HomeMy WebLinkAboutPermit Electrical 2009-6-18
Electrical Permit Application
D
225 Fifth Street+Springfield, OR 97477. PH(541 )726-3753. ~AX(54I)726-3689
I Permit no.: 0.A / f/81-
1o.l5.cP\
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 189 days.
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I Zoning approval verified? DYes' D No I
l.fr:h:-""%Y'ilil17y::r:-'C''''EGO'R''I:f,O'','',fC,' O' ,NSTRU"C' "'10' 'NfrRIo_, -,-' !.iiili~,:
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I" [J~,esid~?tial "', ," ,,I 0 GO,v,ernment.. "~m_mercial,,.. ..,1
Ili~&ill!\lJOB\SITE~INf:ORI\II~TIONifAND~l!:O:CATIONilI.~~rtlll
I lob site address: 9.2 9" /.>>A/N J--j- I
I CitySr>.<'hU6,.c/,G"U] State: D'€" I ZIP: I
I Referenc; \'HY~/)tb'2."\ I Taxlo!. O.lela2-
~r"Y2f , '; "''':lrmLj,. .', ',"'," 8!, fi ' ' " !t;~f0:s5?k:]f"Bt!:l,a;,'i;<
,.....!I!liI\RiJ!l!ili.,ffloDESCRII?,TION"-'OIi"WORK",,'-~f-'TIfflo1f4j-r?'Blii!lt'"
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I /' J C'-'y J" " y ~ ". I
[:::~\1!(1i~~R~~~'~J\B!~\~'R1
I Address: 1I}L4 \J{~ .s, \' I
I City:.Cl,N 0 ilMo Qd I State(JL I zIPCl1,",111
I Phone: \-~- I Fax: - I
I E-mail: I
This installation is being made on residential or fann property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560( I).
I Residential, per unit, service included:
I 1,000 sq. ft. or less (4)
I Each additional 500 sq. ft. or portion'
thereof .
I Limited energy (2)
I Each manufactured home or modular
dwelling service or feeder (2)
I Services or feeders: insmllation, alteration"relocation
200 amps or less (2) $ 81.00
$134.00
$ 25.00
$ 32.00
$ 63.00
201[0400 amps (2)
40110600 amps (2)
601 to 1.000 amps (2)
Over 1,000 amps or volts (2)
$ 95.00
$158.00
$205.00
$469.00
$ 63.00
$
$
$
$
$
$
$
$
$
$
$
$
$
Signature: Over 600 am~s or 1,000 volts, see services or feeders section above
1~.ilihCOI>ITRAci(OR~INSTAI.!I!t\.'!;ION!J!lii.1j[_IlfiP.;i~~.@iI!1 Branch circuits: new. al/eratian. ex/ens ion per panel
I Business name: ~~.. ~ ,- /' J" J c/ee- /..IU<b a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: 2 .L 1 D 4:" e /~. r-r /1/ d I Each branch circuit I I $ 6.00 I $
I City:/! r'rn-1/J rvJI State: O-e. I ZIP: 97?-J.A-I b. Fee for branch circuits without purchase ofa service or feeder fee:
Phonef~ S t 7 0 2. <-- [$ I Fax: f"Y/- f6? "71. / C,. I I First branch circuit (2) I I $ 55.00 I $
E.-mail: I I Each additional branch circuit $ 6.00 $
Reconnect only (2)
200 amps or less (2)
$ 63.00
I
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I
I
I
I
I
I
I
I
I
Temporary senrices or feeders: installation, alteration, relocation I
I
I
I
I
I
I
I
I
I
I
CCB licenseno....:2 935'0 I BCD Iicenseno.:..?o .,I;,.t;; r I Miscellaneous fees: service orfeedernot included I
Signing supervisor's license no.: ,~g?..s - I EachPumpOri~gatlOn~ircle(2) $ 63.00 $ I.
