HomeMy WebLinkAboutPermit Electrical 2009-5-27
Ele~trical Permit Application
225 Filth St....USprlngfi.ld, OR 974770 PH(54!)726-3753. FAX(54!)726-3689
~ o:;"l,\':~'-:":;' .~-;i;, ";< 'i~ ""'cL:i>r~~. ,';.;~ .,;;<;->W_ ';:_',_~_ ",";"'C"j'
c: 'l"cDERARTMENT,USE,ONl!y~,,~-1)
~jtJ~~:~'~;:~~:":~;:~o;~~7j
I Date: S/z 0:> 9 I
This permit is issued under OAR 918-309-0000. Penn its are nontransferable. Pennits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
11:,'~~~n,i.,,'g;,i~p',~p,",:, .~~~;;~~, E" RN,M E,oNtyifieAslIP, R, bV,.' OAl!, :~o:~,'~',;',~i,;;;(i'-;r,:;',:l' r'!if~~'I~~,*',;.;.~;,j~,:fjI;EEtSCHEDUI1E.- - ;"~~;J
,', ,-, ","',.' "'", , , '" " ". '" ", ",. 1~~.~~~:~~~~i;:~~~~1~~~tt.:0:IRt;~I.c~._~~~(~~O~I,~~:~g~~~~~-l
li;~.,8i_A\.f:~CATEGORYf,()F.:;,CONSTRUCiTlON:E-l',1imi\:,'
I 0 ~;~~~~~~ITE.;IN~~R~A~:~WAND~~~;;~~;~a~~A~ I ~::~::tit~l,;:s:~:; s.rvic. includ.d: $134.00 $ j
I I B r ? R l'\ I Each additional 500 sq, f\. or portion , $ I
Job site address: ,~ ..>> lO"'$"" r~7 ~ thereof $ 25.00
City: S-t>f'b I State:bll- I ZJP:~ 7'11'7 I Limited energy (2) I $ 32.00 $ I
1~~:[~'~~~~~~;1Jl~~;~I~~OFJw~;~~~l:>~~?~:~ ~~~il::~~'~~~~i~~r~~ }~~~~r (~)nodular 'I $ 63,00 $ I
'^ "-""-~dd:"'~~,tc-i... -. 2-. C-(;;:;;~-;'~'" ~ Services or feeders: installation, alteration, relocation
I /\ JL I 200 amps or less (2) $ 81.00 I S
05""'-0 ~ro.::;r ,
l'~rt::Q[:.\;*",l~~;~?i?::F?ROPI:RTYj:o.WNER_~.}.~~~~~}!2~~~ I 201 to 400 amps (2) I $ 95.00 J $
I Name: -r/L s;4-uE L L C 401 to 600 amps (2) 1 $158,00 I S
I Address> 1'.73' Alew,4..d ~ t>k-...u, ~/&cpi N '!0YtIH~~OOO amps (2) I $205,00 $
I City,.(,./,L -~.., A....A,_[ Si"Te::t,.l;)ii)\~' Y7:;hACl:>Vt,l:\<>-,4l., '~l~~\ojlliboampsorvolts(2) I $469,00 S
.lItNw rrve ~ ,....;ltUIL. ~.'::-,. ~H~,.,u r _ ~I~~ a ~'U ,_
I Phone: \cl'F'!;'x~ ~'- :center. I I\uo-Ugh C All R'e~Jil'~,only (2) I $ 63.00 $
" .".. ..\'On -/"" .hro 't "'- .;.__ ,
I E-mail' ~. ~\l.v".1\ R 952-UU I ~V"" ' -'f\ COp\es II 'l~ kWtlffl~u'y services or feeders: installation, alteration, relocation
' In Ot'\. .~n\_' nbta\ ,_. ~~",f) H ,_ ~ .
This installation is being made oljlresld,utiaJ;Qi la}lilqlroPe'nYUtiiit ' N ?tltlcm\\pJbr less (2) I I $ 63,00 S
owned bl: nie or a member of my iIqnie~ifi't.l:t:a)IIHl),CUhi~~~,a.32_: ,344:\81 to 400 amps (2) I I $ 87,00 $
property IS not mtended for salc;e"!i!J<mge;fJe'ilse or\~e\lllYN< .
