HomeMy WebLinkAboutPermit Electrical 2009-11-3
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City Of Sp,ringfie,ld ,',
225 Fifth 5t ,~:'?':SG~:'i:'
t<) ~pringfield:' O~. ?f!.~77:'
f:;:;,'8," Phone:'541-728-375J
r't~; Email: permilcenter@cLspringfield..or.us
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Commercial Electrical Authorization To Begin Work
69600-BEL-09-00222
App,oval Code: 11302~ 11/3/2009 9:38 am
E-mailedTo:johnr@builderselectric.com
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I 0 New Construction ' ,';','; ~;:"' IRl Addition/alteration/replacement
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I 0 1 or 2 family dwelling D Multi-family [&] ~omme.rcial 0 Accessory
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.1 City/StateJZ!P: SP.RIN~FIELD; OR 97477
I Suite-'bldgJapl~o;:' ., ,
I Project Name: Riverstone Clinic
I Cm.. S"eetJdlroetions to job site:
D Hazardous locations
o A serVice or feeder rated at
600 amps or more
i 0 Buildi~9S more than three stor
'0 :,
, Marinas and boal yards
o Floati~g buildings
o Commercial-use agricultural
buildings
o Installation of a 150 KVA or
larger:seperately derived sys
,:,0 "A", "E", or "1-2" or "1-3"
o Recre'ational Vehicle Parks
,,0 Supply voltage for more than
600 s~PPlY volts nominal
Please check aU that apply:
o A service or feeder beginning
at 400 Amps where the
available fault current exceeds
10,000 Amps at 150 Volts or
less to ground exceeds
14,000 Amps for all other
o Fire pumps
o Emergency syslems
o Addition of a new motor load
of 100 HP or more
o Six or more residential units in
one structure
o Health care facilities
:.:
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1703254201100
Tax map/parcel no.:
I Description
Temp service for job trailer.
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I Temp services 200 amps or less
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$63,00 I
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I Subtotal
I State surcharge (12% of permil
total)
I TeChnology fee (5% of permit lolal)
1 TOTAL PERMIT FEE
$63,00 I
$7.561
$3,15 I
$73.71 I
I Name: Russ Crane
I Phone: 541-485-0922
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Email:
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I Elec lie. no.: 20-12C ~~ .J; ceB lie. no.: 4296
I Business Name: BUILDERS ELECTRIC 'INC ~~, -
I Contact:
Address: 195 MADISON ST
Clty/StatelZJP: EUGE~H1tIG.lii~ " ,
I Phone: 5414850922 'I HI~ t'tHMII :;H~kI,;J;..W.lill: I~ In, WUflI\
;:'J"flICF.IZ:L~ UfJUEF; rHI:! ;:ERMf1'1B NO";'
Emall: FRED@BUlLq~~nl',tli',T~~~'0~ GR IS ,^.B,'\~J,]~W[~ fRA
Mo"o lie, no,: ' ANy' 180 DAY Pfpti'fl'lt no,:
I Supervising Electrician's lic. no.: 5275S ~ I,
I Supervisin,9 Electrician's Name: RUSSELL R ROBBIN~
ATTENTION: Oregon law. requIres you to
follow rules adopted by the Oregon Utility
Notification Center. Thos~ rules are set forth
In OAR 952-001-0010 through OAR 952-001-
0090, You may obtain copies of the rules bV
calling the center. (Note: the telephone
number for the Oregon Utility Notification
,Center is 1-800-332-2344).
Number of inspections included in paid services:..
Residential Service:'" fl :...t. .
Reconnect Only: -~. . ;1 ' ~,~ ',I "
AU Other Services: t "2:'
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The local buildIng department may determine that an Authorization To Begin Work Is null and '\ '\ .~.. ~ ~Q/
void If It does not meet applicable land use laws and~'~~~I,?rcIlnances.) \ ~ I "-b \
',::' ;;,',J;:" ",,;~':~~ InspectionB Phone: 541-726-3769 ~s
1 This Authorization To Begin Work must be posted at the job site until replaced by a Permit
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Upon review and approval by y~ur local jurisdiction, your permit will be e-malled or faxed
within one buslnen day, with Instructlons,on how to _I-Chedule your Inspection.
NOTE: This Authorlzatlon To Begin Work expires within 180 daya If a permit Is not obtained,
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CITY OF SPRINGFIELD
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Building/Combination Permit
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Status Issued.': );',' :'{..;ii;i'~'" "
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225 Fifth Street;Sprlngfleld, OR '.'
541-726-3753 Phone' ,
541-726-3676 Fax,:"i
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541-726-3769Inspec'tion Line".
