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Home My WebLink AboutPermit Electrical 2009-5-28 r " . Electrical Permit Application 1"t-j;;Y'l~:,~~.'1;'~{;H'ij)iSlr!t"XI!~l:H:'t,~~QJ1'$~~JI ~~r~'le~J~~~[M~~~f~9~~~~; I Pemlitn6: OJ-7Lt? I I Date, ~/;)-S /0 C; I 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. II~g--:p'~p~~~~~~~~~~BNMEDN~~ee~r:lMAD~~~ 'I~N-~=~f~!;:t:=:~l~tS~~IIt;t~~I~€iJs?~I~m' ,:, . umuerio imspec IOnS)per,:1 eml(~)lW,?,h~ ,Q y;,; ~r-.~~;" ==.;,~~""" ~'iit ~~:G~iJjEG:0BYil[OF;!t.oNsml;l.l!J,cmIQNl'II,~~[~ i1>&"''''''a1"j'!Z''M'''''!N{~m~'.'''''.0j.j',f''i",,,",, ,_."i"!l~.",,!j l!LIi,<:.os1!!!j.j 1=~ai~,mE~JN~~Ba,;~~7@;~N~J~~C~;7;~~~1 i ~~~~::ti;I,:el:S:n(:; service inclu~ed: $134,00 $: I Job site address, 3 \00 _ A 1 ~~~~:fdditionaI500 sq, ft, or portion" $ 25,00 $1 I City' Srr;N:c -~;e-\J... I State, 0, I ZIP, '11 ")1'l I Limited energy (2) /r $ 32.00 $'1). I ~ Subdivision, -1 I Lot no" j 1 Each manufactured home or modulai I IRli::;-E~J.PI:S~Ci:~1:(O~~~K~~~~1 I ::::~:: ~:r;~::::S~~:::I~::ion, oit~ration, relo:at::~OO $ I I I I 200 amps or less (2) $ 81,00 $ I ~~iIl.~iJlillf#eRoeIOR;fJ;f1l0WNER~I\,~~%t~~rf;Y;;;1fl:\\1 I 201 to 400 amps (2) $ 95.00 $ I I Name, O;e, /MIL DEP'T I I 401 to 600 amps (2) $158.00 $ I I Address: PC? 'i(;, (; l't JSCJ II 601 to 1,000 amps (2) $205.00 $ I I City: S~ I State~ I ZIP: '}'7] "')' I I Over 1,000 amps or volts (2) $469.00 $ I I Phone: I Fax; _ I I Reconriect only (2) $ 63.00 " $ I I E-mail: I I Temporary services or feeders: insi,allation, alteration, relocation I This installation is being made on residential or farm property I 200 amps or less (2) $ 63,00 $ I owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87,00 $ I property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479,560(1), I 401 to 600 amps (2) I $126,00 $ I Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I 1~~~~C:l:5NiTi~Gir:OB!!iINsmI1lLEI!AmION~1!llt~J,\~.~~i!~ I Branch circuits: new, alteration, extension per panel I I Business name: nO\.. i-~D'-t'\c...' YlA LJor k Se.( J;Ce 5' I I a. Fee for branch circuits with purchase of a service or feeder fee: I I Address: 30<... Sh<..I\,"J S\-' "i~;1", b I I Each hranchcircuit I $ 6.00 I $ I I City, Spr :"'C .(:",_lrJ, I I State, Or I ZIP: Cj 7 LJ 77 I I h, Fee for hranch circuits without purchase ofa service or feeder fee: I I Phone5'11- nr: '1'-09 I Fax, I I First branch circuit (2) I $ 55,00 $ I I E-mail: I I Each additional branch circuit 1: I $ 6.00 $ I CCB license no,: 15'4300 I BCD license no,' ,Y'l.LJ \ L['1i I Miscellaneous fees: service or feeder notincluded I Signing supervisor's licens,e no,' 4241 L[ f{ I Each pump or irrigation circle (2) $ 63,00 $ I Print name of signing supe~isor: Seo tt H-o <AS Ie I Each sign or outline lighting (2) $ 63,00 $ I Signature of signing supervisor: /. ,.+ ) ) /J Y I Signal circuit or a limited,energy pa~,el, $ 63.00 $ A WVt 'fr:J.tt/J//o alteratIon, or extensIon (2) :: r 11~::;~~~~=~:C,ti~~}I~'T<' ,.___~~O,,~,-~ ""i!I.""","~,"li;"l.!_~,~B.~I.C'~!:I[~J(l!J,SE"ll!!,!Uli!?~,~~""'-_ill \ \~\ (A,) Enter suhtotal of ahove fees .~ 00 \j\" ~~ (Minimum Permit Fee $58.00) , $ 5 c::...,~ro.- I (B) Enter 12% surcharge (.12x [A]) , $ 0.1.i- ,U\.\.....CJ;:;;(- I (C) Technology Fee (5% of[A]) $ 2. "'_Q. '~ I TOTAL fees and surcharges (A through C): $ ~ ~ y"l\(: \\ ~~. 440,2584,) (9/08/S0M) f , CITY OF ~rKll~lJl'lt<,LU I: Building/Combination Permit !' 