HomeMy WebLinkAboutPermit Electrical 2009-6-29
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(54t)726-3689
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!~,'ClDEeARTMEN1i"USE\ON~Yi "'
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PermIt no,:
I Date:~~Z?-6 , 'I
Electrical Permit Application
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This permit is issued under OAR 918-309-0000, Permits are nontransferable. Per.mits expire if work is not started within 180
days of issuance or if work is suspended for 180 days. II
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1~~~IfQ"e~LljlG'Qv,EI':l.NMr:NiTi!f~I'lI'lROIJ'p':Il;1___~ . 1~~~~~~IiEr:(S:~BE1jJ!ltl!Ei~~'iY#~li.l1
I Zoning appro~a] verified? , .. 0 Yes = ". .... 0 No _ fN~~~ffir~~,tl~~'f(i))1llil'Qfjl!iI.€~tJjl~Tot;;~!1
1~~f[c:;AJjEQORYf!~F.I<:::G5NSjl1RUJ:\lIilQ"N~~~~~ ~'''-"",~\R_'''''''~._~''':'~ owA''' ~ea'h""" illli~l!5ti\!'iJl
I .. 111'01 . 1 Residential, per Unit,' service included: I
o ResIdentIal 0 Government 10 CommercIal ' "
1~1l0B~SlffiE~INliOBMAmJONwgNJ.:)II!!:>Gl<illIONJI~~~1 11,000 sq ft. or less (4) , .]! $134.00 $ I
I J b. dd. . '- l ^"""h.J.-. ( . \. 1 I Each addITIonal 500 sq. ft. or portion $ 25.00 $ .)
o sIte a ress. It' 0 Lll., vV1JUl..)( 'J)l\r, '1'0A1'\ ) thereof . Ii
1 City:~:{'<j,~t.~ I State: b~ I ZIP: Q1.41-1 I 1 Limited energy (2) Ii $ 32.00 $ I
1=~~~i;-~~F~WJ~~~~~~i I ~~~71~~s~~~~~~r~~ ~~~:r(~)OdUli $ 63.00 $ I
1l2.n -fJtN\W.fi.. sir Clll~rr c:;;.,,..., ~ D"v.t-] I~t;!"vi~esorfeeders:installation,olifration,relocation I
1 Vn.Bo- ~..-- ~ ~ 1>(>\J.. . "l I)),f~~~~~,or.;:ess (2) I I I $ 81.00 $ I
1~7~~R==~f~~:~~:~~~~~?~i~ :9~i~~~~i~:~~:'~~~;;;',/,qW re~.!, I I :1:::::: :
I Address: \ ~'::::> f'.:.. ~n \'\... ~~ 1),~lq/;lt,991~to})~Q9barnp~I@)Se'~:~ dr~~~s j,b,,, I $205.00 $
1 1 71'-1 ~ "IP ~ VDI "Irt;> . -,t'S ""VI} i 'V
City: ~\Uo(\lk"", ~ State: D~ ZIP: Cr:rlJl{'l.' €0);~~-~;~~';'J!!!psi;:'l'-~:.!.(~),:,,/rd'o::~tillt., $469.00 $
I PhoneGi\1 li'\'&- ;nfl,<{, 1 Fax:5<il-m~~S-:2,l l<Req?iJ~e.cl'l!n)yJ2lot". .~OftA,!9S2.,I.~rtl} $ 63.00 $
I E-mal'l" n ~V".n. . ,~- - r' ,.,l ... . ~ :cr-., ~.. I Tempo~~~Ysi';.~'Je~/o'rI'f~~ders-:"',ihklbll~;ldn, alteration, relocation
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This installation is being made on residential or farm property 2 amps or less (2) -<34<1, IfJcak e $ 63.00 $
owned bJ: me o~ a member of my immediate family. This 1201 to 400 amps (2) /0 ('I $ 87 0 $
