HomeMy WebLinkAboutPermit Electrical 2009-9-30
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Electrical Permit Application
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225 f'ifth Street+Springfield. pR 97477+PH(541)726-37S3+FAX(541)726.3689
I Pennit no.: ('C1 - C\ 7'0
I Date: q l?Of oC;
This permit is issued ur;-der 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 180 days.
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1:;-;~"ii!~l!oC~l"t{G.0YERNME~TJAIi'PROYAl!'",jf,\1il-!k~
I Zoning approval verified? 0 Yes D]\io
1iJl!i\!,1l#il"'t:;-;ni.CATEG.ORY501;IC0NSTRuc;rI(:l,~.1Ji!;a,:;-;}t;0,:t
I. 0 Residential .1 [] Government I 0 Commercial_
It'.U(j0Bji:SITE~.INI;:eRMA'J:10Ni\~ND)i1!0CMI0Nl!FJ1~!~:1
I Job site address: 179q ftonnv fk!:'"""" Wf"S1'
I City: Springfield I State: OR t ZIP:
Reference:
Taxlo!.:
I Install Electrical Service and branch circuits for Q .Street
I Northbound and Southbound l TO EMX Stations.
Name: Lane Transit District
I Address: 3500 East 17th Avenue
I City: Eugene I State: OR
j Phone: 541-682-6100 I Fax:
I E-mail:
17-his installation is being, made on residential or farm 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(1),
I ZIP: 97403
Signature:
ii~~i:~,::~~~Ct::k~~:c;~;~~0Nlim:;-;;;?~lLC[;1
I'.'" '1'..... I
Address.:, Prq !3:9~,41~PO.., ^ I I r",...,l'......- ,... .,..., ,r- lA'.....,...,,/
. tllfU I l-IlIVlI '(VI 1i\lj_l- L../\l qlt.. II I(IeL V~'/llf\
City: E~g~.n3nn 17r:-n I trllr.1 ~1~t~t~lg~)cn~ nkIR:2'97t49~
Phone: :~~iii~'t4~~~H,17~1n' ~~ ~ I~' '/l ~f~~~ ~~~,~i4'i ~~~!t.8' v .
- -- - -. .-- --
E.mail:.:m!~e@R~~p.He.e~.?!.?.s\rjc.com
CCB license no,: 164877 I BCD license no.: C81
Signing supervisor's lice..nse no.: 3023S
I p'rint name of signing supervisor: Dave Feiereise~, _
I Signature of signing supervisor: ~~ # / " ""'--
.~
.~~~
~V S'"
440-2584-J (9!08/COM)
I Residential, per unit, service included:
I 1,000 sq. ft. or less (4)
I Each additional 500 sq. 11. or portion
thereof
I I Limited energy (2)
! Each manufactured home or modular
dwelling service or feeder (2) .
I Services or feeders: installation. alteration, relocation
I 200 amps or less (2) 1 $ 81.00 81,00
I 201 to 400 amps (2) $ 95.00 $
I 401 to 600 amps (2) $158.00 $
I I 601 to 1,000 amps (2) $205.00 $
I lOver 1,000 amps or volts (2) $469.00 $
I I Reconnect only (2) $ "63.00 $
I I Temporary services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 63.00
1201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
lOver 600 amps or 1,000 volts, see services or leedcrs section above
I Branch circuits: new, alteration. e.-Ttension per panel
I a.. Fee fOTI brancl);circuits with..purchase,of a.service or,feedcfufee:
1"\1 1 L-l~ IIVI". VIC;...JVlt tcnv IC.....Ullt;;~ vvu ~
I Each(or!kch'ciiCtitS adopted by ljI28(1re$C6:obl1l :i68,00
I b.. Feeft07bran~hICifCJitg.{.:rI{l1out'purHlase'of~a'="SerV'ic?or feet{crt fee:
:_ 1"'\ ^ n f'\l:'f"'l "........ ""O! r, n.......... .""h ,...., ^ D nt='1 ('\('\-1
I FirsE~ri~r~ ~4r~l}~-T21~ ~bt~in"~;[li~~' elf' t~j~f.99.:1; -tv
I I Each addition~.1 brai1chrcircuit (Notl!: thE ti$1E~:OO) lE$
I I . nllmD-:'Ir Tnr Tn/:) I lr':"fl:")n I 'T!lIT'; '\l"'IITICa[.lon
Mlscellan~ous fe~:~s~T\?~~ 9rle't.ii~~/nR!//JC!1!,4e..a:\
I I Each pump or ilTig;[;~~'C;r~j;, (2r~~ ~I-- -I' j;'63,OO I $
I Each sign or outline lighting (2) $ 63.00 $
I' Signal circuit or a limited-eo..erg)' panel. I $ 63.00 $
alteration, or extension (2)
I $58.00 $
$134.00
$
$ 25.00
$
$ 32.00
$
$ 63.00
$
Each addWonaJ inspection: (l)
I (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (13) Enter 12% surcharge (.12, [A])
I (e) Technology Fcc (5% of[A])
I TOTAL fees and surcharges (A through C):
$249.00
$29,88
$12.45
I $291,33
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CITY OF SPRINGFIELD
Building/Combination Permit
Status Pending
225 Fifth Street, Springfield,'.OR "
541-726-3753 Phone,
541-726'3676 Fax
541-72623769 Inspection Line
PERMIT NO: COM2009-00925
ISSUED:
APPLIED:
EXPIRES:
VALUE:
06/25/2009
03/30/2010
SITE ADDRESS: 1799 PIONEER PARKWAY WEST I SPRINGFIETYPE OF WORK: Electrical Work Only
ASSESSOR'S PARCEL NO:: ROW-MISC
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION:' Electrical Conduit for LTD Station
Owner: .