PERMIT NO: COM20,09-01605
ISSUED: 1110312009
APPLIED: 1110312009
EXPIRES: 05/03/2010
VALUE:
SITE ADDRESS: 2073 OLYMPIC ST ',' " Springfield TYPE OF WORK: Use Initials
ASSESSOR'S PARCEL,NO.;;,!70}254201100
L' ,,:.J': : "::'.;',""1::;;::'" TYPE OF USE: New
PROJECT DESCRIPTION:' TeriIp service for job trailer
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Commercial
Owner:
Address:
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LANE COUNTY.'.?>"
125 E 8TH AVE '. .:f;e :;\
EUGENE OR 97401
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Contractor T~pel: ',-; Contractor
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Electrical ',1' \ BUILDERS ELECTRIC INC
I CONTRACTO~ INFORMA TION I
License
4296
,
Expiration Date
12/10/2011
Phone
541-485-0922
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BUILDING INFORMATION'
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type'
Secondary Construction Type:
, ,
# of Bedrooms:", ' ,',
!. .i:: :.
\f;j' ,;+ ,.;.
of .~
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft J'st Floor:
, ~
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
,.
I DEVELOPMENT INFORMATION'
c
REQUIRED PARKING
,
Frontyard Setback: Overlay Dist: Total: "
Side 1 Setback:NOIlCC, " :,:' # Street Trees Rqd: ' ,Haudicapped:
Side 2 Setback:~iJl' ~ ...~,', ", Paved Drive Rqd: ATTENTION: Oregor1<!%'r\\/i~€/!Ires you to
Rearyard Setback:S, PERMIT SHALL EXPIRE.JF TNEoWQ!Rll:overage: follow rules adopted by the, Oregon Utility
Solar Setbacks: }THOR,IZED UNDER THIS PERMIT IS NOT Notification Center. Those rules are set forth
".,"'~~:::~: 31 X3 ,\:,\!I~f.r;;T. f':V, tn QfR.~fi2.001-0019throuQh OAR 952-001-
"NY i 80 DAY PERIOD PUBLIC IMPROVEMENTS.o090,. You may obtain caples of the rules by
, ' ' ,I calling the center. (Note: the telephone
Street Improvements:, nunSidf\!Gdlt~jilregon Utility Notification
Storm Sewer Available: ~, .... u,.,' Do'*'~~teJt~ful;flg~:332-2344).
Special Instruction: , '''' ,;'" .. "
Notes: '
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I V aluation Des~ri9tion I
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$ Per Sq Ft
, ,) or 'multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Description
Type of Construction
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Pa!!e 1 of2
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, Status.1; Isgti~d'(:k:::",';h'
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225 Fifth Street, Springfield, OR}'
541-726-3753 Phone'
541-726-3676 Fax
541-726-3769 Inspectio~, Lin~,
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Fee Description
+ 12% State Surcharge}...
+ 5% Technology Fee ,<,
Temp Power 200 amps or less
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Total" Amou;;t Paid
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Amount Paid
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$7,56
$3.15
$63,00
$73,71
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Total Value of Project
Fees P,aid I
1111 I ',1
Date Paid
Plan Reviews I
11/3109
11/3/09
1113/09
CITY OF SPRINGFIELD
Building/Combi~ation Permit
PERMIT NO:. COM20.09-01605
ISSUED: 11/0312009
APPLIED: 1;1/03/2009
EXPIRES: 05/03/2010
VALUE:
Receipt Number
2200900000000001250
2200900000000001250
2200900000000001250
. I 1
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. wilfbe made the following
work day. ' ,,/,!; ",~ ."j, '" , ' , '
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,Re'1,Jired r nsp,ections I
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Temporary Electric: Apl1rofal required prior to Utility Company energizing pole.
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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 correct, and I furtber certify that any and all work performed shall be done in accordance with
the Ordinances of tbe 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 Divi~ion, 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 tbe permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during co~str~,cti~n. ,,':;...: -i::~ -~~...' '
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Owner or Contractors Signature" ;
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Paee 2 of 2
Date
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~25 Fifth Street;:::,,</), "':;1/\1~"f:'
Springfield,Oregol(,9?4?7;;"/,:"'\" '
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;;41-726-3759'Ph~ne
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City of Springfield Official Receipt
Development Seniices Department
Public Works Department
RECEIPT:#: ,2200900000000001250
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Date: 11103/2009
Job/Journal Number D~scription
COM2009-0 1605 .Temp Power.2QO amps or less
C0M2009-0 1605 <,;, ,,+ 5% TechnoiogyFee ' '
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C0M2009-01605" ,:,;",., ';:+"12%'Stiite'Sui'ch3rge
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Pa,yme~ts:" ~'..,:,.,.,.~?: ~" \,'. '~i;",,\
Type of Payment.; "!i'a.d:,BYiii',,
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ONLINE CHGS ONLINE PEJWIJ. CJIGS
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cReceint 1
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Item Total:
Check Number Authorization
Received By Batch Number Number How Received
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ONLINE BUILDERS Online
ELECT
Paym~nt Total:
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Page I of I
9:45:4IAM
Amount Due
63,00
3,15
7,56
$73.71
Amount Paid
$73,71
$73.71
11/312009