479.540(1) and 479,560(1), cent\;)' /401 to 600 amps (2) I 1$126,00 $
Signature: lOver 600 amps or 1,000 volts, see services or fceders section above
1~'~tit{~..:t/KC:.bN.TRACf(OR{;INSJAllIiATIONfteT?-ii;~~~~;J,~'1;t: I Branch circuits: new, alteration, extens~on per panel
I Business nanle: AiJs>, GL.'LC ,(/,Ie. Lt.. (', I a, Fee for branch circuits with purchase of a service or feeder fee: I
I Address: 'I q '5 f J.... fl../ v~,iUt!O(lO'!i Oil... Each hranch circuit I $ 6,00 I S I
,I City' ,/2,[4/0 I State: t}il... ;./ ZJP:9770:l. I b,Feeforbraneh circuits without purchase ofa service or feederfe e:, J
I Pbone5"//,bll (1617) I FaxfQ/-g3() ?6b'f I First branch circuit (2) I / $ 55,00 $5'5;110
I E-mail: Ar'ilEL15:.TiLI~ @../10{/l1l1(../ coi11 I Each additional branch circuit II $ 6,00 $ 6,C'P
I CCB license,IlO,: / 7'1 II~ I BCD'license no.:C<tli'/' I Miscellan.ous fe.s: service or feeder not included
I Signing supervisor's license no,: i/'1:;"'5,.s' I 1 Each pump nr irngatioll circle (2) I 1$63,00 I $
I Print name of signing supervisor: A)o'>.;v A.ff~r, I 1 EaChSl!l.,\,g~\'I!"i'~\i;IIh~% I 1$63,00 I $
I Slgnatnre of sIgrung supervIsor if' -il \\~ DI'R~\6 t~~\;:~~~e~~~~:~gy panel, I I $ 63,00 I $
~ J\Ul\-\ORIIE 0 3~~~\i.I!.\i~spection: (I) I I $58,00 I s I
f'O,"~Et1CE\) p'n\"t'\~'~"~-"""~''AppllICA'N-T,.USE-';e~", "".,1-' ',.. e'j
~ \J WI OJ\'i ....\"\U\J.h""'""",,,c,.~,, ~ > L;. ,1<' .' ~",:;;_~+,~,_.,'_'
~ At1'i '\80 I (A) Enter subtotal of above fees / I
t\ \ ~ ~ f\ l- I ' (Minimum Pennit Fee $58.00) $ b
'\.}lV' '0-:! n..1jl, (B) Enter 12%surcharge (.12 x [Aj) I $ 77ZJ
A,\\ ~ 't),t),1v ~ (C)T!,ehnology Fcc (5% of[Aj) I $ .7a..rr
r\\ ~ ~ I TOTAL fees and surcharges (A through C): I' $ . 71 ~
~
440-2584-) (9IOE/COM)
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00744
ISSUED: OS/27/2009
APPLIED: OS/27/2009
EXPIRES: 11/27/2009
VALUE:
Status
Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone '
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1853 PIONEER PARKWAY EAST
ASSESSOR'S PARCEL NO,: 1703262302301
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF VSE: Addition
Commercial
PROJECT DESCRIPTION: Add alter 2 circuits'
Owner:PK SALE LLC
Address: 3333 NEW HYDE PARK RD #100
NEW HYDE PARK NY 11042
.I CONTRACTOR INFORMATION I
Contractor Type
Electrical
ContractoJ'\TTENTION: Oregon law requires bjgttl!se
APEX EL!'l~eif~RI€IU:lJcadopted by the Oregorlt5,lIlilt
. ...,""'v..~lI'''' "..., "...., .,,, ,"'....." "r_'C' ,.,..,... .......~ "nrtn
in OAR 9"b,BilTI'-'DH'SG_INFORMA-IIONiJl_
0090,. You may obtain ~opies of the rules by
calling the cEI/I~.fr~t?o'ps~~: the telephone
number for th,Htig!'~9.~~m~}'\%tification
CenterTrpe(l)~iJlMt1-2344) ,
Water Type:
Range Type:
Energy Path:
Sprinkled Buildillg:
# ofVnits:
Primary Occupallcy Group:
Secondary Occupancy Group:
Primary COllstruction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
Fronlyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Expiration Date
04/01/2011
Phone
541-330-5030
II/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvement~:
Storm Sewer A vailable:
Speciallllstruction:
I PV~LTS M~p.Y"IY'~PIRE IF THE WORK
, A~TH'ORIZED UNDER THIS Ps.-lilMJIlIlSr~Q,T
COMMENCED OR IS ABANDljlt,j~Rst~.fislDrains:
ANY 180 DAY PERIOD.
Notes:
I Valuation DescriRtio~ I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Paee I of 2
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% St~te Surcharge
+ 5% Technology Fce
Add, Alter, Extend Circ
Add, Altcr, Extend Circ Ea Add
Amount Paid
$7,32
$3.05
$55,00
$6,00
Total Amount Paid
$71.37
Total Value of Project
Fees Paid I
Date Paid
5/27/09
5/27/09
5/27/09
5/27/09
I Plan Reviews ,
CITY OF SPRINGFIELD
"
i
Building/Combination Permit
PERMIT NO: COM2009-00744
ISSUED: OS/27/2009
APPLIED: OS/2712009
EXPIRES: 11/27/2009
VALUE:
Receipt Number
1200900000000000557
1200900000000000557
1200,900000000000557
1200900000000000557
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 Rellllired Insnections I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete,
,
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
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 d~ring construction.
Owner or Contractors Signature
Pa2e 2 of 2
Date
225 Fifth Street
SpringfleIil,'Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00744
COM2009-00744
COM2009-00744
COM2009-00744
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
1200900000000000557
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
BRYAN KIRKPATRICK
Received By
djb
Check Number
Batch Nu~ber
Page I of I
r
'i;
City of Springfield Official Receipt
I'
Development Services Department
Public Works Department
( .
"
Date: OS/27/2009
2:55: 19PM
Item Total:
Authorization
Number How;Received
"
Amount Due
55,00
6,00
3,05
7,32
$71.37
Amount Paid
175441 In B,erson
, Payment Total:
I'
$71.3 7
$71.37
5/27/2009