property IS not mtended for sale, exchange, lease, or rent. OAR. 1.0
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts, see s~rvices or feeders section above
1~~C"0.Nm~Gi1!0Rll~SffiAH!I1A]ION~jgitk;it.it! I Branch circuits: n.ew, ~lter~tion, eXf:.enSion per panel
Busmes~ name: ~~ \( \"~ S':J- -.S I I a. Fee for branch CirCUits with purchase of a service or feeder fee:
I Address. ,;:)l"n G-,t'.N\f-S STO<.F.P'''-- 1 I Each branch mcuil I 1 $ 6.00 I $
City: ~'l ",0 1 State: tjR I ZIP: q:P-lOJ.lh71'~fee for branch circuits without p~fchase ofa service or feeder fee:
Phone:5'1t-~il\.- ll.\.U 1 Fax:5'll -Y(,1- "(,0\'1'\ 7H1S b,..X\rsthranchcircuil(2) I $ 55.00 $'
1 E-mail: J.e:o..", C \~V\A"'O(:" c:.\ ..)S, (()"" ~UiHn~;~~jfadtN,i\>p~lbrilJ'~hcirc~it i I $ 6.00 $
I. I I '\. ~ GUll M ",.~u "^",~ '-e7f;..,/{r:: 'F Ie
CCB "cense no.: I (p I ~ I ~ BCD license no.: ,]0- ~)bocd:. ',11?'lsf<;.\lllnwutftel'9iP."i;< D J?1i4~ rlP/J~cl"ded
I Signing supervisor's license no.: q'tfq'.5! b- ''''f r8b.lii2h)\l\f!!l'd&rjjp'}jilPJ[~&~i!1T)~1 $ 63.00 $ I
I Print name of signing supervisor: gOB PI' ErpLE. I Each s{~'d/QJtjine 1;~ii{Ynl!'(;l}l F6RlTI $ 63.00 $lP3,~
I Signature of signing supervisor: /1/' 4' ./ I Signal circuit or a limited-energy pa~el, $ 63 00 $ I
f /4 ~// - // alteratlOn, or extensIOn (2)' I, .
1"~~:.~~::':~.t~"-~:.,~I)..".,..il~."'T"~. ~.' . ~~:k,;"_...". ,I
1Wil'J!""'~__"'l!R;aw~p.p.I!H<::~~1f,,;USE' .' : w~Jll:.!I~~
(A) Enter subtotal of above fees II
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(Minimum Permit Fee $58.00)::
1 (B) Enter 12% surcharge (, 12 x [AD ,I:
I (C)'Technology Fee (5% of[AD ii
1 TOTAL fees and surcharges (A !hrough C):
1:
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$
(.,"3 ,CO
$ 1- ,.!5lp
$ 31 \01
$":/-3 :1-\1
440.2584-1 (9/08/COM)
CITY OF SPRINGFIELD
Building/C!,mbination Permit
).
Status
Issued '
PERMIT NO: COM2009-00955
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: 610 Q ST
ASSESSOR'S PARCEL NO.: 1703262405502
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Sign lighting
Owner:
Address:
ALPROP CO
6149 S W SHATTUCK RD
PORTLAND OR 97219
1 CONTR;^CTOR INFORMATION 1
Contractor Type
Electrical
Contractor
IMAGE KING INC
License
161313
1~
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Expiration Date
\;
09/0)/2010
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Phone
541-484-1482
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I. Bt:JILDlNG,II1oIFORM.UION 1
~e-' 0\1' .."'<' ""',.
