/2011
Phone
541-747-2724
, "
"
'!
.,
. BUlLDlNI/l.'l'iihtr~aw requires you 10 follow
I u'''s aOopl.;a"by'ihe"Oregon Utility Notifil'ation '
_ # of Stll~r, Those rules are set forth IrklJ\I\i~-001-
Height ~g~\l!'.tliOAR 952-O01-0090, S'QtftnWdilllllli:
Type q eSt!' e rules by cal/lng the ceSlflF(Nble: lIIoor:
ohe number for the Oregon I "'liMtJ";", '
Wate~ Is 1-800-332-2344) ""'I"'" ....mtloot:
Range Type: . Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secoudary Construction Type:
# of Bedrooms: " '
..
"
;,
,
j,
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Front yard Setback:
Side 1 Setback:
Side 2Sethack:
Rearyard Setback:, ,
Solar Setbacks:;- -' ,'-' ,'C
"
'. -
.
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
'I ,
Street Improvements:
Storm Sewer Available:
Special Instruction:
N01\..:tXJJ,I}~l!fQij'~T8i
- ", ,- ~~R~A\lT~g~'COMMENCEgA~~PER\OO. Sidewalk Type:
: PERMIT IS cOR ANY 180 .
ABANDONED c Downspouts/Drains:
Notes:
.'
,;.. .
11. ?"
I Valuation DescriDtion .1
Description
Type of Construction
$ PerSq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
, Pa2e 1 of 2
"
,.' :/.:-~;'.
; Status, Iss~ed\." "
. ',' . '::>,;,: -j ~! . ..!:i',; _:, "'_ :.
. 225 Fifth Street;Springfleld, ORt,; /.
541-726-3753 Phone .", ';'
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee " " .
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
" $7.32
$3.05
$55,00
$6,00
10/8109
10/8/09
10/8/09
10/8/09
"'i
. " :;.:"
~. -." .
Total Amount Paid
$71.37
Plan Reviews I
CITY OF SPRINGFIELD'
Building/CQmbination Permit
PERMIT NO: COM2009-01066
ISSUED: 10/08/2009
APPLIED: 07/23/2009
EXPIRES: 04/08/2010
VALUE:
Receipt Number
2200900000000001154
2200900000000001154
2200900000000001154
2200900000000001154
To Request an inspection call the 24 hour, recording at 726-3769. All inspections r~quested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will'be made the following
,1 ~ ,
work day. ,. ,.- ,
Reouired T nS\lections .
" ., lIlt" "
,)
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete,
By signature, I ~tate'and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and corr~ct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances ofthe 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 card is locate~ at the front ofthe property, and the approved set of plans will remain on the site at all
times during construction. '
"
;f
Owner or Contractors Signatnre
>
,
Page 2 01'2
Date
,. '..":.
, U~~~'j4
',: ~ ..:i _;~,:-r... 1 "'. '.....
..-. I
.,';'....
(I ~ '. ~
",> . .. -.....:,-'.. . -'
. <; ,'-;-" .......~.....-,
City of Springfield Official Receipt
Developmet;!t Services Department
Public Works Department
. 225 Fifth Street.:, .
Springfield,Oregon97477.
541-726-3759 Phl:lIie'. :';
-,. ..~\J'~::,.<:,~~~ ::;.
.' ,'i1:g:Piliik'tEirfi
2200900000000001154
Date: 10/08/2009
7:S2:12AM
c;.. ,'..,...,,'.:.... I
Job/Journal Number.~~0~;:'\~'DesCription ;. ;:~ :. .' .
COM2009:0 i 066r',{;if:i:"Xda'Ali~r:Extgnd Circ
, . ...., ' to" '~"';: '::: . ...c._': ':"", ':,:-' " . .
, COM2009-0 I 066 ;:: : .,'; Ad<J,Alte'r; Ekiehd CirCEa Add
. ' . ....-
COM2009-01066 ' .'0: 5% Technology Fee
COM2009-01066 ,+'12% State Surcharge (,
, ,'\~ ": " :, -,.!:l,':"':
,,' '.: ';'.,,,,;'~: .'. .
",,",--,..
Payments:" : ::::.:;~{:;. :~~~~~~-~~E;;. ,;'?
Type of Payment ',;P;.id;By:' " .
C~f:d,~l~ard . .,:)ASONBURRELL
~}:\:~~W~:~~f:~::~?~;~..\.' '
......
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
55,00
6.00
3,05
7,32
$71.37
Amount Paid
djb 05513c - In Person
Payment Total:
$71.37
$71.37
",'
"
"
.' ? ,. " .J '"
:' ..
;
1 1 ; :H. :,
" 11
:-
"
" ::!
\ ,j~~ ,
"
" ,
,
;
"
:1
q
:. ...
"
cReceintl
Page I of I
10/8/2009