HomeMy WebLinkAboutPermit Electrical 2009-9-11
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CITYOF SPRINGFIELD, OREGON
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225 Fifth Street.Sprin~,field, OR 97477+PH(S41)726~3753+FAX(541)726-3689
._........... I - DEPARTMENT USE ONLY
& ~ I Permitno.('Sl- \ 3E)O
I Date q - \ \ - nq
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Electrical Permit Application
This permit is issu'ed under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance of if work is suspended for 180 days.
I LOCAL.: GOVERNMENT APPROVAL I FEE SCHEDULE
1 Zoning approval verified? 0 Ves 0 No ]1 Number or inspections p<r item () !Qty.1 ~ I ~::I
I CATEGORY OF CONSTRUCTION I
I I I I Residential, per unit, service included:
o Residential ,M'Government 0 Commercial
I JOB SITE ilNFORMATION AND LOCATION 1 11,000 sq. ft, or less (4) $134.00 $
I Job site address' 3 f, '1 '8 f";l... t \ ~ " ~, v rl 1 I ~~~~:ritionaI500 sq. ft. or portion $ 25.00 $
I City: E" '" 0, ~ .... ~ I State. '> ~ I ZIP: 91 ~ 071 I Limited energy (2) $ 32.00 $ I
I Reference: ~~\ I TaxlotDO\CX) I I Each manuractured home orl1)odular $ 63.00 $ I
I DESCRII'TION OF WORK I dwellmg servICe or feeder (2)
I -r C""'..1::' ": ("' I I I Services or feeders: installation. alteration, relocation I
I (~"'" C' ...)1J "'."
I r- v~,' It> 1 '1 I] \ 1"\ 1 200anlps or less (2) I \ $ 81.00 $'g\~1
r~"..........h...' Dt "'~ H">>d....,Sl>,..., n Ve-
I PROPERTY OWNER ! 201 to 400 amps (2) $ 95.00 $ I
I Name: 0 DO)' , \ I 401 to 600 amps (2) $158.00 $ I
1 Address: 'is'&S J\;Y'~o<\ ~d -Sf... B).\e, I'l I I 601 to 1,000 amps (2) $205.00 $ 1
1 City: 0d\~-': I State:O'R, I ZIP. "I "P3 0 1 I Over 1,000 amps or volts (2) $469.00 $ I
I Phone:~o3 -<t~6-2633 I Fax:S0 -"l'86-<.6Q,5 I 1 Reconnect only (2) 1$63.00 $ I
I '1 C\' c. L ""D ^ ( . , ;t ~ ~ 1 Temporary services or feeders: installation, alteration, relocation 1
E-mm:' .._ .1\.'<;.)E.(!)O<i1J ..~I"I~.O'_l.1~
200 amps or less (2) I $ 00 $ I
This installation is ,'being made on residential or farm property 63.
owned by me or a member of my immediate family. This 1 201 to 400 amps (2) $ 87.00 $ I
I ~l?1qp~t!Y=)s not mtended for sale, exchange, lease, or rent. OAR I I
.. 472.~40Ul and 479.560(1). 401 to 600 anlps (2) l$1~..00 $
. ~11'~a I-'tuE,Re.rVlIT SHALL EXPIRE IF THE WORK - lOver 600 amp,s or 1,'OoO!;jbi~,\~;~~ld~!:t'i~ ,,~'r'foe'd~;.'declionabove I
1'-1 M 1l""r'1 ".... ....."",," '"'.., .1..1111 n Ilnr,::.l h '::).\'11 11'1 .1i-lnliHlul
I", ,-.-.,;, ;;~.CO~~1iO~I~S"Atll!AnQ)l\ll J I Branch cii.~its;de;;'~;I&;di;:'~,<!xt.nsiD;'jJZerJo'l!!~11 BUlIIBO 1
;i~~~~~;R~:~~~~.~~Mo~ftl~~c:t.. L I a, Fee r9ll~~~C;~i~l;;~';&r,,;;:Se~~";~ce6'{feede'i(fee~ I
l"Adch-~s~: '1O"l.?::'<:::t:~ J S1',......~ $,E. I 1 Each?hQ.~li:CSt20!.'?~.~,,~u:,;,\~'I.l:cJ~~$,~,~~!l,~I~:$rt~ I
1 City: '" ~ 1 0 ~_ I State: <.) ~ \, ZIP: to 7 <' ","11 I b. Fee rOl;~rahclicircu[t,wiiiiou(puiciias~~o'f,aservice:orlfeede;j'fee.
-....J.. ,.... .~ J'.,. -, ~ ",,-- 1\1111111 ulludJf I dUJ. J,U I..IO~Uu.....", ......1'... ."...11....,-
I Phone(6o,3),s G 6~t \) 0 I Fax:(s~) <5 S9-c'l "I-S I I First braIlWcircuit(,g)lbaJ Mel uotlaJol:MJ5).06~1$V' I
IE-maiLk.h...~;'\'\~"..<:.k.rfJc;-r~e,.,-:h~",.l'.o"",1 I Each additionalbraoch circuit I 1$ 6.001 $ I
[ CCB license no.: 7t \ ~ G "8 I BCD liceJse no.:3 7-~z..() c. \ \ Miscellaneous fees: service or feedernot included I
I Signing supervisor's license no,. 13 8t;- 5 I I Each pump or irrigation circle (2) $ 63.00 $ I
I Print name ofsign'l"ng supervisor:,<~y\"T'~)... W ~ ~o. ~ \ 1;1~ Each sign or outline lighting (2)' $ 63.00 $ I
I S. f."" . :....y ..1\\\. \y I ...... t\h Signal circuit or a limited~energy panel, $ 63.00 $ 1
19nature 0 slgnmg supervIsor. t\ ~W '" ~ alteration, or extension (2)
I Each additional inspection: (1) $58.00 $
Ilml~1i!;l~:;,;mi!~i!Yiiiif.i~~cii/'A~~UC:a:NTllJSE.ifdiJ."'d.iil~'1iB~dilF
I (A) Enter subtotal of above fees 0"3
$l::!':<-.
