HomeMy WebLinkAboutPermit Electrical 2009-11-25
,
11/24/09 11m 11:59 FAX 5417263689
CITY OF SPRINGFIELD
141002
22> Fiftb SIT<d.Springlicld, OR 97477 .PH(541)126-37530FAX(541)726.J689
I,j,. ,DEPARrMENTUSEONLY ,I
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I Date: [1/ 2--61 Oc) (I
Electrical Permit Application
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This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire jfwork is not started within 180
days ofissuanoe or if work is suspended for 180 days.' ,
I,'... ,:,L:.'OCAL',-,G'OV, '"ER"N' :M' ,ENTA'P"_RO'~A-L' -,-,,:, ",.",_.:",., I:,"..., "",".','-"i";';Y:":"'~:'fE""':'''C''''E O"U"E""v"
, r. !II, J.. !..':,'_:C"'::""~':"-,:,",.,.:'~"., ,~"lO,' -n", :J:.: ;.::,.",
I Zoning approval verified? ~ cs 0 No I rNj,mber.firl~~~ie~" p'r~~() ',,'jQty.}. ~~' I'Total
!: ,',C.....TEGORYbfCON'STRUCTION I ' cost,
I Residential, per unit. ~ervit.f: illduded:
I 0 Residential I 0 Government' 'j $ Commercial I
1(~l;Yj,\jbEl\'sfte"mFbRMATrQJit:4;N(jsl:otrAtrON',,":'iN;;1 11,000 sq. fl. or less (4)
I -I- Each additional 500 sq. ft. or portion
Job site address: ~"{ Q \ lJV\ a (1/1 t."., 'I thereof ,
I Cit)': 4ft> +'~ . I State: () I~ I ZIP: C( 14'1 r Limitcd cnergy (2)
I Referen~r '~IOt.:" I I Each !"anufoetured home or modular
I 'OESCRIPTIONQF WdRl(',:,'..', .'1 dwelling Servlcc,Or feeder (2) ,$ 63,00 $
Il&1~ f)ct,/../pt V pelf e ~,v- r~ >) Service, orfceders: lm/aI/alion, alteration",.location
Ill'tp I /01 " '-, '1200ampsorless(2) , $81.00 $
! PROPERTY OWNER " I I 201 to 400 amps (2) $ 95.00 $
Name: Me k~ (/)7-1 ~ C rftJr;SI;,1 q fc1rilll ev;rUJrf'19600 amps (2) $158,00 $ 1
Address:7j~~ /I ' 1:::: c.,'f. t?t,;?Fe (S 1 1 601 10 1,000 amps (2) $205.00 $ 1
ICity:tMV'e..kq "!slale:CA IZIP:7~50/1Ioverl.OOOampsorvolts(2) $469.00 $ 1
I Phone: I -7c71'12. 82861 Fax: I :Y07<f12::~74 I ReconncctonJy(2) $ 63.00 $ I
E-mail: 1 I Temporary services or feeders.: im1qiialiQn, ~Ileration, 1"elocallon I
I This installation is being. made On residential or farm propehy 1 200 amps or less, (2) X $ 63.00 $ b ~ I
'owned by me or a member of my immediate family. This " I 20110400 amps (2) $ 87,00 $ I
f property is not intended for sale, e~change, lease, or rent. OAR I ' I
i 479.540(1) 8nd 479.560(1). . 401 to 600 amps (2) , $126.00 $
.]. ' Signature: ' lOver 600 amps or 1,000 volts. See sc::rviceso.r feeders section above I
I' CONTRACTOR INST ALLATIOR I Br.neb circuits: new, alr.ration, extension per panel I
I Business name:' ~ t5-. (/'I J I~ ~ ms T ree9 I a. Fet;:; for branch circuits with p.urchase ofase"r'Vic:e?r feeder fee: I
[Address Po enx: 71bS? I I Each braneb circuit I 1 $ 6.00 I $ 1
I City: Eva.e.ne. I Slate:O~ I ZIPQ7t.tD( I b,Fccforbranch cireuitswilhoulpurchasc ofa service Or feeder fee: I
I Phon~Y L) 7 h 1- qqqq I Fax: 1 FiI,1 branchcircuil (2) I · I $ 55.00 I $ I
1 E-mail: I I Each additional branch circuiI . $ 6.00 $ I
I CCB license no.: 1 BCD license no.: I I Miscellaneous fCI;$; 5e(1'ice c::jf!.eder ~ot included I
I Signing supervisor's license no.: I I Eacb'pump or irrigation circle (2) I $ 63.00 I $ I
1 Print name of signing supervisor:. 'Y1' I 1 Each sign 'or outline lighting (2)' I $ 63.00 $
~,Signatureofs---,unpoe~""'" p' '/,r:::\/I. /), {O,/),/,V ...SigIUlIcireuitorali!"i,ed.energypanel, 1$63011 $
r , ~...... ~~' l/L L.-f (~ alteratIon. or extensIOn (2) .
