HomeMy WebLinkAboutPermit Electrical 2009-10-28
Electrical Permit Application
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726,3689
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I Date: /0 ~2-f-O 7 I
This 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.
".,',,' ""liIKOCAL:."GOVER/IlMENT!~F!RR.OYAl\'i:1~ifN'@".i~\'(~ll
I Zoning approval verified? G3-- Yes 0 No I
lii3:e;lr;1\',1?<f,W.c:ATEGORMfi0I7I'C.oNSJRLJC'!110N(\;\ti"!:':jj!';'.(;lI
f~~;~,~~~~JJ:El'JN~~R~;m7;N~ykNDlJl~~;~;~r;~i~~~.:i I ~~~~::ti:I,:,el:S:n(:; service included: $134.00 $ : .
I Job site address: S C)C:; m ~ >t/ S~ . I I ~~~~oa?ditional 500 sq. ~t. or portion $ 25.00 $ I'
I City:")Jl---(2 (i 1 State:rM 1 Zlp:q?C(7Cj I 1 Limited energy (2) $ 32.00 $ I
I Refer;n~,~.L2~~;;~LoF.wl;~\~~~f:fu~~;~~.~I' I ~;~~I~:nS~~~~';~~ ~e~~~r (~)odular $ 63.00 $ I
~~ ~ C:rvLC~~"'fl1-. '5of-"r ) I Services or feeders: installation, alteration, relocation I
Cc' I I 200 amps or less (2) $ 81.00 $ I
J<1/lJ/'u. 51,,0\1
I. ." 'PROPERTY"OWNER . ",.",. 'I I 201 t0400 amps (2) $ 95.00 $ I
" 1 Name: \M+l t,(o-{ ~ (..( III I I 401 to 600 amps (22,0'" reouireS VO'l.t~. $158.00 $ 1
1 Address 5~ ;il\ 14, >v S~ '-' 1 60Fi~'I;:iioo~~'P;j2-1'l lhe ore_~~~,j~~rl.! 1 $205.00 $ 1
I City: <;7-Clci I State:U~ I ZIP: 41'0(.) ."1 oye;!,b~~.a~psiJfrv(1Rf~";;~R9s -001-$469.00 $ I
j1 '.. .", m)~~\~;~w th r 1811 ~r I
I Phone: i ~ _ 1 Fax: i ; ;.: )<,c.onnect.oIiIy,,\" ies 01 ,e ..I $ 63.00 $
" ",," m"y vb'. . ,"'A tel" Jr.. I
I E-mail: \ ,.J~ ".J!.empp.!!!.r"Jffi'Eif,es(,WO\:ii:l.t.t'S':' t "teralion, relocation
This installation is being made on residential or farm property ~ ~~~'1h'as~~g~ ~~-2344}. $ 63.00 $ I
owned by me or a member of my immediate family. This 201 t.!Ao\!!f,~~(1) $ 87.00 $ I
property is not intended for sale, exchange, lease, or rent OAR I I
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I
I .',,; '.' ,};'C.ONTRAC:T;OR)'.INSTALI:iATION: " I Branch circuits: new, alleralian, exlension per panel 1
I Busmess name'f.\ I' (' ~~.e.l' <Z.. (Q~ r2- _ I I a. Fee for branch circ~its withpurchase'of a se'rvice or feeder fee; I
1 Address p. (j, tad't-- l2.. & l( 1 ,I Each hranch circuit " I $ 6.00 I $ I
1 City: W 4l1-f.,tv: (i..? 1 State: iJvu, '1 ZIP: 0{7l(r2J'f I I b. Fee for branch ci~:uits with?u! purchase of a service or feeder fee: I
I Phone: ':)1.\ { <;'~-'2P1"'IY I Fax: I I First briinch circuit (2) . '! I $ 55.00 $ 5S'1
I E-mail: . I Each1~dditjonal branch Clrcuit-- Of $ 6.00 $ S'( I
I CCB license no.: -pHq 1,- I BC;D license no.: 20;;'2- ~C I MiseellaneousJees: service or feeder nOI.i~f!~,j",r,.:,." I
Signing sup~~ft~;?ense no. 4e- 0 ( ~~ _.um.p:;~:::,ng::::_:I~~PIR;.~ ;~~: II
Print name of signing supervisor: elfiN b4. c!~' !:~:\;\lTT'...",..n'-'~ ~"'l
IS' f" . ).1// n (V~ "iP-/'1 I S'kli!'\'t,/..~,o,,.i;:li,,~~rIt\l:.b~f 0 FIt\D3,~0 $ I
Ignature 0 slgnmg supervIsor: / ~V\; '-V"'i'~'1 alt}\.i\iItTdrI!..N'\W<!e~il1'}lt\t ~Cl.1II0 E iii"',
I ~;~~~~~W!li~~JANIJ,iU'SE~(~:,l;~;:~~~;~:f,~,,~:
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440,2584,) (9/08/COM)
1.~",q:'''''E~;'''ili''f'''''!iw.;''t/FEE1I.!S'C''ED'U' '"E'",\~,ii;"i$"":E~~J18".i",>i-l11
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(A) Enter subtotal of above fees'
(Minimum Permit Fee 558.00) .