I :-ll O~ '~0~Jt"'" >ctl
# of Units: f0 \'cl' oiS'e s#.of'Stories:J'l
Primary Occupancy Group: O~e~~o '0'\ ~e ~0~ (H1i.'g-ht't,f.St~ucture
~\, ,,~o" C\,' \" ~"". ~
Secondary Occupancy Gr!l,up':l\~'n<\.o\l, '\'<:\ ",~00':"Ds'f.:niejof)l"a't:
, "'W. c:. V' ~e" f"\\\' "\v,.,, ~ "'\''::1
Primary ConstructioIL<T.ype,v.\e ('e0 ,,\)\v. <:,0". W:it~'I'dType:
1\.,.\ ,\ , :0 v \.\.) \'0- 1\.10. ..,....". ~~,.
Secondary ConstructlOJ!iryPJ',:~ _\)\) - 0'0\'3' ~o '0R~n~~~Type:
# of Bedrooms: ~o\;'\" ~ ?,S'l,; ~\).'\ f0\e~' e9,o'0- !~nergy Path:
'00'1' --{00 oiS'e G~e O~\"I,<::J\) Sprinkled Building:
~ ^o.(J.. _c\ _of ~ ..c...
v- G\).'1:.'Oe~ Ge'0-\'6' I DEVELOPMENT INFORMATION 1
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if
Lot Sile:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft 9arage/Carport
Sq Ft Other:
J::
Occupant Load:
~I
n/a
Notes:
:, Hau.<licapped:
. Il\~~fi!jmct:
. ''!c.~''-':~~;\
<:\~ ,\S"
. :,,:fi~';f$\~~
I PUBLIC IMPROVEMENTS I ~"-\.. '(;.\\\~ 1~~~ .
t''''. -< Sy:..,,<:..<(.. ,~\~ "
f\"\\'v" o...~\\ ,\W.ide~~Type: ]'
..\\) <(x." <_\) \) ,SA \~""~ " .
. \" y.,\,o ~~1..\- S\) 'lJtj~~uts/Dra,fns:
\'I::J'\YI- S~\J ~ <(S ii
,,\J~~\ '0'0 \) ::
,,~-.l,:1
r I:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I'
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I .
I
I: REQUIRED PARKING
,I
~ Total:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Set hack:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Description-
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
I;
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~:
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Value
Date Calculated
I Valuation DescriDtio.n I
Paee I 0\'2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone'
541- 726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% StateSurcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
Amount Paid
$7.56
$3.15
$63.00
Total Amount Paid
$73.71
Total Value of Project
Fees PlIid 1
II I II I
Date Paid
I Plan Reviews ,
6/29/09
6/29/09
6/29/09
CITY OF SPRINGFIELD
"1
Building/cd'mbination Permit
1 .
r '
PERMIT NO: COM2009-00955
ISSUED:' 06/29/2009
APPLIED: 06/29/2009
EXPIRES: 12/29/2009
VALUE:
Receipt Number
1200900000000000755
1200900000000000755
1200900000000000755
To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested 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
I R~v~i,~e.d Inspe5tions 1
Sign Electrical: After connection is made but prior to energizing
Ii.
. By signature, I state and agree, that I have carefully examined the completed application and do hAeby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall'tbe done in accordance with
the Ordinances of the City of Springfield and the Laws ofthe State of Oregon pertaining to the wo'~k described herein, and
that NO OCCUPANCY will he made of any structure without permission of the Community Servi~es Division, Building Safety.
'I
I further certify that only contractors arid employees who are in compliance with ORS 701.005 willibe 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 constructh;m. ~~
Owner or Contractors Signature
Paee 2 of 2
Date
225'Fifth Street
",' .' , .
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00955
COM2009-00955
COM2009-00955
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Sign - Outline Lighting Each
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
IMAGE KING lNC
1200900000000000755
Received By
Check Number
Batch Number
djb
Page I of I
City of Springfield Official Receipt
Development Services Department
"
Public Works Department
Date: 06/~9/2009
2:06:42PM
I:
Amount Due
63,00
3,15
7,56
$73.71
Item Total:
I,
Authorization ,;!
Number How):Reuived
I'
Amount Pnid
12978
$73,71
$73.71
In 'Person
paymJllt Total:
6/29/2009