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2009-00747 ISSUED: OS/2812009 APPLIED: OS/28/2009 EXPIRES: j 1/28/2009 VALUE: Status Iss u ed SITE ADDRESS: 3100 PIERCE PKWY A ASSESSOR'S PARCEL NO.: 1702300001000 SPRINGFIETYPE OF WORK: Ele~trical Work Only PROJECT DESCRIPTION: Low voltage only- Data cables TYPE OF USE: New Commercial I.CONTRACTO,R,INFO,R~.~~IQN:t AT1t:1'l I lVI'll. '-',.....":::'''',. ._.. -, ... I d t d by the Or"(1on UtJllty Contractor ,f,~I:,~:::~~~~e~~?tr \hose rules\;'SI(,I!~~orth Expiration Date NA TlONAL N1C'TF..Q,~~~~,~~,~\=;!';~IR,IM?~~'~4~Q.01-001- 02110/2011 069CIBliI\JDING)INF0RMl':TiON~lrules DY , '. ,_. ,,' ..,.. ,hone calling tllt: Lil:;llll:;l. \'."""~' ..n .. ,'. . ber ,"" 'IS- n'''(]on Utility Notification num /POI' torles: ) CfI"eigii;%f1S~g,q;r.,~,~-2344 , Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Owner: STATE OF OREGON MILITARY DEPARTMENT Address: PO BOX 14350 SALEM OR 97309 Contractor Type Low Voltage Electrical # of Units: Primary Occnpancy Gronp: Secondary Occnpancy Gronp: Primary Construction Type Secondary Constrnction Type: # of Bedrooms: n/a Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION I NUl II''''. . THIS PERM~MHA!-hpPIRE IF THE WORK AUTHbRIZE#1St'r~'fiIif1:t~lB P..ERMIT IS NOT COMMENC~'il.Qd\Dili.l\,[k'i~ONEO FOR ANY 1 SO 0/\\1 ~tiIl>'illhverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone 541-726-9209 Lot Size: SqFt 1st Floor: Sq Ft 2nd Floor: Sq Ft ~asement: Sq Ft Garage/Carport Sq Ft Other: OCCUP~lIt Load: REQUIRED PARKING Total: ,. Handicapped: Compact: Sidewalk Type: , ,~ Downspouts/Dniins: Notes: I Valuation'Descriotion ~ Description Type of Construction $ Per Sq Ft or mnltiplier Square Footage or Bid Amonnt Page I 01'2 Value , Date Calcnlated { " . Status Issued CITY OF SPRINGFIELD Building/C~mbination Permit PERMIT NO: COM2009-00747 ISSUED: OS/28/2009 APPLIED: OS/28/2009 EXPIRES: 11/28/2009 VALUE: 225 Fifth Street, Springfield, OR 541,726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project !,pp, Paid,' Fee Description + 12% State Surcharge + 5% Technology Fee Low Voltage - Commercial Indus Amount Paid Date Paid Receipt Number $6.96 $2.90 $58.00 5/28/09 5/28109 5/28/09 2200900000000000572 220p900000000000572 2200900000000000572 Total Amount Paid $67.86 Plan Reviews ~ To Request an inspection call the 24 hour recording at 726-3769. All inspections ~,equested 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 Insnpctions I Low Voltage: Prior to cover. By signature, I state and agree, that I have carefully examined the completed applicatinn 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 w~rk 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 0 y contractors and employees who are in compliance with ORS 701.005 wiil be,used on this project. I further agree to e ur that all r uired inspections are requested at the proper time, that each ~ddressis readable from th~ ''''., .... ". ,. .. ",;. ,,,. .,.. '" # ..... ,row", .., .., .,,'"'", '" ',""'" wm "..." .. ....." .. ." timesdUring~oA 'l/J~~ __ 5 -'2?~ ()9 Owner or Contractors Signature Date P3ee 2 of 2 , ' , 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00747 COM2009-00747 COM2009-00747 , Payments: Type of Payment CreditCard cReceintJ City of Springfield Official Receipt DevelopmJnt Services Department Public Works Departmenf RECEIPT #: 2200900000000000572 Date: OS/28/2009 Description Low Voltage - Commercial Indus + 5% Technology Fee + J 2% ,State Surcharge Paid By SCOTT HOUSLEY Hem Total: Check Number Authorization Received By Batch Number Number Ho~l Received cjc 082910 In Person !I Paym~nt Total: " Page J of J 9:40:2IAM Amount Due 58,00 2,90 6,96 $67,86 Amount Paid $67,86 $67,86 5/28/2009