HomeMy WebLinkAboutPermit Electrical 2009-10-28
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Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753+ FAX(541)726~3689
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, I Date!O -2 ~-O f I
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 180 days.
I Residential, per unit, service'included:
11,000 sq. ft. or less (4)
I Each additional 500 sq. ft. gr portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
I Se!:yi~es or feeders: installation, alteration. relocation
20.0 anips o! less (2) 11 $ 81,00 81.00
t.o 40.0 amps (2) $ 95,00 $
I Name: Lane Transit District () , '~'o'l,i~'609'?lri~~Ji),,, $158.00 $
1 Address: 3500 East 17th Avenue 'l,,~~;~)jli,~~'ti!Jqo'a(]Jp"s\i):'? .(;", $205,00 $
I City: Eugene 1 State: OR 1 ZIP: 97403 I.~I ffl\!>;.rIll)9Ynip~)ct9;Y91k~/'~h I $469.00 I $
1 Phone: 541-682-6100 1 Fax IOJraGj..B~>>fiif)f9/'0;'6>/'''1:~?/';19<l';, I $ 63,00 I $
E-mail: 1 I f'(lIli>~<i!>))~~fQGe"'/'.II,;qt1l(i<j'<<~~alleration. relocation
Th" II' . b d 'd' I r 1200affi~~. '.It<:O'..1''1'',:,,&,,,,,, ~;..- $ 63.00
IS msta atlOn IS eing ma eon reSl entia or larm property '/~ U) \7",-_" AJ-"Y
owned by me or a member of my immediate family. This I 20 I to 400 '. . ~ A r6~:- ~/:'OO'j~ $ 87.00 $
property is not intended for sale, exchange, lease, orrent. OAR iZ;.:~( --"
479.540(1) and 479.560( I). I 40t to 600 amps (~{~~-'}O.,~'" ~( $126.00 $
Signature: lOver 600 amps or 1,000 VO]~ervices or fceders section above I
IrtMt;~,i~~;"~.C.oN"rAA'"c;roa."~INSTAl!li!~iI7I0N~~:1 I Branch circuit~: new, altera/ion. extension per panel I
I Business na~e: Camp Creek Electric LLC I I a. Fee for branch circuits with purchase ofa service or fceder fee: I
1 Address: PO Box 41900 1_ I 1 Each branch circuit 114 I $ 6,00 [84.00 I
1 City' Eugene 1 State: O~:~OJk;::'IP: 97404 1 I b. Feefor branch circuits without purchase ofa service or feederfee: I
I Phone: 541-746-1471 I Faof;~~M'~08 :"It! Fie;tbranch circait (2) I $ 55.00 I $ I
1 E-mail: mike@campcreekelectri~:ijO.o~.y4.l.l I, Each additional bra~ch circuit $ 6,00 $ I
I CCB license no.: 164877 IBtBl(t$'~;(!'a::A~iSr.4', I I Miseellaneous fees: service orjeeder not incladed I
1 Signing supervisor's license no.: 3023f!T(J /) l.;~{) ;:!VfJ,t:; '( ~, l'Each pump or lITIgatIOn CIrcle (2) $ 63.00 $ 1
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Print name of signing supervisor: Dave FelerM'"~ /0' '~~' l,cf-,-'nfh sign or outline Ilghtmg (2) $ 63.00 $
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Signature of signing supervisor: ~.._ ~..c14'j). I 'rc~it or a limited-energy panel, $ 63.00 $ I
' .. -wc.~, .'. extensIOn (2)
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:i!!ii'lhr-4!rti!!1!l1!:tlig~Ii'f4.il'ARFll:!ICAN;rlS.USE;;",;f~"'\-':-7j!.jj!J1'<.;:;~;.i "I
I (A) Enter subtotal of above fees $165.00 I
(Minimum Permit Fcc S58.00)
I (8) Enter 12% surcharge (.12 x [A}) $19.80 I
1 (C) Technology Fee (5% of[A}) $8.25 I
I TOTAL fees and surcharges (A thr.ough C): $193.05
.1~j!iiiC~jtrO.CAlij(C;<:>YE.RNMEN'I'.fA~RR0YAL!:~:)l'j1!1!'1!i:l'...'!l:!1
I Zoning approval verified? 0 Yes D No
Ilitil5:itflH.:mICATEC;0.RY!I'OF1IGONSJRl,j,C't10N~.:l(_~!111!,i
1 0 Residential [I(] Government I 0 Commercial
;:ii:~'\-ilOa:lSliTEiINF:ORMA;rION"';AN[)JlliI<:>CA;rloN!l:,:a:li!l'-!l!:l~
Job site address: (5"::1. P,;'1~f;Y R<.IC~ Wt:S't 1
City: Springfield State: OR I ZIP: 97l(7"t
I Reference: 'i2-oW- JM I~cl Taxlot.: I,
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riN,JU-5di)1bfu'ilihidjfjEilfFlli '.. . " .RI~: '.. lliOF~kWORt('mi!j%"-R;:*d~1fu;rnif~;TI1\8
1 Install Electrical Service and branch circuils for Centennial 1
I EMX bus station.