Print name of signing sup.j'P!iij?"!~~'~-:3<1't. /"-.:.fr,.$"",.., I I Each Sign oroutlme I1gbtlOg (2) $ 63.00 $b"J'-+-
I Signatureofsian_~lil~,,:"n"'-r~...d'a':l).- 'i01?>\f\/O? ./ I I Signaldrcuil ora limited-energy panel, $ 63.00 $ I
.riWCl:~U>S ~~q",,~~~p ~ P./ --- I 1 alteratIOn, orextenSlOn (2)
~. 0' Of""- ~ \Of\>'. '{OU " ~e'. ~': II I
.......,,,"1\0 6b~we elese ;;l;;l9J()' O~ce'OO ,.~Eachadditionalinspection:(I) $58.00 I $ I
p."\ ,- 60",\e lIl\eS ,,-nJ;JO\ ....eclilf\.."'~O 'f"{\ $rt(!1W!m,um"s"""X1If-'TIfflo1f . ~ " ""-'-'*" "''''' "~@-""-&f'
lIl\es e "I~oslil ~ 9J"~ ~\\f\\) '" f\ \}\I\i', fj..?\'i'-~ '''I~\S'f,_-D--~(m:illfuJl<A.eaI!ICA.NTlIUSElElNliKR'0l!-'.(*'.:e_f'1
cef\\e~~loll\)~ ~\lilS b~ c~e OIf!!~P C~\ S~"""\. \}~Q~~Q O'il ~\@il.r subtotal of above fees ~ I' I
O()\~es 0\ weUf{lbel\~?y.o\~. O"\l ?~'il.""\:'O'il.\'Z.~~~~~~C... QI'o'{ 'W:inimum Permil Fee $58.00) $6..1' --j
OJ"" f\e f\ QQ''!>'!; ~\s 1'0\)"1<>;( ~o'" \Bv . I
\e\e",~oiS\'~ ~ O'il.'f-, \s~o" ~ d\ (B) Enter 12%surcharge(.12x[A]) I $ 7 sd
11\01 'il.~i"''i eO ' '
ce ?~.;>:.~')O'-l:~ "<\' I (C) Technology Fee (5% of [A)) I $ J./.rj-
" r;vl\i ~ ~.'-' . rv;<< I TOTAL fees and surcharges (A through C): I SJ..J."7 Ii
440.2584-) (9/08/COM) ~
201 to 400 amps (2)
401 to 600 amps (2)
$ 87.00
$126.00
Status
Issued
CITY OF SPRINGFmLtJ
Building/Combination Permit
PERMIT NO: COM2009-00882
ISSUED: 07/24/2009
APPLIED: 06/18/2009
EXPIRES: 01/24/2010
VALUE: $ 600.00
.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 924 MAIN ST
ASSESSOR'S PARCEL NO.: 1703354206100
Springfield TYPE OF WORK: Sign
TYPE OF USE: Addition
PROJECT DESCRIPTION: Wall Sign attached to existing East Wall Sign" Oregon Lottery
Commercial
Owner: MCKENZIE ENTERTAINMENT LLC
Address: 924 MAIN ST
SPRINGFIELD OR 97477
Phone Number: 541-746-8221
. I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Sign
Contractor
PETERSON ELECTRIC INC
PETERSON ELECTRIC INC
License!
29350
29350
Expiration Date
;/01122/2011
01122/2011
Phone
541-567-0228
541-567-0228
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:
jSq Ft 2nd Floor:
'~q Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
\O~lU' '
01l\0 ~Y:"
1l\1~~~0\-
Oll\a'I't~\.l~~~~\'~d:
Ot\". Ot~e O~se\ \0 ~v(,tR"'O~I.R:q\lQlI
,..'(tE.~9\eG ~':I{Illes ~~.oO\~~aS~d~age:
{illeS lit ~5 O"'~ 9 ce.\\\1I9 ~oll
"'~1I\8' ~,~'lI ',,5\)':I .~..Ol .
