HomeMy WebLinkAboutPermit Electrical 2009-6-29
225 Fifth Streett Springfield. OR 97477. PH(541)726-3753+ FAX(54t)726-3689
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Pennit no.: l: 7. -:- '/ ~ (
I Date: G,/?- 9/0 ~ I
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started withi~ 180
days of issuance or if work is suspended for 180 days. '
1!l._,:i1!(;8:;~L'IGOYEBf..lMENjf~~p.~ROYAL!f!',~~'ii,,~~ ~,",l'''~~''',F;EE''.''!S.C'-H'E-BiTil!:EjigF2S-Y'~~--''''''i3'
mm~~'1h1i:~ ,*:h%:_'iW:~il'R~>:li@:.;fc'r.m:~~__"~'"'_'h'''_'_ _.I..!_",*\~~~t~~ft)
1 Zoning approval verified? 0 Yes ,0 No : ri4~'ffi.~!f=m~~~~~~~ll:!fflll.€Osf!;ll;I~1lQla!f~
1~1ll~~1Iii=G~ORY~oli!li(:;&(;lNSjrRujtll\fQN~~~ '"~''~''''""",JI~~m'li)!!ii'M~'...r'>:''' "'~". i1:~~'l! ~-"!lS!~
I. I' 1 .Y 1 I ReSlde,ntlall per UOIt, service included: I
o ResIdential 0 Government I,li Commercial ..
1~~'!JQB'\fSlffiEjjINIi(:))~,N1~"JjIQNffANDliI!0e'A'1iION~~!1 11.000 sq ft or less (4) $134.00 $ I
I'J b' ddr ..,., -" 1 I Each additional 500 sq. ft. or portion $ 2' 5,00 $ I
o sIte a ess: "600nR.\.+~ "-~ thereof '
I City:"CP(L~\;\'H2-. 1 State:o~. 1 Zlp:qtl.f1-l- 1 I Limited energy (2) , $ 32.00 $ I
i~~~~~~~~0NJ[OI;JiWJ~~~~~~~ I ~~~71~:"S~~~~~r~~ fe~~:r (~)odular. $ 63.00 $ I
Iv -'-" (.....,...;. '__ ~I I J^ I Services or feeders: installation, alteration, relocation 1
\\.b- ~~\. -, \'-o-tLW.... ""''''''''''ItA ",l'\o.MM.III'
i8~~~~fut"i~~~~ai~~~;j;,j%~11 ~:~ ~:;oo:;: ;~: : :::::: I
I Name: .<::, fA "'-- __ "I _.i. 1 1 401 to 600 amps (2) $158,00 $ I
, 't ,H(\ L> . 'Dk"'-'UJ\,""'ONU
1 Address: 'i\4.0 \2::" B:-W ~D!ib s..u~ CJod I 1 601 to 1,000 amps (2) $205.00 $ I
1 City: -SpAAMLk.,Ul.ut 1 State: m. 1 ZIP: "'I'l-li'F} I 1 Over 1,000 amps or volts (2) $469.00 $ I
I Phone:5~1-7~/,,}'t;\{\{l\ I Fax:S~r"'~'" ;:o<;'\U I 1 Reconnect only (2) ,$ 63.00 $ 1
j E-mail: \A. )bc.hS ( S\.A,{'o.N"\ . rt"\~ (\.(}~~\L.. ~"J~)I I Temporary services or feeders: installation, alte(ation, relocation I
Th" II' . b . d 'd' '-- Ii .. '\ I 200 amps or less (2) $ $ 1
IS msta atlOn IS emg ma e on resl entIa! or ann property 63,00
owned by me or a member of my immediate family. This 1 201 to 400 amps (2) $ 87,00 $ 1
property is not intended for sale, exchange, lease, or rent OAR 1
. 479.540(1) and 479,560(1). 401, to 600 amps (2)' $126,00. $ 1
Signature: lOver 600 amps or 1,000 volts, see serVices or feeders section above I
1=r~~C;;v0Nrr:RJfC;;m.0~~IN5fu~12I!AmI0NgrL~~W~A I Branch circuits: new, alteration, extension per panel I
I Business name: T"""V1'17 ~~ <,~,,:)S I a. Fee for branch circuits with purchase ofa service or feeder fee: I
1 Address: ~Ioo., ~i''omfCS 'S\~fOT I Each branch circuit 1 $ 6.001 $ I
City: 1_-f;.:A.~"",1 1 State: (')~ I ZIP: Crtl/O~ 1 b, Fee for branch circuits without purcbase of a service or feeder fee: I
Phone:541-Y~'f'-!il[t.;> 1 Fax:S'lI-'i~.> 'l,,\'\~ I Fiisthrancbcircuit(2) I_ 1 $ 55.001$ I
I E-mail: dQ.",,,,r~n.\t\~t;:,,'il ry'<-" ,'n"", I Each additional branch circuit $ 6.00 $ 1
1 CCB license no.: 11J\ b\ ~ I BCD license no.: ~O-.;~ rlS. I Miscellaneous ree" service or feeder not included I
'1' Signing supervisor's license no,: L./c?/( Slr.,- 1 1 ,Each pump'or irrigation circle (2) $ 63.00 $ 1
1 Print name of signing supervisor: /3(1) B P f:r;:.T FiE I 1 Each sign' or outline lighting (2) ;2 $ 63.00 $ 10i1D'"
I Signature of signing supervisor: A::/. _ ./_ '.# I I Signal circuit or a limited-energy panel, $ 63.00 $
1/'lA.,- /Z. // alteration, or extension (2) ,
t~;~~=:;~i~~ANf~8:~Ei~~~~~..i
(A) Enter subtotal of above fees ' I
(Minimum Permit Fee $58.00) $ \.;l(,.oc>
