HomeMy WebLinkAboutPermit Electrical 2009-12-18
225 Fifth Street. Springfield, OR 97477. PH(541)726-375H FAX(541)726-3689
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Electrje,al 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 issuance or if work is suspended for 180 days.
1-' " '.' : LOCAL: GOIIER/IIME/IIT' AF:'F'.ROVAU'~i':'i'j:"I' 1,";':'i!H,A{':1\<13;;~?\':'!i~!:!:(SOHEbl.JuJE~:'H!2,ii,1\\?,}'!(,"i'i"%,Ji'i~~m
~ g pp D D No I,Num..b,fr;'firsp~~iio~i.p~r.it~~(;lQiy.I" ,~~~~,'I~~WI
1::::si:e~;~~~~~~i~~~~~~~~:n~~RUr~O;:~merci~l':i I Residential, per unit, service included: I
1il!%~mrfl?;(bB.j;SIJiE';INfQRMA;r;lbllll"A/IIJj}iLj!()CA."tION..~!.iK",f,:1 11,000 sq. ft. or less (4) $134.00 $ I
I JOb~' addn:ss. \ -:\.'\ ~0JvG,_ . I I ~:e~~:ritional 500 sq ft or portion $ 25.00 $
I City. K\\ 'il..X\~tate:U'f---1 ZI~\'\--r-hl I Limited energy (2) $ 32.00 $
I Reference. n~:~~~~OFWJ;~xl~tC.~)T~i I ~~~~I~:"s~~~~~~~fe~~:r(~)odular $ 63.00 $
'j) -'-- I I Services-or feeders: installation, alteration, relocation
r-e.Pa,'v 5;;',-- ./l'c.-e., A4J T -
( \ f\r~u\JZ-- '\4-'1- "\ I I 200 amps or less (2) $ 81.00 $
I -PROPERTY OWNE~ I I 20t to 400 amps (2) $95.00 $
'f:;t Name: _').\ \\"; '?(}~\l M"'.)\-t I 1 401 to 600 amps (2) $158.00 $
Address:~.6.: ~~ --,~ _ I I 601 to 1,000 amps (2) $205.00 $
City: ~c;L- 1 State: 0\'--1 ZIP: \J( f\ Tl[ lOver 1,000 amps or volts (2) $469.00 $
I Phone: _ _ . I Fax: -. _ I I Reconnect only (2) I $ 63.00 $ 6; ~'I
. I E-mail: I I Temporary services or feeders: installation. alteration, relocation
This installation is being made on residential or fann property I 200 amps or less (2) I $ 63.00 $
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent OAR
479.540(1) and 479.560(1). 1 40t to 600 amps (2) I $126.00 $
Signature: lOver 600 amps or 1,000 yoJts, see services or feeders section above
I :CONTRACrOR INST ALLATIONI I Branch circuits: new, al'era,j~n. ex!~~~ioi!'.er pane:!..
I Business name: Aut- r /~ c.-f-,.; L. .:i:.... I a. Fee for branch circuits with purchase of a service pf feeder. fee:
I Address: )"/70 f1) 2$ -n., )-1. I Each branch circuit 1 I $16.00 I $ I
I City: f/.".k/,~II I State: DI2 I ZIP: 7-7</771 I bFeeforbran:hCjrCurnO~r.o/llJ'~'Wf~1W.~ee I .
I Phone:JfiI -ly7- 2-l..I) I FaxS/I -7ii.- 0 ~ L '1 I I First brancror~I'iW'\1.lll!!\ adopted PYtll"C!i1r~~=~~:rb
I E-mail: I I Each addjt~fioll!ilillli~ter. 1 OS8 \ ~bAA~ 2$001- .
I CCB license no.:", L- (1 L I BCD license no.: 20 _ 5s<:.1 I MisceltaneoJl1i9.'1. , tfmPie:stoftherulesDY I
I V,. /IN t9 R I~:;n
I Signing supervisor's license no.:. .<)D j, i. 5 I Each pump or i_I\,-~Jrt~r.,..o ." .