Address:
LANE FOREST PRODUCTS
800.,42ND ST ,I
SPRINGFIELD. OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
'. CAMP CREEK ELECTRIC LLC
License
164877
Expiration Date
06/09/2011
Phone
541-746-1471
BUILDING INFORMATION I
# of Units:
Primary Occup'anc)' Group::
l'Hf1r~n- .
Secondary Occupancy.Group: Type of Heat:
Primary Constructio,nfIiY~I~T SHAL Water Type:
Secondary Cons!r.u.~~~~ll8eiJ L EXPIRE IF mta'l~l:@'fe:
# ofBedrooms~'OIV1f0HjC ' NDER THIS PERM/f~~r~rrlt.ith:
, \(\1 ; ED OR IS ABANDONED SprRinkleil Building:
".1 IHn n^v nrr-,'............ tU
-. ""-'1.1.
I DEVELOPMENT INFORMATION'
# of Stories:
Height of Structure
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
ATTENTION: Oregoff!\J1,~iF~!l!l~~s you to
follow rules adopte()(Lo}'m~cbregon Utility
Notification Center. Those rules are set forfh
in OAR 852-001-0010 through OAR 852-001-
f"If'\(,,\(,\ \F_.. ___.. ~'-~_' . '." _
-'J --.-... ~~I...''"'''-'....' ",,,", ''''''vv vy
I PUBLIC IMPROVEMENTS' calling the center, (Note: the telephone
. nurg~er fOI'kt~e Oregon Utility Notification
I e~~. ,,5,y,~ei -800-332-2344).
Downspouts/Drains:
Overlay Disl:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
,
I Valuation Description I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I 012
_~SI~"!~.lli!:':!;
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Status
Pending
225 Fift" Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726;3769 Inspection Line
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Total Value of Project
,:
F'~.e:' P,aidJ
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Aiter, Extend Ore Ea:Add
Perm ServlFdr 200 amps or less
. "
Amount Paid
Date Paid
$29.88
$12.45
$168.00
$81.00
Total Amount Paid
$291.33
Plan Reviews I
9/30/09
9/30/09
9/30109
9/30/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00925
ISSUED:
APPLIED:
EXPIRES:
VALUE:
06(25/2009
03(30/2010
Receipt Number
2200900000000001117
2200900000000001117
2200900000000001117
2200900000000001117
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.
Reollired Insnections I
B nderground Electric: Prior to cover
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I 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 with
the Ordinances ofthe City 6r 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 fnrther 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.
.~~,(r_~.
ow~r Contractors Signature
Paee 2 of 2
Date
'7- 30-6,,/
2i5 Fifth Street
Springfield, Oregon 97477
54-1-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
, RECEIPT #:
2200900000000001117
Date: 09/30/2009
11:06:20AM
Job/Journal Number
C0M2009-00925
COM2009-00925
COM2009-00925
COM2009-00925
. Description
Penn S~rvlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
.+ 5% Technology Fee
'.+ 12% State Surcharge
,
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
81.00
168.00
12.45
29,88
$291.33
Payments:
Type of Payment
Cred itCard
Paid'By
CAMP CREEK ELECTRlC
Amount Paid
KR 576194 In Person
Payment Total:
$291.33
$291.33
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cReceintl
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9/30/2009