HomeMy WebLinkAboutPermit Electrical 2009-11-13
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Electrical Permit Application
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225 Fifth Stn~et tSprlngf1cld, 01< 97~77. PH(541)726.3753. Ft\X(S4\ j726.J6SlJ
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This permit is issued under OAR 91H.309-000Q, Permits lire llontl'llllSfcl'ablc. Permits expire if work i~ not started within 180
days Oflssullllce or ifwol'l< is suspended for 180 days.
I LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
I Zoning approval verified? 0 Yes 0 No I Number of inspections per item () IQty.1 ~~~t
I CATEGORY OF CONSTRUCTION, I 1 '
I I I 1 Rcsidelltml. pCI' unit, service Included:
o Residential 0 Government 1ZI Commercial I
I JOB SITE INFORMAT41)O AND LOCATION 'I 1,000sq Ii orl",(4)
I a.n c;. ~ I Eachaddilioll<l1500sq', ft. orponioll
Job silc address:~""4 r J 1 . _ tl",eof
I CilY: ~ _ I SUI e: ZIP. _ I Limited ellt:rgy (2)
I Subdivision: \ -Un lot (V) O~~ I Each llHlI1\J!:'1c(ured home or modular
\ DESCRIPTIO-N OF WORK dwt:lling service or feeder (2)
12 _ Feeders to VFD panels I Services or fcedel's: il/stolln/iOI/, alteratiulI, re/uemion
1 1,.~~9 .a.ll:ps.?r}css (2) 2 $ 61.00 $ 16 2
I PROPERTY OWNER I 201 to 400 amps (2) $ 95.00' $
I I 40 I 1O 600 aml)s (2) $158.00 $
Name: EWEB Havden Bridoe Plant
I 1 60 I (0 1,000 amps '(2) $205.00 $
Address:3957 Havden Bridoe Rc:l
I I OR I lOver 1,000 alllps or volts (2) $469.00 S
City: Sprinqfield SlOte: -- ZIP: 97477
I,Phqn~:541._685 7,409 I Fux:54l 484 3762 I Rl'conneCI only (2) $ 63.00 $
I I Tellll)tJrar,\' services Ill' ['ceders: ill.l'udlal[o/l, II/tertlliol/. I'('/oct/lioi/ I
E-mail: tom, teutsch@eweb. orq
, . . . 200 amps or less (2) $ 63,00 I s I
'1 hiS Illstallation is being mude on residclltifll or lann property
owned by me 01' a member afmy immediate family. This 1:2:()D,04,4'9'U,-~~i'rj,~~'(2)~~I,!;I~~;,d;:''(~~; ~:~ -$-87.00- ~$~:;::, -II
'property is not intended'for sale, exchange, lease, or rent. OAR
479,540(1) and 479.560(1), 1401 to 600-iiiTIpi'(2)~;';, ;:1"- --- - -$i26,O~h-.--;,,:-\
Signature: I Ovcr600 RIl1PS .01' 1,000 volts"see services odceders secti911 ab?vt' 'I
I CONTRACTOR INSTAllATION I I Branch circuits: ne\l', Clllerciilol1. eXleJl.\'iimperpollel I
I Business name: Olsson Industrial EIF.c I I a,Feeforbranchcircuitswithpurchaseofascrviceorfeederfee: I
I Address: 1919 La\lra Street I I Ea~hbranchcircuit 12 I $ 6.00 J $12 I
1 City: Springf ield State: OR .1 ZIP: 97477 I b, Fce for bl'llllch circuits without purchase orn service or f't:euer fee: I
I Phone:541 747 8460 Fax:54'l 747 4846 I F;rst bmnchc;rcu;t (2) ..1 I $ 55001 $ I
I E-mail: ' " I Each additional branch circuit : $ ~:99 ~ I
I CCBliceilSC''ri'ct'63'4-73'' ""I I3CDlicenscno,:20-241C I Misct.'llalll'IHlsfl'cs:.fen'iceor/efHh'rIlOfinclllded I
I Signing super"isor~slicensc no,; 3 3 3 4 Sr 1 Eilch pump or in'igalioll circle (2) 1 S 63.00 $ I
I Print name of signing su'pervisor: DoUP'ias Heer I Ench sign or oulline liglning'(2}- "- -..- -$-63;00'~ -$--.1
I S~gnaturcofsigl1ingsllpervisor: /JA P&- '/G:- I I ;il~lt::~i~::'~~:.\:~:t~nl~:~:~(~jcnergypnnd, s 63,00- ~- -I
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I Elich lIddhiollal insjlecliuu: (1) $58,00 $~ I
~ ~\SP APPLICANT USE I
'( I (A) Enter s\tblOlal of above fees
~,' . ",W -fV9", ',~, \ ,\\.\(l...t "s$ 12704'~8080!
.:J''' . ,"lfiI W' (r\'linillltllll Pcnnil FCl' $58,()())
l{f:( I (0) Enter 12(l/u surcharge (.1,2 x {A})
,~t.\:l~":,\':I'''':''.' rl'()"\:i' \' ~ I (C)TechnLllogyFt;e(5%{if[A]f ~"::YI_;iS 8,7(:) I
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I (:',.1i~~i pi\ n;\~ tJ', ;1 I'J';'Jlrp. :':i :;1, ijl' '.";.LiI1Irof1jtl)' : r \? I ,TOTAL fees 1IIHI,sui\'hiii-gc-s"(A t1lrq~l~h.t;):;. :_~:~:l $ 2.03':-58,1
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Total
eost
$134,00
$
$ 25,00
$
$ 32,00
$
$ 63,00
$
440-2584-) (9108/COM) .
