HomeMy WebLinkAboutPermit Electrical 2009-10-27
) Electrical Permit Application , '
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225 Fifth Street+Springfield, OR 97477. PH(541)726-3753+FAX(541)726-3689
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Perrnitno: ~AA~\o
Date:
'Q.~1-q
This permit is issued under OAR 918-309-0000. Permits are uontransferable. P~rmits expire if work is not started within 180
days ofissuance or if work is suspended for 180 days. '
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I ~ I I Residential, per unit, service included:
~ ,,~sidential 0 Government I 0 Commercial
~1ll!!t~(;lal$lmaINFJ:)R.M>>.mll1!Nr"<<NDjl.~C1,(1l11t:)N~ 1 1,000 sq. ft. or less (4) $134.00 1$
IJobsiteaddress:4if'75 lJlI/5)l5f7?a:-/ 1 I :e~~:ritional500Sq.ft.orportion $ 25.00 $
I City:)jJ/'f/N6i'lELb I State:~ I ZlP:'17'177I I Limited energy (2) $ 32.00 $
i~~=m~iG~wJ~~~_ I ~~l::~~:~~fe~~;r(~)odular / $ 63.00
1 m.lI, <)cge VI I!.g If' q{/}-Cg)71trA/ T - 1 Services or feeders: ins/al/ation. ai/era/ion. relocation
~~ ~~J I I 200 amps or less (2) I $ 81.00 $
~f>R.t:)eER.MOMINER~~1 1201 to 400 amps (2) I $ 95.00 $
NamelJt?tI tJmv mAAI~~ lie I 1401 to 600 amps (2) $158.00 $
I Address:L/tf75' ~/115'V5'J;.iftjl I I 601 to 1,000 amps (2) $205.00 $
! city5J j{ /1I/6/ld.o I state: 01( 1 ZrP: CJ7~1.J lOver 1,000 amps orvolts,(2)_.d~ 1,.$469.00 $
Phon~: 5 r,t/ . 7'17 . g'1l~l Fax: _ _ I RecOlmect only (2) .. I $ 63.00 $
E-mail: [ Temporary services or feeders: installation, alteration, relocation
This installation is being made'on residential or farm property I 200 amps or less (2) I $ 63.00 1 $
ownedbymeoramernberofmyimmediatefarnily. This 1201 4" " ~ I
property is not intended for sale, exchange, lease, or rent. OAR to "'~ "''''''''l'lUN: preaon.lall reg Il'eft~~ Iii
479'M~~Jtr:79.560(1)..",. 1401 tofoU_r~s adopted by tpe ElBMiWlijy
Sign.' t'!' 'It '~. ! T .. V:. ..., Overd1l@! q!litl6lW~r'eg\!jl;jM~e!lfIl!i!i!~!II~ve
~" ,\ ' , , .. .. w " ltW-. Brao r. a1
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Bust j. I a. Fee rotl/l!l1l'!f1<tl'fei~llYitlel'.4~ef \tve'tel",';\";,,,,:"_:
Addr v-. 1 EachQYOO!il~tM Ine. ureg,?" !{1~ltylN!ltIV.i8l~OiI 1
Ci~: ,0 /A'61"/./~ ., 'State:t/(< "I ZTP:q7~?} Ib.Feeforbranch~fetl~~Ju~~sm1:eorfeederfee: I
Phon~:SI.f/",7~7,6t-3jl Fax;'jI.JI~747. 71:;1' 1 First branch circuit (2) ,I I $ 55.001 $ I
E-mail: hhA-t/f~A@4ajJVltf./.lt-r I I Each additional branch circuit '. $ 6.00 $ 1
I CCB license no.: --10'71 b 1 BCD license n.o.~/J ,j7c...! Miseellaneans rees: service or feeder nol i~c/uded I
1 Signing supervisor's license no.: ~f,I~s ,I I Each pump or irrigation circle (2) I $ 63.00 I $ I
I Printnameofsigningsupervisor:~7 ~~,9A1l'1.~1. I Each sign or outline lighting (2) $ 63.00 $ I
I Signature of signing supervisor: --/' -? /. / III I SIgnal. CIfCUlt or a h!TIIted-energy panel; 11 63.00 $ I
. ....;:?"/lA~ 'ZJ...t..._." ,#- 01 alteratlon,orextenslOu(2)
-, ,7' /"
. ~ach a.~:=:;~~~:,(.l~"';~i"~_!"''''':~:''.OO' $,'. . ','"".' [
_"""""-ilf~~p.el!le~N;r;~SE~_~
. l'. ~~,.{^ I (A) Entersubtotalofabovefees -I
W,\I \J' . (Minimum Pe~mitFee$58.00) $fJ;.3,
~ f\ ~ I (B) Enter 12% surcharge (.12 x [AD $ 7. 5'~ I
'" "'cfi<....~ I (C)Technoiogy Fee (5% of [AD $ 3. / 5 I
~ ! TOTALJees and surcharges (A through C): $13, 7J I
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01570
ISSUED: 10/27/2009
APPLIED: 10/27/2009
-. EXPIRES: 04/2712010
VALUE:
".; .,
Status Issued;:";,
, 225 Fifth Street;.Springfield, OR
541-726-3753 Phone'; .::.