Eneb ndditional inspection: (I) I $58.00 $ I
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""i".""'}'::");'",' ;C'".'''''' '0-'""",, ,L1. ~,....",'.:- ,',:..;,,', ," '"" ,',. , "
I' (A) Entcrsubtoral ofabovcfcc~ $ / ~3 [60
(Minimum Permit Fee $58.00) , <..0 f
'I (B) Enter 12% surcharge (.I2x [A]) $ '3 IL5
1 (C) TechnologyFoo (50/. of [A]) $ l '15~
I ..,ll.. u"""'''~M""", q, '-,:; r", f:;
~~
$134.00
$
$ 20.00
$
$ 32.00
$
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440.2584.J (9108/COM)
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO:' COM2009-01694
ISSUED: 11/25/2009
APPLIED: 11/24/2009
EXPIRES: OS/25/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5701 MAIN ST
ASSESSOR'S PARCEL NO.: 1702334103101
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Commercial
PROJECT DESCRIPTION: Temporary Power for Bo's Trees
Owner: MCDONALD'S CORP 36-113
Address: 2896 CRESCENT AVE STE 105
EUGENE OR 97408
Contractor Type
Contractor
I CONTRACTOR INFORMATI?N ,
License
Expiration Date Phone
BUILDl,NG .INFORMA T10N I
# of Units:
Primary Occupancy Group:,
Secondary Occnpancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
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
~q Ft Other:
Occupant Load:
n/a
I ,DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
1:.. . .?:~........ ""'''''1\ l''''1reg,uires you ~,~
I PUBLIC IMPRO\fti~, . -!l$ adopted by the Oregon Uti /
" , _"\ J.;tenter Those rules are setfo.th
Street Improvements: NO 1111;""" aM' 1lIlU\Y'P<0AR 952.001-
In OAR 952-001- ~~o ie ofthe rules by
Storm Sewer Available: 0090. You may q!yA\\lQN1\\~~sU?~'\\IIt:;Jhone
Special Instruction: ,calling the center. -( 0 Utility Notihcation
TICE' . "WORK number for the Oregon )
NO . ALL EXPIRE IF 1HE , Center is 1-800-332.2344 .
TH~ .~E!.~I~ ~I~\[)FR THIS PERtv\11.:~NO!
I-\U" ,v...-LO OR IS ABl\lIit:.;",ocl. . -"
COMMENCEA\I PERIOD. I Valuation DescriDtion I
ANY 150 0 ,1 .,
$ Per Sq Ft Square Footage'
or multiplier or Bid Amonnt
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:"
Compact:
Notes:
Description
Type of Construction
Value
Date Calculated
Page 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01694
ISSUED: ' 11/25/2009
APPLIED: 11/24/2009
EXPIRES: OS/25/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
, Total Value of Project
Fees Pair! I
I, I
Fcc Description
+ 12% State Surcharge
+ 5% Technology Fee
Temp Power 200 amps or less
Amount Paid
Date Paid
Receipt Number
$7.56
$3.15
$63.00
ll/25/09
11/25/09
11/25/09
2200900000000001330
2200900000000001330
2200900000000001330
Total Amount Paid
$73: 71
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.
,,.
R.~/l~,irf~ I~sp~~tio~,s I
Temporary Electric: Approval required prior to Utility Company energizing pole.
By signature, I state and agree" that I have carefully examined the completed application and do herehy 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 of the City of Springfield and the Laws of the State of Oregon pertaining tOJhe 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 he used on this project.
1 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
Date
Pa~e 2 of 2
22~ Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1694
COM2009-0 1694
COM2009,0 1694
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001330
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
I
Paid By
BO'S TREESIBO LEACH
Date: 11/25/2009
Item Total:
Check Number Authorization
Received By Batch Number. Number . How Received
njm 017629 017629 Phone
Payment Total:
Page I of I
1:51:34PM
Amount Due
63.00
3,15
7,56
$73.7]
Amount Paid
$73.71
$73.71
11/25/2009