HomeMy WebLinkAboutPermit Electrical 2009-10-27
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Electrical Permit Application
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225 Fifth Street+Springfield. OR 97477 tPH(541)726-3753+FAX(541)726-3689
I Pernlit no.: ~g - \ 51 \
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Tbis 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 suspended for 180 days. .
1~~I!~C;A;!l.I[G'E!YER.NMENf(li~ee~i::lY~~1
1 Zoning approval verified? 0 Yes 0 No
1_-'r'~C),-1iEGIi5~:r..(C!FJ{e'E!N$;lil~lllC;I":ION_
~~~e;~~lilI~IIJI;~~~;;7;;~NPj~~C~~:~;~ Residential, per uni4 service included:
I Job site asIdress tfL/75 J)/16V 5t-,flfe/ I
I City: ,:y11\./Al6~/E[/) I State: Of<.. IZlPQ7'l-1f I
l~~~;!:;;;;z:J~~r
I \1~P']...~' 6~~<:::. .I~ 1 200ampsorless(2).$,81.00 $
1~:m;:;~Wtr~-i ~~: :::~~:::~~;. ":1:::~~ :
I Address: ~"I7 E .f)/}-!5/ST. .:If:- '11. I 601 to 1,000 amps (2) $205.00 I $
1 city5 p 1\/ A/6;::? et;) [State:, /)1(, I ZIP: q- 7 ~ 7JI' Over 1,000 m'~t't'l~Ia) nr..gnn~ ~Ja~ tn
~1'lJ'-'!971f I FaX::':,.~..,'.,. I ReconnectflY!k:AN)rUlesadopted ythl,l~iIIty
E-l'l'l~ p0041T SH.~,I_r_ t:_,V,D, ',0, ,: II' '!I:lE lIVOO, ,It', _ I Tempora~Q~tiG\l'\GM~rns~.ri.i!M~A1~
.- m_ -.- 200 amps~1 ~~i!:~:~D J.l::;~~' OAR ~-f)61.
~!tm~~J~~tt.!it~f~:R 201 to 400 ~YJBlI(~ the ~nte~.I~~-;t;~~;'~~~e"'-
4~Nfl~186"tlA)9p~lbD. ,'"' ./, ' 401 to 600 ~jlr for the Orego 1 Utility1~fi~~on I
Signature: ' Over 600 amps or l,oWlmil!!, Je\, !eR\WS'iI1'~eli~ion above 1
IlIj_!llIC,C!N!1lRJ1l:Cf(li::l~IIINSm'<<l!l!;4.mlC!Nr_1 Branch circuits: new. alteration. extension per ponel
I Business name: l-. 1(. ,!7If/l-bl1lJ1f1. JAiG . -I' a. Fee for branch 'circuits with purchase ofa service or feeder fee:
I Address: tPJ a;. 'q If . _~ I I Each branch circuit ,[ I $ 6.00 I $,
I CitY:_<)/2 ~ / A/6F/etl) l State: tlA:, L ZIPq /.1/77 1 I b. Feefor branch circuits without purchase ofa service or'feedeffee:
I PhonelStf-/-7'17,&;g 2 I Fax$ If/ -7'17,7/'5' 71 I First branch circuit (2) I I $ 55.00 I $
I E-mail: IJJ1I'1iMIliPt/(.(LJtntJ( nef I I. Each additional hranch circuit I I $ 6.00 I $ I
I CCB license no.:' n,r'l V [ BCD lic~se TIQ.: ~-27c-1 I Miscellaneous fees: service or feeder not included
I Signing supervisor's license no.: 'I11/'IJ I I Each pump or irrigation circle (2) I I $ 63.00 $
I PrintnameofsigningSUpervisor:~/ 61f1?il#,ftJyV,/( I E~ChsignO~outlindighting(2) $ 63.00 $
I Signature of signing supervisor: /" .L7 /' /' fA I Slgnal.cITcult or a h~ted-energy panel, I I $ 63.00 $
, ~4~/~ ;/"". - h ! alteratIOn, or extensIOn (2)
,,:? : / Each additional inspection: (1) I $58.00 $
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440-2584-1 (9/08/COM)
1,000 sq. ft. oTless (4)
I Each additional 500 sq. ft. or portion
thereof
I Limited energy (2)
I. Each manufactured home or modular /
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
1
I
I
I
$ t;J.4f
I
I
I
I
I
I
$134.00
$
$ 25.00
$
$ 32.00 I $
$ 63.00 I
I (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (12 x [AD
I (C) Technology Fee (5% of[AD
I TOTAL fees and surcharges (A through C):
$61/JJ
$ 7,) &,
$3-151
$l~ .1/ I
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Status
Issued
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225 Fifth Street,Springfield;':OR~;
541-726-3753 Phone.':"." ' ,
541-726-3676 Fax .