.1 (B) Enter 12% surcharge (. i2 x [AD
I (C) Technology Fee (5% nf [AD
I TOTAL rees and surcharges (A through C):
!o 7'
$ n OJ[
$ .slip
$ /17'>$
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CITY OF ~rK11~GFIELD
Building/Combination Permit
PERMIT NO: COM2009-01524
ISSUED: 10/16/2009
APPLIED: 10/16/2009
EXPIRES: 04/28/2010
VALUE: $ 6,000.00
,I >
. Status
Issued:', :
. ~:
225 Fifth Street;,SPr\ngfield, OR.
541-726-3753 Phone,,':)',!: '
541-726-3676 Fax . > .
541-726-3769 Inspection Line
t
'-,
SITE ADDRESS:. 555 MAIN.S'rc'::>' SPRlNGFlETYPE OF WORK: Restaurant
ASSESSOR'S p.(\R~Ei/NO:::';'i70~353111000
~:. )' ,'. . , TYPE OF USE: Alteration
PROJECT DESCRIPTIpN: T.I.: Interior Remodel to Existing Bathroom and Kitchen.
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Commercial
Owner:
Address:
.. . /.!"; . .:~t.
BT OFFICE LLC ,.,. f
7941 EDGEWATERDR ..
EUGENE OR 97401
Contractor Typel; :,'. contractor License
General ,W?'{"'.r h OWNER' . yOU to
, ." ... . U\res .'
Electrical GLEN A CAMPBELIe.,~. (.,.., /:'l ',!?,'N re6regoo311ll~tY
Plumhing OWNER ,I:;.!.'. ,..,cdbVtne "lesetlortl\
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. ,~' _1-~UlUD~N4,,'iNfO~svbV
.!: ,;l" ,,,\ :)o:c"Jv '~- lain cop' ~.. telephOne
# ofUnits: r". 'c. .,~ '; '('-'~O, 'IoU rrff.'b ~ Wi~ote...t~e Notification 1
Primary Occupancy. Group: A'2 ca\\ilig 1\1e1W ~ ~dJ\i\~). '
Secondary ~ccujlancy qroup: number \o~ ~S'l\lbOO:332- ,
. Primary Constructio'n Type ,. VB ce\1W er Type:
Secondary Construction'Type:' ." :~, Range Type:
I ~,
# of Bedrooms: Energy Path:
Sprinkled Building: No
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, C,ONTRACTOR INFORMA TmN .~
Expiration Date Phone
0512412010 541-744-0705
Lot Size:
, Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
'Sq Ft GaragelCarport
Sq Ft Other: 340
Occupant Load:
'" "'~,.~.. ,,-, ,:,-.o:;:'~~""~.
{"; " - ~ . .- ,..
. "l :II;'~ :
Frontyard Seth;i~k: f ' ,
Side 1 Setback: ," I; ".
't~, " I, "
Side 2 Setback:""'"<I,... ..t... .......: :_~' ",~
Rearyard Sethack:
Solar Sethacks: .
I D,,- v "'LV':!""-J' I mr ORMATION ,
REQUIRED PARKING
.
.
Overlay DiS!:
# Street Trees Rqd:
Paved Drive Rqd:
% ~tot Coverage:'. I<
, ~:~l\,JMlT ~"~~~ ~P1~;~~~~ :~~T
I PU~LffiJm~s',' fOR
, -~nrim I II' U '." ,_IL,,,,MDOMED . .
COMMEN\';tU t'I Sidewalk Type:
ANY 180 DAY PERIOD.
. . ,:~ '
Total:
Handicapped:
Compact:
Street Improvements: }:.': ";'~;~!~~' ,
i . :',
Storm Sewer A vailahle: .
Special Instruction:;\ ;.
