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Home My WebLink AboutPermit Electrical 2009-4-17 E.lectl'ical Permit Application 1~~DE'MRTMENTh~sEI0~y!~~l '/';""i'"_,.fr"';'~1-'~';'-~~'i",_"".-;j):'~;~3iiji":;;~0;8,;:;k,:y~,,,,.-=~.. I P~~~~o ';- OOf4 Z I Date: c.(-( 7 - 0 ~ 225 Fifth Street+Springfield, OR 97477.PH(541)726~J753.FAX(541)726-3689 This permit is issued under OAR 918"309"0000, Permits are nontransferable. Permits expire if work is riot started within 180 days of issuance or if work is suspended for 180 days. I~Jh~[0:C:;:~1!IG:QME:BNME;Nif,f~P.R~b)/~I.~~ le~~~'~~=~"i~~ I,."'""",.,"",,"",",",,",,, 1~"'1I0Bl!SlmEjJINJ;;QRIIIIJ\mllD.NTANElJl!Q~~~mIQNil~J~~ 11,000 sq. ft. or less (4) I $134,00 $ I Job site address: Z bSb o Ly'Jttt'<,f1 L I I ~~~~oa~ditionaI500 sq, ft, or portion I $ 25,00 $ I City: 'S P ~~ I State: oIL I ZIP: 97'177 I I Limited energy (2) I / $ 32.00 II~o'~~~1-D" ~(!Dt77E~1,;~.~~y' Wb(,I~~~,~':'~r'= I ~~~71~:ns~~~~:~~ re~~:r '(;)'odular I $ 63.00 $ \.- "v \J , ~II ~ "", ,. U lYe I Services or feeders: installation, alteration, relocation I I 200 amps or less (2) $ 81.00 $ ~~1!lI~~IJJf!ji!RR0P.E:Bmifdl.0WNE~~~l?~~~~1li*~jJJ I 201 to 400 amps (2) $ 95.00 $ I Name: ~ m 0 v1 , L.l:" >Tn I 401 to 600 amps (2) $158.00 $ I Address: /., 2. ( s 1.,/ ytr ))~Q~':,~f.~)r~?o~' :,h~<i!J!\lM2!WM'iI'tR) $205,00 $ I City: 7or-4-1A.- ~ I State:' <<><1iotitlcZIP.:~~(~ uj ICHi5A~oQe)iilriPsiiitl"olts (2) $469.00 $ . _ . 0.. '" ,un::;ov ell e S~f l-)1nn I Phone: I Fax: 10 YAI:! 952-001'0010 Ilr,,&rfioPHr8 si,:l); 't'A< . $ 63.00 $ I E-mail: nI'12~j' \"'::;~h"r'o.y v;.Jlctill l,;o~mlJ1Pbt.~ril~rcYlc~wr feeders: installation, alteration, relocation , , ", ., ~ In~~ e ~RntA' (' Ju "i001ilnlps TlI ~ ThIs mstallatlOn IS bemg made onreslde~tI1iILo'flfannfprdpertY.>reg( n _"'~:!" t:,:,:ft: ess(i2) owned bJ: me or a member of my ImmedIate famll)ClIilws.lr is 1-80 J< ,,@.lflO4'4lP .;np~Y:!j property IS not llltended for sale, exchange, lease, or rent OAR I u. 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 '~C:0N!f;UG;l1.~~l'!INSjl1J\I!I!A"'IOIiI~~~\!1Jli!.lt~~1 I Branch circuits: new. alleralion, exlension per panel Business name: t:" / J' j (, r: J t:c."A I G I (a. Fee for branch circuits with pl;1rchase ofa service or feeder fee: I Address: ,P 0 flex tJ iJ I I Each branchcircuit I $ 6.00 I $ I City: /7''''A) ) State: '/Ai? I ZIP:4f7r-j I' b. Fee for branch circuits without pu~chase ofa service or feeder fee: I Phone: S.;I']J~ q'J \-" I Fax:sii) ,J]" 7y (J I I First branch circuit (2) $ 55,00 $ I E-mail: I I Each additional br<l?..0_ circuit $ 6,00 I CCB license no,: 177<->n I BCD license no.: CZ./7 I I MiSc~s;.G~orfeedernotincluded I Slgnmg supervIsor's license no.: ,'Ii. ~7- -".' NOTldE.1 Each pump ofllTlgatlOn Clfcle (2)' I $ 63.00 I I Print name of signing supervisor: . -y;;-" ,_ II -/,~/" THIS PER v1tl"~!-'I!A'lqr ~fl'Ifl~~frjffW WOR~ $ 63.00 I I Signature of signing supervisor: t/'~ . AUTHORI;~I\;flIDERtqffi~Mli[dSaNli)T $ 63,00 $ I - - .l:N' r~\Qn,,,,r:W~_Q enD 1 lJUIVIIVlt J t.tt (oj . . -.. I ,ANY 180 ~l'f'al inspection: (I) $58.00 $ I Tft,~.ilr~Ffl!IGAW~tJSE~~~1 (A) Enter subtotal of above fees $ ..:.. B (Minimum Permit Fee $58.00) --> I (8) Enter 12% surcharge (.12 x [A]) $ b 9l:. I (C) Technology Fee (5% of[A]) $ ? ~ I TOTAL fees and surcharges (A through C): $ /, 786 $ 63.00 $ 87,00 ~~ ~~~~ .~~ 440-2584-) (9/08/COM) $ $ _S..~.,.tl\lCU'...Im.....~....D~..).......~.. . .... .....'............. Wic=- " \ .. 1 '.. : . . f , . ,..-,-"---,---,,..--_..- Status Issued CITY OF SPRINGFIELD . Building/Combination Permit PERMIT NO: COM2009-00142 ISSUED: 04/02/2009 APPLIED: 01/30/2009 EXPIRES: 10/09/2009 VALUE: $ 10,000.00 225 Fifth Street, Springtield, OR 541-726-3753 Phone 541,726-3676 Fax 541,726,3769 Inspection Line SITE ADDRESS: 2656 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703254100102 Springtield TYPE OF WORK: Cell Tower - Communication Tower TYPE OF USE: Addition Commercial PROJECT DESCRIPTION: Antenna Co,locate Owner: T MOBILE Address: 621 SW ALDER STREET #300 PORTLAND OR 97205 Phone Number: 503-241-0279 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I CONTRACTOR INFORMATION I Contractor f~i:E~:,':?N: Orego/'! :"w req!nf~~n,se Expiration Date HPS CONSTRl)~1,~2!ir,IN~ adopted by the Oftet;n~'lto 02/11/2010 ELITE ELECT~5;j!lJt!;:~~Me<n~e!