HomeMy WebLinkAboutPermit Electrical 2009-11-13
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,Electrical Permit Application
225 Fiftl1 Street.Spriog6eld. OR 97477.PH(54I)726-3753>FAX(54I)726_3689
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This pennit 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~~U:oCAl!!GoYERNMEN;r:fA~eR()YA~.~~~i 1.~~'T~~F.EEI1SCaEDtJl!'E1l!~~]!J1
I Zoningapproval verified? DYes D No I I~J~~=~~~IQml~g.ea"~~llr.c-oos)iit~
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1~\fJOBi\SI1:EfINF.ORMATIONWAIIlD~trocA;rION~~1 1,000 sq. 1\, or less (4) $134.00 $
I J b. dd 0<1{, II. I n \ ,. -, "-1,1/.[ Each additional 500 sq. 1\, or portion $ 25,00 $
o site a ress: O~ 'D l1'IM'itJ4) #<DI\lJ Ii).. ',-, "'. . (thereof
Icity: f:Pw'~C.:'/,J I State:oY _ 1~~;m7:?';..:I;I,I:L,;w\(b':'W,r~(2) $ 32,00 I $
, I Reference: 170~_7-:"7-0 ~ I_T'V!J9ff'~?~nr.E~c.hrnatwfacmse9..homeormoduiar I $ 63.00 I $
I"''''',''' '''''-, "''''''''''''''', ',' DES',CRl.......ON "OF.'.'WORKd."'..,, -'l'''', ,,,~~,,' ~,rdwell lUg se<Vlce bt-r"'der (2)
iili.JU!~~' . r.,1;t' ::.'....at,' '~A."?k~-ite-~.', .'..:i.~~.......,"ul':..C',...,..;',";,
, I 1\6& J JJ ~c... L.... (\~ T"&~rth,,':~ .'G ~jl~~~~-I'r~!",Cj'JSihlta{i8n. alteration,relocation
, "'9rl.: Vr~ i'I\9 llIlI\?6 0 e/1:flly 1 $ 81.00 $
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I City: SOn'~~~/J I State,o.,.. I ZIP: '17'177 I I Over 1.000 lUllpS or volts (2) I $469.00 $
'I Phone:SY.L-7n-/y".t I Fax, I I Reconnectoniy(2) I 1 $ 63,00 1 $
I E-mail: I I Temporary senrices or .feeders; installation, alteration, relocation
This installation is being made on residential or farm property 1 200 lUllpS or less (2) I $ 63.00 ,$
owned b~ me or a member of my immediate family. This 1 201 to 400 lUllpS (2) I $ 87.00 $ 1
property IS not mtended for sale, exc~ lease, or rent. OAR
479.540(1) and 479.560(1). ,:~I::Tl'ft:~. I 401 to 600 lUllpS (2) I $126.00 1 $ I
S,i~nature: , " ," ~/ ~:S P€,,, ~, _ lOver 600 amps or 1,000 volts, see services or [eeders section above !
~'(CON7J"AAC.;rOR~I~1~~~1 1 Branch circuits: new, alteration, extension per panel , I
I Business name: ~o ~/'I1h. ~ ttll. 1,l.1: Fee for branch circuits with purchase ofaservice or feeder fee: I
1 Address: Po &;.~/9t)lfIo /)A Ot) I? "J-" Z ,Eacb"branchcircuit I I $ 6,00 I $ I
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City: ~(J<;tE~ State: 0" ' c-~.P..Y ~ ' vt'l'fJ:' fo~ branch CircUIts Without purchase ofa service or teeder fee: I
I Phon,e:5YI-7Wr/'/7/ 1 Fax:5W- V C? 'r;:'~Qtf'ircuit(2) I' I $ 55.001 $$a:lJ
I E-mail: rt:lb ~ c.u..,.~__K..I..,""c..","", ~I~~onal branch circuit $ 6.00 $ I
I CCBlicenseno.:/W877, I BCD license no.: (.:i/ 1 1 Miscellaneous fees: serviceorjeedernotincluded I
. 'I Signing supervisor's license no.: 301.3 5 I 'Each pump or irrigation circie (2) I I $ 63.00 $ I
I Print name of signing supervisor: 0...,..,. n:.e.ye.s~ I I Each sign or outline lighting (2) $ 63.00 $ I
I Signature of signing supervisor" ~ ~ '-:..-.-r__ j I Signal"circuitoral~ited-energypanel, I I $ 63.00 $ [
" .....-...- a1teralIon, or extensIOn (2)
I Each additioual inspectioo: (I) I I $58.00 I $
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I(A) Enter subtotal ofabovefees f '" I
(Minimum Permit Fee $S8.00) , $ S~-
j(B)EntcrI2%surcharge(.12x[A]) I $ "'9''' I
I (C) Technology Fee (5% of[A]) I $ ;lAO 1
I TOTAL fees and surcharges (A through C): I $ '7,g" I
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440-2584-J (9/08/COM)
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Status
Issued '
225 Fifth Street, Springfield, OR , '0 ;,
541,726-3753 Phone' , ' , ,', ';':r';!;":", '
, 5,41'726-3676 }1a~,\hi;i;l!it~:~~t;j!:t;~i;!h2"
541'726-3769 IrispecliorlLine" :;:"'i
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, SiTE ADDRESS;;;"'~"886 HARt OW RD
ASSESSOR'S PARCEL NO.:';;"1'70:hioo02206
CITY OF SrK11~'-'HELD
Building/Combination Permit
PERMIT NO: COM2009-01650
. ISSUED: 11113/2009
APPLIED: 11/13/2009
EXPIRES: 05/1312010
VALUE: .