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_ Status , Issued: ' :,,', _
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, 225,Fifth Streetr~pringl!eld;jp~}, :;: -
541-726-3753 Phone"'..,",. ':-}"''>;:::)-''
541-726-3676 Fax'
541-726-3769 Inspection Line .. ',"
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CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01651
ISSUED: 11113/2009-
APPLIED: 11/13/2009
EXPIRES: 05/13/2010
VALUE:
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SITE ADDRESS:,;!(c-'3957 HAYDEN BRIDGE RD
ASSESSOR'S PARCEl: NO.: 170i190003300
Springfield TYPE OF WORK: Electrical Work Only
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TYPE OF USE: New
Industrial
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-, PROJECTDESCRihiC>N:.", Feeders to VFD panels
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Owner:
Address:
CITY OF EUGENE
CITY HALL -'-;':
EUGENE OR 9740f
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I. CON:RAC:OR lNFO~MA :ION .1
tontract~r T~~~;t~,ifcontractor
EleCtrical OLSSON INDUSTRIAL ELECTRIC
Stree, t Improvem, eots: .".: ij'\:'jfJ;
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Storm Sewer Available:", ' ,
Special Instruction: 1 ' '
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Notes: , ' THis P~R~~;" -~ ~_
~II.,.,,_ _ SHill" t-v,,-.~_
COfi' - 'Unft::tU UNDER -,~ 1\ "'iiIJH
^ '11,MENCED OR , THIS PE ti~escril)tion I
iiNY180 '0 IS ABANIDO I 1 ."".. ,
, At PER' !" D FAA
.. I,,', _ ' .tOO:,. $ Per-Slj Ft Square Footage
DeSCrIptIOn ,,- Type of ConstructIOn I ' I' B' I A
f . :~ ',or mu tip ler or I( mount
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# of;Units: :' '.' '!>; ";': ;..:
Primary OccupancY,.Group: ':" . -,', "
Secondary Occupancy Group: "
Primary C'!ustruction Type
" Secondary Construction-Type:
# of Bedrooms: ., ..;, . -1_,_.",...-
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Frontyard Setback: ': ": '
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Side} Setback: ,\: .-: ,
Side:2 Setback:~;' :if''-
Rearyard Setback:'"'' V'
Solar Setbacks:
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License
63473
Expiration Date
01126/2011
Phone
541-747-8460
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I B~ILDING INFORMATION ~
# of Stories:
"eight of Structure
Type of "eat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION. I
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of-Lot Coverage: "
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I A
. " . TrENTION: Oregon law requires you to
" fO".Ollid~Wa:IIell~p~"d by the Oregon Utility
Nollflcatlon Cerr!W, Tho~e rules are set forth
, , In oAll.~~eB~_-tJO'f8\Wr'Ough OAR 952-001-
0090,. You may obtain copies ofthe rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center ill 1-Rnn_~~?_??....}
Value
Date Calculated
Page I of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
225 Fifth Street, Springfield, OR " ';:,
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541 726 3753 Phone " .,,' ' .."".F',:"..,".'..
541: 726:3676 F~~ ;~~~:1~t1}{:::;}~:~'l~~:~}t1r;{. '.
541-726-3769 I?,spec:!ion Line '
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PERMIT NO: COM2009-01651
ISSUED: 11113/2009
APPLIED: 11/13/2009
EXPIRES: 05/1312010
VALUE:
Status
Issued
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Total Value of Project
,,' " Fees P3,irl I
, ";;~c"';::'ii;~:;:;f~ft~Ji.)t~;:i~:~unt Paid
Fee Description7i._....it.jf..::,:'t./ \-' ," .'1.
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+ 12% State Surc,h,!rg~ $20.88
+ 5%' Technology Fee "i' ' $8.70
Add, Alter, Extend Circ Ea Add' $12.00
Perm Serv/Fdr 200 amps or less',: '. $162.00
Date Paid
Receipt Number
11/13/09
11113/09
11113/09
11113/09
3200900000000000757
3200900000000000757
3200900000000000757
3200900000000000757
Total Amount Paid
$203.58
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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
wO,rk day. '-"
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Reflu,irerl\.w,necti?ns ,
Rough El~c!r~c:Prior to Cover
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Electric Service: Approval required prior to utility company energizing service.
.
Final Electric: When all electrical wnrk is comlllete.
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By signature, I s,tate an~ agr~~, that,~ 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 sball be done in accordance with
the Ordinances of ih~ 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 pcrmission of the Community Services Division, Building Safety.
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,I further certifY.tJlJlto"Jy'.co~ra~to!s and employees who arc in compliance with ORS 701.005 will be used on this project.
I further agree io ensure that'all required inspections arc 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.
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Owner .or Contraetoh Signature
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Date
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225 Fifth Street; I ,
Spri.igfield, Oregon 97477 "
541-726-3759 Pho';;-'-~":' ','
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT',#:
'3200900000000000757
Date: 11/13/2009
2:02:1IPM
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Job/Journal Number 'k::; D.escpptJon ;::?~'~;-,.,-r -;,
COM2009-01651 '~:::r),PeijiiServ/Fdf 200 amps or less
COM2009-01651 ,~} \Add, Alter, Extend Circ Ea Add
COM2009-01651 ',.'::~i.::;-:,;,+ 5,% Technology Fee
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C0M2009-01651 ,::,' '~',d2% Sta,te,Sui;charge
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Paid By
Item Toial:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
162,00
12,00
8,70
20,88
$203.58
Payments:
Type of Payment
Check
Amount Paid
"OLSS(),N,ELEGT:RI'o,',;,\
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njm 54002 In Person
Payment Total:
$203.58
$203.58
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Page 1 of 1
11113/2009
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