541-726-3676 Fax ", '
541-726-3769 Inspection Line
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SITE ADDRESS: 4475 DAISY STSPACE 71
ASSESSOR'S P~RCEL:NO.: . 1702323406500
i
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Electrical Service Replacement
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Owner: COUNTRY MANOR LTD PTRSHP
Address: 7007 SW.CARDINAL STE 185
PORTLAND OR 97224
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I CONTRACTOR INFORMATION I
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Contractor Type
Electrical .if .,
Contractor
'.
, LR BRABHAM
License
8699
Expiration Date
12118/2010
Phone
541-747-6638
,. ~UlLD!NG INFORMATION'
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: . 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: . to
_ Il-"'. \I"" 1~ rA{1U1reS you
I DEVELOPMENT INFORMAT1~~ ~~ ~ciopied by the Oregon ~l~~h
. ,~. ," , Notiiica'i~~center. ThCMiWItMqt~~~G
I OAR 952-001-0010 througn OJI.R I b
Frontyard Setback: '.. _.overlay Dist: n y may obtain aJ/jRls of the ru es y
S~de 1 Setback:NOTlCE: ; ;, ' '. '# Street Trees Rqd: 009~iin o~he center. (~/iPPIl~pho~e
Side 2 Sethack:W)S PERMIT SHALL EXPIRE IF W!6'a.A'OR!(e Rqd: C mb~r for the Oreg~ddtpiiYIl'lotlficatlon
Rearyard SetbaliD HORIZED UNDER THIS PERfIJIlirqSLNMoverage: nu Center is 1_800-332-2344). ,
Solar Setbacks: rn~n~nJ:~I('m nR I~ ARANDONED FOR
ANY 180 DAY PERIOD,. I PUBLIC IMPROVEMENTS I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: (; :'
=:.;'
Street Improvements:
Storm Sewer Available:
Special Instruction: .
Sidewalk Type:
DownspoutslDrains:
Notes:
t. I.'
I V ~IUlition DescriDtion I
Description
Type of Construction
. $ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of2
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
.- '.
541-726-3769 Inspection, Lin~'
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01570
ISSUED: 10/27/2009
APPLIED: 10/27/2009
EXPIRES: 04/27/2010
,.VALUE:
Status
Iss u ed
. -
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Total' Value of Project
Fee. Paid ~
Fee Description.... ..
+ 12 % State Su'rcharg~
+ 5% Teehnology Fee
Manufactured HomeService
"Amonnt Paid
Date Paid
$7.56
$3.15
$63,00
1 0/27/09
10/27/09
10/27/09
Receipt Number
3200900000000000734
3200900000000000734
3200900000000000734
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Total Amount Paid $73.71
. ; I Plan Reviews I
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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, ~enllired In.oection. I
,
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MH Service: ~Apjiroval required prior to ntility company energizing service.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the 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 projeet.
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, aud the approved set of plans will remain on the site at all
times during construction.
$r "
Owner or ContraCtors Signature
Date
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Paee 2 of 2
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225 Fifth Street
Springfield, Oregon97477. .''-;' ,
541-726-3759 Phl)ne:fi~'d.S\:Ji;F:,
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City of Springfield Official Receipt
Development Services Department
Public Works Department
llECEIPT #:
3200900000000000734
Date: 10/27/2009
11:21:SIAM
Job/Journal Number .'
COM2009-0 1570
COM2009-01570
COM2009-0 1570
Des~;iptiri~..~,:,- ,~:~;;.:,\:.):,
Manufactureo Home Service
+ 5% Technology Fee
+ 12% State Surcharge c,
". .:..:{;<o~",'
Payments: ".; .....,..
Type of Payment .Paid By
. .;
Item Total:
<":heck Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
3.15
7.56
$73.71
Amount Paid
Check
'LR BRABHAM
KR
38287
By Mail
Payment Total:
$73.7]
$73.71
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10/27/2009