541-726-3769Inspection'Lirie . .'
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CITY OF SPRINGFIELD
Building/Combination Permit
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PERMIT NO: COM2009-01S71
ISSUED: 10/2712009
APPLIED: 10/2712009
EXPIRES: 04/27/2010
VALUE:
Springfield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 4475 DAISY ST SPACE 89
ASSESSOR'S PARCEL NO.: 1702}23406500.
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PROJECT DESCRIPTION:.': 'Eieciri~al Service Replacement
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Owner: .. COUNTRY MANOR LLC .
Address: 7007 SW CARDINAL STE 185
PORTLAND OR 97224 .
Contractor Type' .'$Contractor
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Electrical ~,:'. LR BRABHAM
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# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: ;. , -,
.
Residential
TYPE OF USE: Repair
., I ~ONTRACTOR INFORMATION ~
License
8699
BUILDING INFORMATION I
Expiration Date
12/18/2010
Phone
541-747-6638
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
'. I DEVELOPMENTINFORMATlON I
. . .. ; "'-""""';N":"~'<:"""-"'_' ATTENTION: Orego~N\fiN.y~()IG
-MorICE' ,"'''''~h,,'p:'':''''r..'''''' , follow rules adoptetl.h\lthe Oregon Utility
Frontyard Set_. , . R~<;t;~..u.ist: ~fIl'l:il' et f rth
Side I Setback:T,HIS PE, RMIT SHAll EXPIRE IF TI1I~tYl'H~ees Rqd: . Notification Center. ~ ~;m~2, ~1
Side 2 Setback:AUTHO~!ZE[) UtJD"ER THIS PERM~~tIDt~)qd: ~~\':J:~::~ntloijjl6f the rules bV
Rear:ard Setb~fv1,M.E.NCED OR IS ABANDONElJfaa.?r{ioverage: calling the center. (Note: the telephone
Solal SetbacksANy 180 DAY PERIOD. . ",,:, ,. ' number for the Oregon Utility Notification
I PUBLIC IMP,ROVEMENTS I \iElr1ter lit 1-0.....................,.
Street Improvements:
Storm Sewer Available:
Special Iustruction:
,t. ,
Notes:
'h,.~ ,'l \.-'
Description
Type of Construction
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Sidewalk Type:
DownspoutslDrains:
.,
I Valu~tion Descriotion I
$ Per Sq Ft
or multiplier
u
Square Footage
or Bid Amonnt
Value
Date Calculated
Pa~elof2
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Status
.. Iss-iIed/
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225 Fifth Street, Springfieid, OR":, ,.
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspec!ion Line
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Fee Description
+ 12% State Surcbarge, ,it
+ 5% Technology Fee' ,,:'"
. Manufactured Home Service
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Total Amount Paid
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'Amount Paid
$7.56
$3.15
$63.00
$73.71
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, TotalValue of Project
F~e~ ~",id .
Date Paid
I Plan Reviews I
CITY OF'SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01571
ISSUED: 10/27/2009
APPLIED: 10/27/2009
EXPIRES: 04/27/2010
VALUE:
10/27/09
10/27/09
10/27/09
Receipt Number
3200900000000000735
3200900000000000735
3200900000000000735
,
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. ",'.'f ::
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I ~elllli~ed Insnections I
MH Service: Approval required prior to utility company energizing service.
By signature, I state and agree, tbat I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify tbat any and all work performed shall be done in accordance with
tbe Ordinances of the City. of Springfield and the Laws ofthe State of Oregon ,pertaining to tbe work described berein, and
that NO OCCUPANCY will be made of auy structure without permission of the Community Services Division, Building Safety.
I further certify that only eontractors 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 located at the front of the property, and the approved set of pia us will remain on the site at all
times during construction. - .... -'.
Owner or Contracto'rs Signature
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Pa2e 2 of2
Date
I
'~25 Fifth Street'
Springfield, Oregon 97477
sin -726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
'!ffiCEIPT'#:
3200900000000000735
Date: 10/27/2009
1l:23:40AM
Job/Journal Numbed . Description
COM2009-01571 ';' Manufactured Home Service
COM2009-015713r;' }+ 5% Te~hn~!ogy Fee
COM2009-01571 + 12% State.Sm;charge
Paid By
,LR I?~HAM ,.,"
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Item Total:
l.:heck Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
3.15
7.56
$73.71
Payments:
Type of Payment
Check
Amount Paid
KR
38287
By Mail
Payment Total:
$73.71
$73.71
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10/27/2009