1 (B) Enter 12% surcharge (.12 x [A]) . $ IStlJ.1
(C) Technology Fee (6% of[A]) $ lD, bol
TOTAL fees and surcharges (A through C): $1 ~ 't ~ ~
440-2584-1 (9/08/COM)
Status
Issued
CITY OF ~nuNGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00954
ISSUED: 06/29/2009
APPLIED: 06/29/2009
EXPIRES: 12/29/2009
VALUE:
225 Fifth Street, Springfield, OR
541.726-3753 Phone
541- 726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 800 BELTLlNE RD
ASSESSOR'S PARCEL NO.: 1703153000900
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Sign & ontline lighting.
Owner: SYCAN B CORP
Address: 840 BELTLINE RD STE 202
SPRINGFIELD OR 97477
J
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
IMAGE KING INC
License
161313
BUILDING INFORMATION I
Expiration Date
09/0112010
Phone
541-484-1482
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
'Lot Size:
Sq Ft l~t 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 I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd: .
% of Lot Coverage:
. REQUIRED PARKING
Total:
, Handicapped:
Compact:
Street Improvements:
I PUBLIC IMPROVEMENTS ~TTENTION' 0 I .
,.' .' regon aw requires you to
toHoWSii1€W:iIk!my'pe: by the Oregon Utility
~otlflcatlon Center. Th0se rules are set forth
m OAR DownspoutslD"lams:
W~'V" '-w Iv ,,!vugh OAR 952-001-
0090.. You may obtain copies of the rules by
. caHmg the center. (Note: the telephone
number for the Oregon Utility Notification
NOTICE: __., Center is 1-800-:1:1?_?,~LlLl\
THIS PERMIT SHALL ~)\: ',::::. :r ,-- on" ,r..:
AUTHORIZED' UNDER bV.aliiiifioiiTJjes~~F.~btio~ I
COMMENCED OR IS ARANDONEU I-UK
T j. Ct' 00 $ Per Sq Ft Square Footage
YPf~~188slJr~ft~ot.tR\ or multiplier or Bid Amount
Value
Date Calculated
'Storm Sewer Available:
Special Instruction:
Notes:
Description .
Paee I 01'2
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726"3753 Phone
541-726-3676 Fax
541-726~3769Inspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
Amouut Paid
$15.12
$6.30
$126.00
Total Amount Paid
$147.42
Total Value of Project
Fee~ Paj~ I
Plan Reviews I
Date Paid
6/29/09
6/29/09
6/29/09
CITY OF SPRINGFIELD
,Building/Combination Permit
PERMIT NO: COM2009-00954
ISSUED: 06/29/2009
APPLIED: 06/29/2009
EXPIRES: 12/29/2009
VALUE:
Receipt Number
3200900000000000492
3200900000000000492
3200900000000000492
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'. wiIl,be made the following
work day.
I Reouired Insoectioo,s I
Sign Electrical: After connection is made but prior to energizing.
By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all
information hereon is true and correct, and I further certify that any and all work performed shallbe done in accordance with
the Ordinauces of the City of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Servi~'es Division, Building Safety,
I further certify that only contractors and employees who are in compliance with ORS 701.005 will,he used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readahle 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 ')
r
Page 2 of 2 I
~ I ~'\ I 0'\
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3.759 Phone
City of Springfield Official Re'ceipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00954
COM2009-00954
COM2009-00954
Payments:
Type of Payment
Check
cReceiotl
RECEIPT #:
3200900000000000492
Date: 06/29/2009
Description,
Sign - Outline Lighting Each
+ 5% Technology Fee
+ ] 2% State Surcharge
Paid By
IMAGE KING SIGNS
Item Total:
Check Number Authorization
Received By Batch Number Number How -Received
12986
njm
In Person
Payment Total:
Page] of I
2:02: II PM
Amount Due
126.00
6.30
15.12
$147.42
Amount Paid
$147.42
$147.42 .
6/29/2009