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440,2584,J (9/0S/COM)
$134.00
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$ 25,00
$
$ 32.00
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$ 63.00
$
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Status Issued'
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225 Fifth Streei;Sprlngfleld;:OR{\ ,"~
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541-726-3753 Phone ',' ,';:"c
541-726-3676 Fax'
541-726-37691nspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00924
ISSUED: 10/28/2009
APPLIED: ' 06/25/2009
EXPIRES: 04/28/2010
VALUE:
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SITE ADDRESS:' ,,{.c1302'PIONEER PARKWAY WEST I SPRINGFIETYPE OF WORK: Electrical Work Only
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ASSESSOR'S PARCEL' NO.: ROW-MISC
Commercial
::..' ~ ~,.. . TYPE OF USE: New
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. PROJECT DESCRiPtION:')-rElecthcal service and brauch circuits for Centennial EMX bus station
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Contract~~ t~~e\f',;i:.'Contractor License
Electrical CAMP CREEK ELECTRICLLC.. 164877
I BUlLD.ING,INFORMATlON ~
() m OAA'''~ol) Ce -vPled b -" requ' .
009& <1,%wr~tter. Iho Y the Or:res You It Size:
cat~el~lilff!~h;f{Ql~r~e rUles aYOf/ Uti/ F t 1st Floor:
I1UIr/#.'{{,t!ltr ~I?ta/f/ Co ~9h OAR e Set fo Ft 2nd Floor:
WhlE\'llycJlOer. (Not~!eS Of the 952'00. Ft Basement:
Raif'glltJ}y/Se{e90f/ Ut/he tete ~Ule8 biq Ft GaragelCarport
Energy Patti:800-?J;.lty NOt;'!! o~e Sq Ft Other:.
Sprinkled Building: <344).n'fillt'O/J Occupant Load:
Nn""A,
, fH'sr~;&ic ~MPROVEMENTS I
1 't'f' AUrf-lO 1 /"'I'n~ ",H,'. ,
::.".: ;;,~ljJ Co '1 RIZED o)riAll fXp "',,,;,,.:.~~~ewalk Type:
,. . ,t, AlVy~MEIVCED glVDER rHl~E IF 'THE ~o';'nspoutS/Drains:
80 DAY PE~~ A8AIVDb~RM'" IS :O~/(
D. . ED FOR '
Owner: LANE TRANSIT DISTRICT
Address: PO BOX 7070 ,:. "d), ,;' ,',
EUGENE OR 9740it'!E' ",.
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# of Units: " . .<<r.
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Primary Occupancy,Group: ' .;
Secondary Occupancy Group:
Primary Construction Type
, Secondary ConstructlOll'Type: "', .'
# of Bedrooms: -- . . '." ':; 'r
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Frontyard Sethack::: .'; .
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Side 1 Setback::" .-
Side 2 Sethack: Ii: "",' . :~
Rearyard Setback: 1- [;1 ~',. ",
Solar Setbacks:
."'...... ;:
Street Improvelllents: . "'
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Storm SewerAvailahle:: .:
Special Instruction: '
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Notes:
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Description ;; Type of Const~~etion
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Phone Numher: 541-682-6100
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I CONTRACTOR INFORMATION ~
Expiration Date
06109/2011
Phone
541-746-1471
I'DEYELOPMENT INFORM~TION I
REQUIRED PARKING
,
,
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
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"I Valuation Descrintion I
. _,' III
$ Per Sq' Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of 2
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00924
ISSUED: 10/28/2009
APPLIED: 06/25/2009
EXPIRES: 04/28/2010
VALUE:
225 Fifth Street, Springfield"O~>j",;:,. ' "
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541-726-3769 I.(spection Line
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Total Value of Project
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'",.; ,',,"",,' ""'.,>,.,,]. ''Amount Paid
Fee Description"i.~.>~'.?r/'.'.:,~.:, "':"
+ 12% State Snrcharge
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., '+ 5% Technology Fee .': .
Add, Alter, Extend tire Ea Add;
Perm Serv/Fdr 200 a.mps or less" ',I
F~es PaidJ
Date Paid
Receipt Number
$19.80
$8.25
$84.00
$81.00
10128/09
10128109
10/28109
10/28/09
2200900000000001229
2200900000000001229
2200900000000001229
2200900000000001229
Total Amount Paid
,$193.05
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Plan Reviews I
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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. <)
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~eollired Insne"tjo?~ ,
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Electric Service: ,Approval required prior to utility company energizing service.
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Rough Electric: Prior to Cover
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Final Electric: When aU electrical work is complete.
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By signature, I state and agree, thatI have carefully examined the completed application and do hereby certify that all
information her~o~ ~ trfte and 'corr~ct, and 1 fu~ther certify that any and all work performed shall he 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 O<;CUrAN,~Y..~i11 he made of any structure without permission of the Community Services Division, Building Safety.
1 further certify:!ha(only contra~tors and employees who arein 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 readahte 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 dnring construction.
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Date
Owner or Contractors-Signature
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225 Fifth Street
Spr~ngfielil, Oregon,97477 .'
541~726-3759 Ph()Jle'~. -
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'.';>;:;RECEIfl]:#: .. 2200900000000001229
Job/Journal Num~er Description
COM2009-00924 Perm Serv/Fdr 200 amps.or less
C0M2009-00924 ",'. ',AddiAlt~r,Eii~ndCircEa Add
COM2009-00924 : ":;Gutiji;~o/;i'T';~iril&iJ~Fee -
COM2009-00924' -ti,'! T+.12% State Surcharge
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Payments:
Type or Payment
CreditCard.
cReceintl
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Received By
Check Number
Batch Number
.CAMP CREEK ELECTRIC LLC
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Page I of I
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 10/28/2009
8:53:36AM
Item Toial:
Authorization
Number How Received
Amount Due
81.00
84.00
8.25
19.80
$193.05
Amount Paid
278100 In Person
Payment Total:
$193.05
$193.05
1012812009