I printnameOfSlgningSUpervisor'~~~ C Jlf'f/eJ,e71 1 EaChSignOroull~i~:'~~" ~" . $
I Signature of signing supervisor:~ ..{ ~,_ n /~ P--=-I I Signal circuit or a limitePenergy panel, $ 63.00 $
/ V ?'::::~/.J..D/ _' alteration. or extension (2)
~~D\ ~~, ~!~~~~;;7"@Of:.i~:;~;~~J;
\\: ~<:y NOTIC:~M\T S\1f\.LL EXPIRE If T~{ ~~~~ .1 (B) Enter 12% surcharge (.12 x [AD $-1 .~\W
~ THIS ~R\ZED UNDER THIS PERM FOR. .1 (C) Technology Fee (5% of [AD $ <~_ ~.V')
\S- ~~~MENCED OR IS f\.BANDONED. I TOTAL fees and surcharges (A through C): $l-J ~ II
ANY 180 Df\.Y!ER\OD. .: j\ "i'\ ~(\o,.t\.k" '^~
440-2584-) (9108/C04{\:1'0W ~ ~~ \.'J\,^ ,~,
~~t)tI ~ O\0MJ \J\O-.. \~~\\J,\
Status
Iss u ed
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01811
ISSUED: 12/16/2009 I
APPLIED: 12/1812009
EXPIRES: 06/1612010
VALUE:
225 Fifth Stl'eet,:Spri,iglield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 444 MAIN ST
ASSESSOR'S PARCEL NO.: 1703353107700
Springfield TYPE OF WORK: Electricat Work Onty
TYPE OF USE: Repair
Commercial
PROJECT DESCRIPTION: Repair Service Mast
Owner: DUGGERJACKL ). .<.M.""~"(\(\RXCL~ "'~\\t'\.
Address: 420MAIN ST 0\ ,VVJ V' . ~V
SPRINGFIELD OR 97477
I CONTRACTO~INFORMATlON I
Contractor Type
Electrical
Contractor
ALERT ELECTRIC INC
License
12772
Expiration Date
OS/22/2011
Phone
541-747-2213
BUILDING INFORMATION'
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Eifergy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
I
Compact: I
I
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
. DownspoutslDrains:
Notes:
I V aluation De~criDtion ,
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
CITY OF SPRINGFIELD
Building/Combinati.on Permit
Status
Issued
,
PERMIT NO: COM2009-01811
ISSUED: 12/16/2009
APPLIED: 12/1812009
EXPIRES: 06/16/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect.
Amount Paid' ,
Date Paid
Receipt Number
$7.56
$3.15
$63.00
12/18/09
12118/09
12/18/09
2200900000000001405
2200900000000001405
2200900000000001405
Total Amount Paid
$73.71
I Plan Reviews I
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 Re(llJir~\1 Insnections'
Electric Service: Approval required prior to utility company energizing service.
By signaturc, 1 state and agree, that I have carefulty examined Ihe completed application and do hereby certify that alt
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 Cily of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY wilt be made of any structnre without permission of the Community Services Division, Bnilding Safety.
1 further certify'that onty contractors and employees who are.in compliance with ORS 701.005 will he nsed on this project.
1 fnrther agree to ensure that alt required inspections are reqnested at the proper time, that each address is readable from the
street, thaI 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 co~struction.
Owner or Contractors Signature
Date
Paee 20f2
225 Fifth Street
Sprin"gfiefd,'Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1811
COM2009-0 181 t
COM2009-0 1811
Payments:
Type of Payment
CreditCard
cKcceintl
RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
GREG HATLEGERG
'i;f~i
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001405
Date: 12/18/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
lIh
18489
18489 In Person
Payment Total:
Page I of 1
2:38:40PM
Amount Due
63.00
3.15
7.56
$73.71
Amount Paid
$73.71
$73.71
12118/2009