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
. PROJECT DESCRIPTION:, . A~,~,\branCh, circuit
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Owner:
, Address:
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: CLOVERDALELLCit. ",
84Q:BEL'fLINE RD STE 202
SPRIN~FI~LD OR 97477
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I CONTRACTOR INFORMATION'
License
164877
Expiration Date
06/09/2011
Phone
541-746-1471
Contractor Type
Electrical
, Contractor
: CAMP CREEK ELECTRIC LLC
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# of Units: I \;'!.~,.'~ ".
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Primary Occuplincy'Group:,..
Secondary Occupancy Group: ,_ .
Pri'11ary Construction Type
Seco'ndary Construction Type:
# of Bedrooms:
. R2
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Frontyard Setback: ,......"., . ""'; ~~'~,
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Side:l Setback: " .
Side',2 Setback:
Rearyard Sethack: . ""
Solar Sethacks: . , ':nr ,',,, '
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Street Improvenient~: ;. ,
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Storm Sewer Available:'~ ,";-,:,,-~:~
Special Instruction: ;!fo
Notes:
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De~criPtio~'-'", '~r' :rke ~f Const;uction
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I Bl!l]J~lNG.,INFORMA TI~N I
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If] O#'oft~l:J!ri{l~(fO/J gOf] faW Lot Size:
00901lI~,i@I.!>-~t~~bYth;eqlllre8 Sq Ft 1st Floor:
cq//fjP& iatrol0 nosel'tJ OregO Yo~ Ft 2nd Floor:
lI/Jtn6W/'J#!e ~btal. fhro/J9h'e'lIre II Uti!. Ft Basement:
" ltaJi>>et, r. ~ CoP/es O/Vi s/;;U. Ft Garage/Carport
, ~llr. &!1~Ofe; 1fJ O( the f/J!. '00 q Ft Other:
Sprinkf/U 8'8 tl"~y ~!e(~ B8 bpO~cupant Load:
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I.nEVELOPME~.:.,INFORJVi~N -rc-
REQUIRED PARKING
, Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Total: '
Handicapped:
, Compact:
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~~'~PROVEMENTSI,
~UT-;/'f:RM" SHAll "',"""Side>yalk Type: ,
COMM~~fD UNDER ~RE 'FTII~S/Drairis:
ANy 180DJ~pDFf IS A8AN:'~rr.NOr
'ERIOD IV"" 1011
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I Valuation Descri\'t'on I
I 1111
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
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Page I of2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01650
ISSUED: 11/13/2009
APPLIED: 11/13/2009
EXPIRES: 05/13/2010
VALUE:
Status ISS;~~.d'(;';',;'i<i< ..'~,~t~;\!,."
225 Fifth Streeti,Sp,t\ngfield{OKc, 't'
541-726-3753 Phone;' ;, : '
541-726-3676 Fax'" "
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'541-726-3769 hi~pecJio~,Lin:e.:: "!"..).
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Total Value of Project
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Fees Paid I
Amount Paid
Date Paid
$6.96
$2.90
$55.00
,> $3.00
11/13/09
11/13/09
11/13/09
11/13/09
Receipt Number
2200900000000001288
2200900000000001288
2200900000000001288
2200900000000001288
$67.86
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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
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work day. .~~.....~:.'W~'..,- 'L~ ''',o.Il---;'\;!"'' ,-
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Rough ElectrIc: Prior to Cover
Final Electric: When all electrical work is complete,
I Reouired Insnections I
By ~ignature, I state;an~.agree, that:I have carefully examined the completed application and do hereby certify that all
information hereon js'triie and correct, and I furthcr certify that any and all work performed shall be done in accordance with
the Ordinances'of th'e City of Springfield and the Laws 01' the Statc of Oregon pertainiug 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'ihat'oniy contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I fu-:ther 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 plans will remain on the site at all
times during construction.
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Owner or Contractors Signature
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Date
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225 Fifth Street:i;,'i"'l' 'h ,'; " '.'., ,
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Sp'rillgti!!/(I,pr~g9~n'i9,.74n "", ,
54 i~726~:j759P~8,~~~{i;;W!~';}(i~~;(;t~~;i':: ".;,
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RECEI}>T #::' 2200900000000001288
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Job/Journal Number,:;"',' ",D,e~cflphO~" :'>:~',i.;.";",::"";''':'~ '. .-:.,
COM2009-0 1650,; ;i;i,;;;;rAdd:<,,-it~i;; E'Jti~fid'ci~~
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COM2009-0 1650, ilidS/Miiiimum! Adjustment Electrical
C0M2009-01650 ',i'd:::i+ 5% Technology Fee
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COM2009-0 16,50 ';;;ft;;'jE::,ttAf'Yi,~f~f~,;,~.'!f,chirrge
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Payments:
Type of Payment
CreditCard
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CAM~CREEKE,LEQTRIC;,,,
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Page I of I
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 11/13/2009
Item Total:
Authorization
Number How Received
599845 In Person
Payment Total:
1:20:08PM
Amount Due
55,00
3,00
2.90
6.96
$67.86
Amount Paid
, $67,86
$67.86
11/13/2009