HomeMy WebLinkAboutPermit Electrical 2009-9-15
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Electrical Permit Application
225 Fifth Street+Springfield, OR 97477+PH(541)726-3753+FAX(54t)726-3689
I C(}~2.bo?- 0 13b Z
Permit no.:
I Date 7-/; -04
This permit is issued under OAR 918-309-0000. Permils are noutrausferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I Residential, per unit, service included:
11.000 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)
1t\1S~ IL.t..,..(./IA W~ SlhN A')JO I Services or feeders: installation, alteration, relocation
I I L.-t....J~ "'I-l:m,I V !;OA ~ 1 I 200 amps or less (2) $ 81.00 $
1~~:~~'~Og~T;~26WN6~=~t~~t~C:~~~ i ~~::::~~::::~~~ ~1::::: ~
I Address: 1870 yr/1tIA/ c;.r 1 1601 to i,ooo amps (2) $205.00 $
I SJ) ~ I _,n 1 97"77 1 lOver 1,000 amps or volts (2) $469.00 $
City: I" r->> State: V- ZIP: .,
I Phone: ~, 1 Fax: ' I Reconnect only (2) I $ 63.00 $
\ E-mail: I Temporary services or feeders: installation, alteration, relocation
This installatiou is being made on residential or farm property I 200 amps or less (2) . I $ 63.00 . $
owned by me or a member of my immediate family. This lQ\.,.t?-100 amps (2)_ _ ,r -rll~ \~ Of-\lI'".OO $
property is not intended for sale, exchange, lease, or rent OAR ~\t
479.540(1) and 479.560(1).. I" I~O!:i.9.~Q,Q,i'I"~!\~:p\..l E^Y':'~:~;nI11 IsI ~M\;.OO $
Signature' ~ I A--' T\ "&vJr'6bb.',;;mp"hr~CtfoD'.vbJiM~eb t';;'ices pNf\:ders section above
. . ,._"r\LIl r-I.~\J, _ .~l~-0i\\F-rf V1
r~~;::.~:~~~~~;:O;:~M:~I~~~~. ~1~t~~{~~;!~~~~~~:~::~:':~::::f":S~:i::e~r feeder, fee
1 Address: 9.>'1 "11 S- ~ i tn'.... l2t4. ' '''Each branch circuit I I $ 6.00 I $
I City:,\:1Lbte:N 6' .' I Statet/IL I ZIP: "I")</-O1..- I b. Feefor branch circuits without purchase of a service or feeder fee:
1 Phone:"'~ tf~- 6J;1.llo I Fax:~-I L/A~-~J'2, 1 I First branch circuit (2) I I $ 55.00 \ $
I E-mail: 1!.--n.i..JLI-I-e.v-Cbw<..--.LN)t.sa......n6. c..w I Each additional branch circuit .. $ 6.00 S
I CCB license no.: \f" ';'-11.0 I BCD li;ense no.: ?1}."~~ll..{; I. Miscellaneous fees: service orfeeder not included I
I Signing supervisor's license uo.: t:;'1'I Sllr I Each 1l\'l"pj9r,il'i~~t!911}!r.!'!f..@law r"quirpf$\il~~b.~.~ $ 1
1 Print name of signing supervisor: ~I'"el.... Rb~~n!) I Eachlo!gh:or <ilitliiie1ligRtihg'f;'). bY tn.E ,':t;I!;'X~~qp:~ h$ 1~-1
I ;0 r' S' ""a~ltl""8Tl(\r..l'~""II.t::I. lIIV-uv"'---'- I
Signature of signing supervisor: .. 1.4 IL'J.....I 11 ~ _ , I al\~n~:.c.!!"}u.l! ~,ri:.,hml\t~(~~fe1ml~rBt1g 1 OP R$16~OOO l~$