~ I~ose ,.uleiJ.'Zl11!~l!,t f~'!r... 09/13/2010 UU9~ B\'HJJDliNfl;Ui~gRM1'tION i52'001- cal,..I~ I,,,,, ""mrft (Not . th "I, 'ules by number f !" . e. e telepho wrofS\6tI~on Utilit N .. ne CAr.Iill't/'~ ,. sr.""... Y otlflcatlon -rte,!; ~Ol' u""""Ee2344). Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Phone 503-357,42 I 7 541-330-9750 Contractor Type General Electrical U Lot Size: Sq Ft 1st Floor: . Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla I DEVELOPMENTlNFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/u of Lot Coverage: NOTICE: "';, -- .. p' tt'FTHE WORK C -- ll.u~" ,nl,) 1-t'RM/r.LC' ."'IT. OMMENCED OR IS ABANDONED :5'O.lWkIType: ANY 180 DAY PERIOD. 60!lnSPouts/Drains: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee I of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541,726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Constrnction Bid Amonnt Use Bid Amonnt Fee Description Plan Review CommllndlPnblic + 12% State Snrcharge . + 5% Technology Fee Building Permit Plan Review Fire & Life Safety Plan Review Minor.' Planning + 12% State Snrcharge + 5% Technology Fee Low V ollage -Commercial Indus Total Amount Paid Public Works Review Structural Review Initial Review Plannine: Review Fire D~partment Review Plannine: Review CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00142 ISSUED: 04/02/2009 APPLIED: 0113012009 EXPIRES: 10/0912009 VALUE: $ 10,000.00 I Valuation Descrintion , $ Per Sq Ft or multiplier $1.00 Square,Footage or Bid Amount 10,000.00 01/30/2009 Valne Date Calcnlated Total Value of Project $10,000.00 $10,000.00 ~ Amonnt Paid Date Paid Receipt Number $88.40 1/30/09 2200900000000000115 $16.32 4/2109 1200900000000000234 $12,75 4/2109 1200900000000000234 $136.00 4/2/09 1200900000000000234 $54.40 4/2/09 1200900000000000234 $1l9.00 4/2/09 1200900000000000234 $6.96 4/17/09 1200900000000000275 $2.90 4/17/09 1200900000000000275 $58,00 4/17/09 1200900000000000275 01/30/2009 01/30/2009 $494.73 Plan Reviews I APP CTM 01/30/2009 APP LLH 02/0212009 APP EMM 02/20/2009 APP GRG Plans Review: Addition of antennas for T-Mobile to existing Sprint tower. Job #COM2009-00142. Plans appear to meet co4e requirements. 01/30/2009 01/30/2009. 01130/2009 04/02/2009 04/02/2009 APP TAJ Planning released to building and it is okay to issue permit. See attached documents for approval. 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. ' Pa2e 2 of 3 CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMlTNO: COM2009-00142 ISSUED: 04/02/2009 APPLIED: 01/3012009 EXPIRES: 10/09/2009 VALUE: $ 10,000.00 22S'Fifth Street, Springfield, OR 541,726,3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Re"uired 'nsDe,cti,o~,,~ I Final Building: After all required inspections have been requested and approved and the building is complete. Final Electric: When all electrical work is complete. By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, an,d 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 that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, 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 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 Sig,uature Date Paee 3 of 3 225 Fifth. Street Springfield, Oregon 97477 541-726-3759 Phone' 8L: City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Numbe'r COM2009-00 142 COM2009-00 142 COM2009,OO 142 Payments: Type of Payment CredilCard cR~ceintl RECEIPT #: 1200900000000000275 Date: 04/17/2009 Description Low Voltage, Commercial Indus + 5% Technology Fee' + 12% State Surcharge Paid By ELITE ELECTRIC LLC Item Total: Check Number Authorization Received By Batch Number Number How Received db .J 027207 In Person Payment Total: Page 1 of 1 2:49:10PM Amount Due 58.00 2,90 6.96 $67.86 Amount Paid $67.86 $67.86 4/17/2009