fr, fll~~ -"',
OO~e'sO\elllllll\)8~~~~I'UaLlC IMPROVEMENTS.
cO~ :lIol"i ,&00'" 1
Street Improvements: \ele9 tIS \-
cell\e
Storm Sewer Available:
Special Instruction:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Fronlyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Sidewalk Type:
Notes:
DownspoutslDrains:
p\RE If 1I'1E
tlOi\CE: Ii 51'1j1.\.l. E)(i DER 1\'\\5
1\'\15 '::~\'\ORI1~~~~tlCED tp~R\OD.
wORMl1 \S N01 C RI'.tl'< \'&00
pER OtlEO 1'0
P.61'.~O
Paee 1 of 3
. .
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax,
541-726-3769 Inspection Line
Descriotion
Tvpe of Construction
Sien
Use Bid Amount
Fee D~scription
***+.100/0 Administrative Fee***
+ 12% State Surcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
Sign 0-35 Square Feet
Sign Plan Review
Total Amount Paid
Initial Review
06/1812009
Initial Review
07/0612009
Sien Review
06/18/2009
I, Valuation Oescrintion I
$ Per Sq Ft
or mnltiplier
$1.00
Square Footage
or Bid Amount
600.00
Total Value of Project
f,1'~~, fq;rl I
Amount Paid
$14.30
$7.56
$7.15
$63.00
$80.00
$42.00
$214.0l'
Date Paid
6/25/09
6/25/09
6/25/09
6/25/09
6/25/09
6/25/09
I Plan Reviews I
06/18/2009
07/0612009
07/24/2009
WE
10
APP DJB
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00882
ISSUED: 07/24/2009
APPLIED: 06/18/2009
EXPIRES: 01/24/2010
VALUE: $ 600.00
Value
Date Calculated
06/18/2009 .
$600.00
$600.00
Receipt Number
3200900000000000485
3200900000000000485
3200900000000000485
3200900000000000485
3200900000000000485
3200900000000000485
LLH
Plans and chc.ck received via mail.
Check was written in the amoung of
207.71. Incorrect amouut. I will
process the sign permit and place on
David Bowlsby desk for review next
week. I am returning the check to
peterson Electric for"replacement.
Actual amount due 214.01
LLH
Correct amount of check mailed but
review has not been completed. We
cannot hold checks, I issued on
,6/25/09. Issuance in this case does
not mean approval, it recognizes
that payment has been received.
Plan review not valid until David
Bowlsby has completed and
approved plans.
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.
Paee 2 of3
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-00882
ISSUED: 07/24/2009
APPLIED: 06/18/2009
EXPIRES: 01/24/2010
VALUE: $ 600.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769/nspeetion Line
I Reouired" In,S\lection~ I
Sign Attachment: Method of mounting the sign to a structure or pole. Method of attachment of bolts or welds.
Sign Electrical: After connection is made but prior to energizing.
Sign Final: After all required inspections are conducted and approved and the sign installation is completed.
By signature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correCt, and 1 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
timesdUringCOnstr~~:'J"I,4;1 (.l.^,hl.. /."5"...,, jz' ZU},D <::
'1.-'>~ Ji/r -l--o t: t;; r 7 v f
Owner or Contractors Signatu~~#"'- ~fJ Date
Pal!e 3 of3
225 Fifth Street
Springfield, Oregon 97477
541-726-375'9 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00882
COM2009-00882
COM2009-00882
COM2009-00882
COM2009-00882
COM2009-00882
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
3200900000000000485
Date: 06/25/2009
Description
Sign Plan Review
Sign Oc35 Square Feet
Sign - Outline Lighling Each
+ 5% Technology Fee
+ 12% State Surcharge
***+ 10% Administrative Fee***
Paid By
PETERSON ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 25706 In Person
Payment Total:
Page 1 of 1
2:50:03PM
Amount Due
42.00
80,00
63.00
7.15
7.56
14.30
$214.UI
Amount Paid
$214.01
$214.UI
7/24/2009