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Home My WebLink AboutPermit Electrical 2009-12-11 225 Fifth Street. Springfield, OR 9747HPH(54t)726-3753tFAX(S4t)726.3689 li0f:CDERARTMENT'UsE ONLY:::: .,:,,\ ",,.:;.:',";,/':,. '"""';."~;".' ~. :....,,'., . -,' . ",-" ~. .' ',' -<;;', .~" I ~~o'Z.ocr. O.'b'TZ I I Date: (2 - I (- 0 ~ I Electrical Permit Application This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuanee or if work is suspended for 180 days. 1;!"".I;'.~"i~120c::AL::G0VERNMENT,+)l;~PROVAIB~i1:;~~Ii~!!W';:\\I;i,1 lii",(~i!1rli11fi~\i'C1J~'~~;I;:EEffsc::HED,(.JIBEt1\\tts}2Si~iil'{4~~,*1~%.1 ~~;,:~:~~~~~~i~~~i~~~:~:n~~Rur~O:~~:;Ci~:' ,7~ i il';~:~i~~t;!~~?;~:i~~:;~~:~~:;~~::,1:9~~~'I.':;fe1~{.i\il0:~~1~~:,':\ l~t~~.:JOBj1SlJ1E,llN~0RMMfor\llfAN[j1iil!:O:CA"'I()N~}~#4\1'11 1,000 sq ft. or iess (4) $134.00 $ I I I Each additional 500 sq. ft. or portion Job site address: :3>14,':;- ;::::\r,;.,=>1\",_<' 'KJ . . thereof '. $ 25.00 $ I City: .sf" ~"q+:', ~_\^ I State I !") K I ZIP: q, '4 797 I I Limited energy (2) $ 32.00 $ f"~,:i:~:e?~e,:( ~~C~;r;~~'0FcW~~;'~~~~~~'~~ I ~~~~I~:ns~~~~~r~~ ~~~:r (;)oduiar $ 63.00 $ I ~,,~ ~,,,tyio( I I . I ~~,s,or iess (2) $ 81.00 I : ;PR0p,ERTY,OWNER" ,I ilJ9:~19i?9.~ ~L $ 95.00 Name: at ,+-tL\'L 6-1' LIA--1,A,..,.( I ir "Y 8iJfYh~!~;::~~ law.~ $158.00 Address: S CfL()' T~ ~t;(L ,:::"'\) 0 l\b1'/1J,~:oori#~3;ih:;~the (j,Ulre~, "^" _ $205.00 - <i~ . '61ft. 'L :Jc rul 'ego ........ ra. I City: <;?;b IState:oIl-!ZIp:1"X.t7f}'u,11, flMfIj ~B{I."'6t).~e88' SIUti''-:l>469'OO '(.in,. ~~ ./1 c g'?~:;1 !I~ . ')" I Phone: I Fax: _ _ I ~WcM<c'h nl ) (A/~ OPie8 "~9." 10 63.00 $ -6"'0. _ :ee~""...1 -,,,_ '''' -{lv. I E-mail: _Tempo.....Y.t"t:c""""" i;..,.,iJ~1:'ij'if'l.tteration. relocation Th" II' . b ' d 'd' I C 200 amps or less .,~., "". O""-'V~" .,' $ 63,00 $ IS msta atlOn IS emg ma eon res I entia or ,arm property ~. .111....... . owned by me or a member of my immediate family. This I 20] to 400 amps (2) "".I. 111) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR 479,540(1) and 479.560(1). I 40i to 600 amps (2) $126.00 I $ Signature: ,lOver 600 amps or 1,000 volts, see services or feeders section above I .:' ;'- ' ':~':GONTRACl:OR:'INSTAl:.IiATIOW.." :1 I Branch circuits: new. alteration, extensioiiper panel I Business name:r:P_'\1""..r',~\~ et: ~, ~(k){.-~1..;; ( ~,tt,.\.~~r.:P I. I a. Fee for branch circuits with purchase. of aservice or feeder fee: I Address: $'S4&.'-/1-J. I "'Ira, .0 Ii" J'{ .' , I Each branch circuit I I $ 6.00 I $ I City: ~ I"'" _ i State: ~ I ZIP: Q7f1f!!.l'e:1 b, Fee Cor branch circuits without purchase of a service or feeder Cee: I Phone~~_7<,,11 I Fax: AI,'~ci ptR~.Jirstbranchcircuit(2) I $ 55.00 $ 55 I E-mail: cri~~~.UR ~i. ] ~i~nai branchcircui,t. .? $ 6,00 $ I Z I I CCB license no,: /lq7 ~ I BCD license no,: h4IcJ19V 'E ~{VlflF/f!ott/;jaefP'rJr feeder not included I I Signing supervisor's license no.: . '-1/17...5.. '~4} Pt.~f,l1l)ljr,t1J R,l'alii ,:~t-JfOR/( $ 63,00 $ I I Print name of signing supervisor: ;) ..J. <;. /) J Eac!{f"f(jb or out I ,itH1JNOr $ 63.00 . $ I "''\/,.,~ (n<<) A::lVl :OJ} I Signature of signing supervisor:ti" p I iJ J d j _ . 1 I SIgna] Circuit or a limIted-energy panel, $ 63.00 $ I .tJ I~~ alteratIOn, or extensIOn (2) . ~-; Each add,tionalmspectinn: (I) J $58.00 $ ~~~~Q '\~~~~~~~~~~e:~:.~~N~':USE,~tB.4~jl*?:~qi!~; ~ rv~' ,I (B)EnterI2%surcharge(.12x[A]) $ 8<'_" . \' I (C) Technology Fee (5% of[A]) $ :5 r J" I TOTAL fees and sureharges (A through C): $ 7,~ ~ , Services or feeders: installation, alteration, relocation, $ $ $ $ $ \~ rJ' W~~~ ~~~ ~ 440.2584.J (9/08/COM) CITY OF SPRINGFIELD Building/COinbination Permit PERMIT NO: COM2009-01692 ISSUED: 12/11/2009 APPLIED: 11/24/2009 EXPIRES: 06/11/2010 VALUE: . . . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3945 JASPER RD ASSESSOR'S PARCEL NO.: 1802061410600 Springfield TYPE OF WORK: Bathroom PROJECT DESCRIPTION: Install shower diverter and vent fan TYPE OF USE: Remodel Residential Owner: GILMAN MARK R & AMY E Address: 3945 JASPER RD SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type General Electrical Plnmbing Contractor ulres you t~icense JOHNAtmL~rPregon law r:~regon Utill~8372 RICH~~~~~%V~les are setlorth CHAf'JI:I(im't1~iR~~~A~nuOh OAR 952.()\J.1~94 ~O~;ny~ m~' ~mD'tr<<i~ caliing the ct.ri{41. \1, 11!~tili NotificatiOn number lor the Orp~f~t .~. . R-3 Center I8lt\!1!!f 0 tructnre Type of Heat: Wafer Type: Range Type:"."'........:..-.;~:, ' Energy Path: Sprinkled Building: # of Units: Primary Occupancy Group: Secondary Occnpancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB I DE~ELOPMENT I~FORMHION.I Phone Number: 541-852-1335 Expiration Date 11/04/20 II Phone 541-607-8649 541-485- 7311 541-485-1146 05/06/20] 0 n/a Lot Size: Sq Ff 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Overlay Di~t: ',_, "., -. ~",;,~''iJ'i;jyt:::~ENii~~;,~~):i:i'> '.... Total: Nel(~e:Tre~;R(id;" ... 'F'THEWOR1< 'Handicapped: Tt!I'1lvvtJ~rJNl~LL EXPIRE 1 IS NOT 'Compact: At5"~b'f{Wf(l'1J'l~&1:R THIS PERMIT . r.n~~MENCED OR IS ABANDONED FOR '. I ~~R4\ln IMPRffi)'~MEM1S'1 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee ] 01'3 . Sidewalk Type: Downspouts/Drains: CITY OF SPRINGFIELD Building/Combination Permit 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2009-01692 ISSUED: 12/11/2009 APPLIED: 11/24/2009 EXPIRES: 06111/2010 VALUE: Status Issued I ':'~Iua~i?~ o.es~r.iDtion I Oescrintion Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Fffr~ Pqir] , Fee Description + 12% State Surcharge + 5% Technology Fee 1st Appliance Fixture Minimum/Adjustment Plumbing + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $]6.44 $6.85 $79.00 $19.00 $39.00 $8.04 $3.35 $55.00 $12.00 11/24/09 11/24/09 ] 1/24/09 11/24/09 ] 1/24/09 12111/09 12/11109 12/11/09 12/11/09 Total Amount Paid $238.68 Plan Reviews , Value Date Calculated Receipf Number 3200900000000000771 320090000000000077] 320090000000000077] 320090000000000077] 3200900000000000771 2200900000000001376 2200900000000001376 220090000000000]376 2200900000000001376 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. '" Rrl~.~lliplrl, I nsnections I Rough Plumbing: Prior to cover and including reqnired testing. Final Plumbing: When all plumbing work is complete. Rongh Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rongh Electric: Prior to Cover Final Electric: When all electrical work is c'o'mplete. Paee.2 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01692 ISSUED: 12/11/2009 APPLIED: 11/24/2009 EXPIRES: 06/II/2010 VALUE: 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 fhat NO OCCUPANCY will be made of any strncfnre without permission of the Community Services Division, Building Safety. I further certify that only contractors and employecs who arc in compliance with ORS 701.005 will be used on this project. I fnrther 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. Owner or Contractors Signature Date ',J. Page 3 of 3 225. Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/JournaJ Number COM2009-0 1692 COM2009-0 1692 COM2009-0 1692 COM2009-0 1692 Payments: Type of Payment CreditCard cReceintl RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department' 2200900000000001376 Date: 12/11/2009 2:14:18PM Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 55,00 12,00 3,35 8,04 $78.39 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge Paid By RICHARD GROSHONG Amount Paid djb $78.39 $78.39 424326 In Person Payment Total: i{)o .,j. Page 1 of I 12111/2009