HomeMy WebLinkAboutPermit Electrical 2009-7-10
ill FIllI> Stree..SprllllDeld, OR"477.'H\SCI)n6-37S3.FAX(54t)'n6-36II'J
--......
I DEPARTMENT USE ONLY
I permitno.:~C\ - \nl~
I Date: '\ AD - C9\
..
Th.. permit "Iuued under OAR 918-309-0000. Perml" are nontransferable. Perml.. expire If work .. not started wltbln 180
days of issuance or If work Is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning .<<. .,J verified1 0 Yes 0 No
CATEGORY OF CONSTRUCOON
o Residential lOG. ._.._.._.1 j gc_.._.....:al
JOB SITE INFORMATION AND LOCATION
Job site addrcss: 3;:<"T1 ?;\\/Pf"he.v-,d l'l-r. ,S-tI.RDb'--
City: ~'\Y\"+ie. \d I State: ~ I ZIP:. Cn--tll
Subdivision: '---' I Lot no.:
DESCRIPTION OF WORK
~fi:1""'-" f"D..h\(v-g,
"\'" F'\DQY"
PRO~",,,,,' OWNER
Name:
Address:
City:.
Phone:
E-mail:
This installation is being made on residential or fann Y' .y...y
owned by me or a .._.___~._ of my immediate family. This
,....'r'" .~' is not intended for sale, exchange. lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
I CONTRACTOR INSTALLATION
I Business n8JT1C: LD.Y\ Te-l <:..u--vices, \nc.... I
I Address: \ ~N") \r v iVlA Rd.. fl..,14e-.. r I
City: F uq ~Yle.. -J [ State: tJR 1 ZIP: li'l4 {)~
Phone: ~YI- (~--IL/clfl I Fax:S'-t1 -ltEE-L/.!d;1
E-mail: dcbve.r@ 1a.n~_L'~lfi(e.s. e.c.rv,
CCB license no.: 2C -3S3t.LE..l BCD license no.:
Signing supervisor's liccnseno.: W:,)"il'll.-Ep.,
"'._"'..~__~~" "du" /
Signatw-eofsigningsUpcM') - ....., C/~
ATTENTION: Oregon law reqc,;, es you to .
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- 1\
0090. You may obtain copies of the rules b~ '
calling the center. Note:the telephone -A
number for the' 9rp.~ :::1., Utility NotlflcatlOJ U ^'
C:~~)0-332-2344). 0<..f:J~Q./
44O-~:-t1l8l~T' ~ "p ~ .s
~ I><.,;\;
I State:
I Fax:
I ZIP:
1 I FEE SCHEDULE I
1 I Namborofl.,. -".. perltem() IQty.1 Cost Total I
I ... cost
I I RnId.ntial, per UDt~ ..rvtcolndndod: I
11,000 sq. fl. or less (4) 51".00 5 I
Each additional 500 sq. fl. or portion 5 25.00 5 I
thcn:of
Limited energy (2) 5 32.00 53':'.""1
Each manufacnned borne or modular 5 83.00 5 I
dwelling serviee or i:odcr (2)
C __':~-.J or feedtl'l: i1Ul4JllDtion, alieNI/ion. r-e/ocation I
200 amps or less (2) 5 Bl.00 5
20110 400 ~ (2) 5 85.00 5
40110 600 ~ (2) 5.158.00 5
601 10 1,000 amps (2) S205.00 5.
Over 1,000 amps or volts (2) $48B.00 5
Reconnect only (2) 5 83.00 5
Temporary services or feeden: inslllllariti", alteration; relocation
200 amps or less (2) 5 83.00 5.
201 10 400 ~ (2) 5 87.00 5
40110 600 ~ (2) 5126.00 5
Over 600 amps or 1,000 volts, see services or feeders section abo-.e
BraDch drcalll: n~ alteration. extension per paMI
8. Fee for branch cireuits with purchase of 8 service or feeder fee:
Each b,""ch cin:uit 1 $ 6.00 \ 5
b. Fee for branch circuits without purchase of 8 service or feeder fee:
First branch cin:uit (2)
Each additional brancb circuit
I I 5 55.00 I 5
5 6.00 5
MilcellantoUl fea: service 0'" feeder not included
Each pump or irrig~tion circle (2)
Each Bign or outline lighting (2)
Signal circuit or 8 limited-energy panel.
allenltion, or extonsion (2)
Each addldooaJ . . ',. ..:," (1)
-... " APPLICANT USE
(A) Enter subtotal of above fccs
(MInimum P.rmlt F.. 558.00) 5 ~.m
I (B) Enter ~&ji~ (.I2x [A]) 5 f n .qL.
I (C) Technq1~1iY2F~,:(~~,!!fjf.o\Jl..J ^ hi. r-vi'.' ~ - . L>l-'1 D
I TOTALi...-"Ii~.brcb(:':t1i 'ii"h'~' " rw t~~1
- l., ,..,. ~\_f~l!~llgft \r- ,.....,rto...'1~.... '
COMMENCED .."I:. ~"''''']v" I
ANY 180 DAY ~E~:~;BANDONED FOR
5 83.00 5
5 83.00 5
5 83_00 5
558.00 5
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01014
ISSUED: 07/10/2009
APPLIED: 07/10/2009
EXPIRES: 01/1012010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line.
SITE ADDRESS: 3377 RIVERBEND DR
ASSESSOR'S PARCEL NO.: 1703220004102
SPRINGFIETYPE OF WORK: Electrical Work Only
TYPE OF USE: New
PROJECT DESCRIPTION: Speaker Cahle - Earth Quake Brace - 5th Floor
Commercial
Owner: PEACE HEALTH
Address: PO BOX 1479
EUGENE OR 97440
I CONTRACTOR INFORMATION ..1
Contractor Type
Low Voltage Electrical
Contractor
LAN TEL SERVICES
License
90461
Expiration Date
04/19/20 I 0
Phone
541-688-1427
. BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
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 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION'
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type: ,
Downspouts/Drains:
Notes:
I V aluation Descri~tion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
. Square Footage
or Bid Amount
Value
Date Calculated
Paee I of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01014
ISSUED: 07/10/2009
APPLIED: 07/10/2009
EXPIRES: 01/10/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Low Voltage - Commercial Indus
Amount Paid
Date Paid
Receipt Number
$6.96
$2.90
$58.00
7/10109
7/10/09
7/10/09
2200900000000000782
2200900UU0000000782
2200900000000000782
,
Total Amount Paid
$67.86
I Plan Reviews I
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 Rc>(IL' 'c>d hsnect'oos -
,il.......lllllllflllllr...
Low Voltage: Prior to cover.
By signature, I state and agree, that I bave carefnllyexamined the completed application and do hereby certify that all
information bereon is true and correct, and I further certify that any and all work performed shall be done in accordance witb
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 he 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, tbat 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 ~ignature
Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009cOl014
COM2009cO I 0 14
COM2009-01014
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
2200900000000000782
Date: 07/10/2009
Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
LAN TEL SERVICES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
27854
In Person
Payment Total:
Ilh
Page I of I
II :26:33AM
Amount Due
58.00
2.90
6.96
$67.H6
Amount Paid
$67.86
$67.86
7/10/2009