~~ . j" I .
Downspoutsillrains:
;.,
Notes:
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. Status . Issiiiid' , ,
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.225 Fifth Stre~t;:Springtield,.()~).
541-726-3753 Phone" ." iiF; .,c',,;p.;,,:,,,;,,,
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541-726-3676 Fax. .,. ",.':,.....
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541-726-3769 Inspection Line
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,. Description' " A~:;Ty'pe ilr Construction
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Estimate Estiniat~"" )};, .'( ,
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Fee Description;. \ '.
+ 12% StaieSu'rcha~ge;(;;
+ 5% Technology Fee:-
Bnilding Permit. ,
Fixture
Minimum/Adjustment Plumbing ~.
Plan Review CommlIndlPublic ..; .'ie,
+ 12% State Surc"'arge.~ "", "'\'
+ 5% Technology'Fee . '
Add, Alter, Extend Circ
.. . Add, Alter; Ex{~nd :Cir~.Ea ,~d(.
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Total Amount Paid
Structural Review ;,.' :~~" .r,
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. lo/i.612009
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CITY OF SPRINGFIELD
Building/Combination Permit
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. PERMIT NO: COM2009-01524
ISSUED: 10/16/2009
APPLIED: 10/16/2009
EXPIRES: 04/28/2010
VALUE: $ 6,000.00 .
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
. 6,000.00
Value
Date Calculated
101i6/2009
$6,000.00
$6,000.00
. Total Value of Project
F~n~'
Amount Paid
Date Paid
Receipt Number
1200900000000001158
1200900000000001158
1200900000000001158
1200900000000001158
1200900000000001158
1200900000000001158
1200900000000001199
1200900000000001199
1200900000000001199
1200900000000001199
$18.60
$7.75
." $97.00
$19.00
'c> $39.00
$63.05
$13.08
$5.45
$55.00
$54.00
10116/09
10116/09
10116109
10/16109
10/16109
10/16109
10/28109
10/28109
10/28109
10/28109
.
$371.93 ,
<,)
I Plan Reviews I
10/16/2009 APP
KLK
.. To Reque'st a~ insp~ction 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.', 't~pllirr~ Insnection~
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Framing InsJeciion:
::s i~ .
,
Prio; to cover and after all rough in inspections have been approved.
. Drywall:"Prior tp taping. .
'.. I:'; j';, '., ,', .
Final Building: After all required inspections have been requested and approved and the building is complete. .
Rough PIUluhing: Prior to cover and including required testing.
Final Plnmbing: When all plumhing work is complete.
Rough El~ctric: frior to Cover
Final Ele~triJ; 'When all elecirical work is complete.
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"Status Issued
225 Fifth Street, Springfield, OR .
~:c.
541-726-3753 Phone .... ":,.-c':... ,
541~726~3676 F~~,.. ~~.,~.Jj1':! .,\i~,,:~?_;~~::i,::.}{t~~.~': '-r,
541-726-3769In.spection:Line . ":"'1
t' i: ~. - \ '.
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Owner or Contractors Signature
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01524
ISSUED: 10/16/2009
APPLIED: 10/16/2009
EXPIRES: 04/28/2010
VALUE: $ 6,000.00
Date
.;'
.,-1 '~..
225 Fifth, Street;
Springfield"Oregon-97477-
541-726-3759 Phone '+', . :
.P......'.,,'.:...,
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200900000000001199
Date: 10/28/2009
10:59:23AM
Job/Journal Number ';:;'.. ~.pe.sc'rij)ti()n:;:/;:,i-~.t:\~\~:i~,,:,: :.\;,
COM2009-0 1524~~?:;;~.\Add,'\Alih/- EX1~ndc:ii-c
"'".'','''':'!'''.',''''''' "-,.,.,:.;,
COM2009-0 1524 ji: ;f'Add, Alte'r, Extehd Circ EaAdd
,.' ".!
C0M2009-015?4,."~>',,\;,; 5:!Io Technology Fee.
COM2009-01524: iiP,:,~':t:J[2(o Stat7,,~urcharge
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Payments:
Type of Payment 'Paid By ,
CreditCard ,<::AMPBELL,ELECTRIC.;
. ". ,i~i~I;~;y!;,f:~:::"{\{};~;;i{;?'-' "
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Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
55.00
54.00
5.45
13,08
$127.53
Amount Paid
djb
04771 g In Person
Payment Total:
$127.53
$127.53
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cReceintl Page 1 of 1 1012812009