(Minimum Permit Fee $58.00) ,'-.)
1 (8) Enterl2% surcharge (.12 x [A]) $ \ \ ~ 1
I (C) Technology Fee (5% of [A]) $qJ.!- I
I TOTAL rees and surcharges (A through C): $ \ 0 ~ ~ I
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440-2584.) (9IGBICOM)
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CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Iss \1 ed
PERMIT NO: COM2009"01350
ISSUED: 09/11/2009
APPLIED: 09/11/2009
EXPIRES: 03/11/2010
VALUE: '
,
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
"
SITE ADDRESS: 3698 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: .1703343100100
Eugene
TVPE OF WORK: Electrical Work Only
, TYPE OF USE: New
"
PROJECT DESCRIPTION: Traffic signal for Franklin Blvd. & Henderson Ave.
Public
Owner: MOE STEPHEN S 1-2
Address: PO BOX 847
SPRINGIiIELD OR 97477
I CONTRACTOR INFORMATION .
Contractor Type
Electrical
Contractor
CHERRV CITY ELECTRIC
License
91668
Expiration Date
07/20/2011
Phone
sdempsey@Ycher
BUILDING INFORMATION,'
# of Units: # of Stories:
Primary Occupancy ~roup: Height of Structure
Secondary Occup'.ncy r.roup: Type of Heat:
. ~.lill:tl~~
Pnmary Construchoni:fo/pe Water Type:
Secondary Co~,SHfuc'tio,', nrI]yp<l!HALL EXPIRE IF T~"l\~R'~pe:
# ofBedrooms:UTHORIZED UNDER THIS PERMlt~.rl\1~ ath:. .
COMM5NCED OR IS ABANDONED mRn'Ri d BUlldmg:
J;I~ Y IOU UAY t'tKIUD.
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I _ ~' J.El]lla,Cl
. ~\78'1:-'1:88-008 \R \.!UI~E!I.JI~ING
UOllllOll'lON Al!l!ln, uoBalU ~"" Liw" .
aUOllda\al alll :aloN) '!Folli)] alll 6u!!lll0
Aq sa!nrallllO sa!doo U!llHan~It~pp'(,\j: 0600
-\00-'1:96l:llfO ll6nollll 0IQllnl(i.l'ci':;i6l:llfO U!
llPOllas alll salnl aSOll1 'lalua::> uO!\llo!l!loN
A1I\lln uoBalO alll Aq paldopll SalDA MOllol
_"'M' o~,,,,h,,, ",,, uo6al() :N011N3111f
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Availabl~:
Special Instruction:
Sidewalk Type:
Downspoutsffirains:
Notes:
I V~luatio~ DescriDtio~ I'
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee l'of 2
,
-r!~~~~'~;:"::' "
Status
II
Issued
"
225 Fifth Street, Springfield, OR
541-726-3753 Phone "
541-726-3676 Fax
541-726-37691nspection Line
Fee Description
+ 12 % State Surcharge
+ 5% Technology Fee"
Add, Alter, Extend qrc Ea Add
Perm ServlFdr 200 "')Ips or less
Amount Paid
$11.16
$4.65
$12.00
$81.00
Total Amount Paid
$108.81
Total Value of Project
Fee,s Paid I
I Plan Reviews ,
Date Paid
9111109
9111109
9111109
9111109
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01350
ISSUED: 09111/2009
APPLIED: 09/11/2009
EXPIRES: 03/11/2010
VALUE:
Receipt Number
2200900000000001036
2200900000000001036
2200900000000001036
2200900000000001036
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. '
Reruired Tn,~nection~, I
Rough Electric: P~ior to Cover
Final Electric: ,iWhen all electrical work is complete.
By signature, T state and agree, that I have carefully 'examined the completed application 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 ~ith
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
tbat 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
times during construction.
Owner or Contractors Signature
Paee 2 of 2
Date
225 Fifth Street
Springfield, Oregon ~7477
541-726-3759 Phone
. City of Springfield Official Receipt
Development Services Department
Public Works Department
I; RECEIPT #:
,
2200900000000001036
Date: 09/11/2009
1:54:15PM
Job/Journal Number
COM2009-01350
COM2009-0 1350
COM2009-0J350
COM2009-01350
Description
~erm ServIFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
-t: 5% Technology Fee
I'
i 12% State Surcharge
~ .
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
81.00
12.00
4,65
11.16
$108.81
Payments:
Type of Payment
Check
Paid By
MORROW-MEADOWS
CORP/CHERRV CITV
ELECTRIC
Amount Paid
KR
22109
By Maij
$108.81
Payment Total:
$108.81
cReceintl
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9/11/2009