_ /__I!I/''fIA",~ rp.)on,or.ex nston }, . __:,:",,,,",+~.,nrtdoc:::IM
, . EaciP&'d1J~~~~'t.~i~~!P!lt},~~~;llllt\~~~~ ~h~. t ~le~~~JQ!l3 ~ $ I
'ii1Ii~Ii~~Ii',I?j$I~~NmltiSEtml!!I8!!g:JilJl\IUlilil
(A) E~;;;;ubtojjteofialio\fe fuo';00'332'2344). I
(Minimum Permit Fee $58.00)' $ l?k-",
(B) Enter 12% surcharge (.12 x [A]) $ IS'1;. I
(C) Technology Fee (5% of[A]) $ If. r I
1 TOTAL fees and sorcharges (A through C): $ 1'#1.411..
1--,,"'""X'O""'it ,'. . '. .,' ''lP' .... '''a'''~-'-'''I
_",lli-All."'!.! . .c~!.!..g.O.\lt::RNMt::Nifn'f~~~RO.vAl.!Ili!4t..",,1l?""S7
1 Zoning approval verified? li9 Yes 0 No 1
lilh.J0JI!II....'!i:;;;;;;4lo:"iCA:TE:GORY"10.<;i%CO.NSTR.UCTIO,N' 1iili~.'"'liililll'...'Jl
,'-<*L, M5?3i""",~0"" '". '.' .. ,. ,.' __,-". ..rdt<.. " __"'_'_'_' '__ L,_'.. --. .J;;;'1:;;fi~1ffiIi"j'40S.1iiiJ
1 0 Residential l 0 Government .1 QS-commercial 1
11i4llli!li'J,0I3'J!S.lmE:'!l.INI7(:!RMJ.\:r;IO~IA:NP!!JI!:(jCA::r;:Il:5~14IIIi!Ii'1!1
I Job site address: fen 0 MmN s-r. 1
I City: ~Pe."l b6l::1..7) 1 State: 0 fl- 1 ZIP: q7<.f'''''' 1
Reference: 170 ~ 3.6. if l I Taxlot.: DO 800
r
"'....QJ ~
\JJ"'~~
~_.lx
~$
440,2584-J (9/08/COM)
$134.00
$
$ 25.00
$
$ 32.00
$
$ 63.00
$
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01362
. ISSUED: 09/15/2009
APPLIED: 09/15/2009
EXPIRES: 03/15/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Pboue
541-726-3676 Fax
541-726-3769 luspection Line
SITE ADDRESS: 1870 MAIN ST
ASSESSOR'S PARCEL NO.: 1703364200800
Spriugfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Sign electric
Owuer:
Address:
SUPER POLLO GRILL LLC
1870 MAIN ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
E S & A SIGN CORP
License
163470
Expiration Date
03/16/2011
Phone
541-485-5546
I BUILDING INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories: Lol Size: .
Height of Struclure S~11SI Floor:
Type of Heat: \\'C. '-NCSl I 2ud Floor:
Water Type: ?\\\'C. \1'"\ :'i \S 1$ I Basemeut:
"Itf~,:t{ge ~r.~'S\-\!'-\..\.. 'C.~\-\\S 'i''C.\\w,\ rGl'l'q FI Garage/Carport
I' Ene(gyiPat~I~\Dt.\'I"\ DONt.D Sq Ft Other:
"\\-\,Si?riuklealBuildiu,,-: !,-'O!,-N uta Occupaut Load:
...\n\-\\J\\'-~1"r\ u\"\ '?<..... .
, . ~ ." - ,,,. .... ....".. ......
I DEVEI;OPMENTdNFORMATION I
, !,-I'l' .. "', '
Overlay Dist:
# Slreel Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
# of Uuits:
Primary Occupaucy Group:
Secoudary Occupaucy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Total:
. Haudicapped:
Compacl:
,
Street Improvements:
Storm Sewer Available:
Special lustructiou:
. eS 'IOU to
_ 10'" leC\\J11 __ "liliN
I PUBLIC.1M!'.ROVE'Mi~i.s:,'o'l tn~u~~~:r~ set I~g~~
, Ii '/'i .....-- I "lOse n~B 952.
10 o. \"on cenle " 0 \nlo,S!dewaU"a1[ype:; '0'1
l'4o\l\ICa .00'1-001. 0 ',eS 0\ \\1 ",')ne
\n Of>..R g52 ma'l obtaIn ~ f~OlY~.si"ciuiSYI~Irj!\s:
0090. . '/o~ne centel. ~ ~ \Jtili\'f l'401)\\IC
callIng 1 lIne Olego 0,332-2344 .
numbel c~nlel \S '\ -eO
Notes:
Description.
Type of Const~uctiou
I V aluat~on Descrintion I
$ Per Sq Ff Square Footage
or multiplier or Bid Amount
Value
Date Calculaled
Paee 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01362
ISSUED: 09/15/2009
APPLIED: 09/15/2009
EXPIRES: 03/]5/2010
VALUE:
225 Fifth Street, Spriugfield, OR
541-726~3753 Phoue
541-726-3676 Fax
541-726-3769 luspectiou Liue
Tolal Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Tecbnology Fee
Sign - Outline Lightiug Each
Amouul Paid
Dale Paid
Receipt Number
$15.12
$6.30
$126.00
9/15/09
9/15/09
9/15/09
1200900000000001063
1200900000000001063
1200900000000001063
Total Amouut Paid
$147.42
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 Relluired Tn.snections I
Sigu Electrical: After couuectiou is made but prior to euergiziug
By siguature, 1 state and agree, that I bave carefully examiued the completed application aud do hereby cerlify that all
informatiou bereon is true and correct, and 1 further certify that any and all work performed shall be done in accordance wilb
the Ordiuauces of the City of Springfield and the Laws of Ihe Stale of Oregon perlaiuing 10 the work described herein, and
Ihat NO OCCUPANCY will be made of auy structure without permissiou of the Community Services Divisiou, Buildiug Safety.
T further certify that ouly coutractors aud employees who are iu compliance with ORS 701.005 will be used ou Ihis project
1 further agree to ensure that all required iuspeclious are requesled "' the proper time, that each address is readable from the
street, that the permit card is loco led at the froul of tbe property, and Ihe approved set of plans will remaiu on Ihe site at all
times during construction.
Owuer or Conlractors Signature
Date
Pa2e 2 on
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
,Job/Journal Number
COM2009-01362
COM2009-0 1362
COM2009-01362
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Description
.Sign - Outline Lighting Each
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
ES&A SIGN CORP
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001063
Date: 09/15/2009
lIem Tolal:
Check Number Authorization
Received By Batch Number Number How Received
djb 015695 In Person
Paymeut Total:
Page 1 of 1
1:42:45PM
Amount Due
126.00
6.30
15.12
$147.42
Amount Paid
$147.42
$147.42
,
9/15/2009