HomeMy WebLinkAboutPermit Electrical 2009-12-8
Electrical Permit Application
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225 Fifth Strftt+ ':'r~ 1_"".Jd. OR 97.77. PIl(541)716-3753. F A.'X{S4t )7163689
"""'~ I, "',DEf>ARTM~NTUSEONL'f~~:1
~~'-.... \permitnoCLf;:- 01<00 S-
IDate i ~ -()r- - cq
This pennit b iuued under OAR 9J8-309-OO00. Permits a~ nonlransferable.. Permit!i expire if work is not started within 180
da)'5 of issuance or if work is suspended for 180 days..
1 :-:LOCAL GOVERNMENT APPROVAL . "c,:1
I Zoning applOval verilied? 0 y cs 0 No
'. :," CATEGORY OF, .CONSTRUCTlON-- "':.)
o Residential' j 0 Govcnunent ![2(C'lIrunercial
JOB SITE INFORMATION .AND'LOCATlON~. '.. 1,000 sq, fl. 0"= (4)
I I~ "11 Eaeh additiOl1at 500 sq. fL or portion S I
Jobsiteaddre~s: II/:' ~I'7Ga.LfiKI' Sr' <hereof S 25.00
I Ci~nel./){J f).1 Stall:it'J I Z1197'i',11 I Ijmited energy (2) S 32,00 $ I
I Subdivi~ion: ../ \ Lot no.: I Each manufoctured home or modular 1
1 . , ,', . . ..:; DESCRIPTION'. OF WORK' ,.;,' .. "c' " dwelling seMce or feeder (2) $ 63.00 $
A--~ '-'Jnt.J~ ,10 ~/(... I I Servi.... or fo<d.r" ins/alla/im. ai/era/ion. ",Ioca/ioll 1
~ I I L'; , /7 1 I 200 amps orless (2) $ 81.00 $ 1
~ / /')-fr.{, i? CP'~/ L I
.. ," -"", "PROPERTY.:OWNER", " ','0'" . .c, 20t to 400 amps (2) $ 95,00 $
I NamefY\C-iLAu ~ WtJJL ..\t,eo;L'~ <I()l <0 600 amps (2) $158.00 $ I
I Address I ~ ~"::;i\...,.,/V I p.-~' 'c.p .jj;;- f> 1 601 to 1.000 amps (2) $205,00 $ I
I CIty: f,uapf't"/ IStaleOQ) IZIP.q-X-1011 (h'erl,OOOampsorvolts(2) $469,00 $ I
I Phone, " .(\ , Fax" I Reconnect only (2) $ 63,00 $ 1
I E-mail: ITemporarys<rviccsorreeders:inslallalion.aIlemlioll. ",location 1
This installation is being made on residential or farm p,up..;j 1 200 amps '" less (2) $ 63,00 $ 1
owncdbvrneoramernherofrnv inunediatefamilv. This 1201 to 400 amps (2) $ 87.00 S
property"is not intended for sale: exchange, lease,;'r rent. OAR
479.540(1) and 479.560(1), 1401.0600arnps(2) I $126,00 S
Si~aturc: lOver 600 amps or 1.000 volts. see services or feeders section abm'e
I'. . '. CONTRACTOR"INSTALLATIONY'" ", .,.t 1 Branch drc.n": ne.., ai/em/ion, cJdrnsionperpanel
I Business name: ,) K (.., (-...I n r+v J ( -' ~ ( J . '1 I n. Fee fOT bronch circuits with porch..,?" of a serviee or loeder fee:
Address: 2.1"51 1)0(\ :"sh- jJll-f 1 I Each hronch eircui. I! $ 6,00 I $
City S>V1~i Q rr.f I State 0 t': i'j ZIP cn4-11 I I h. Feefor branch circuits \v;thou. purchase of a serviee or feeder fee: 1
Phone: ~""I . 14"'-%'f5Io I Fax:'5tH 'i4b-3~.ss Firstbronchcircuil(2) I / I $ 55.00 10~
E.mail: ~p,(d) JK'-EI..f::l--.coYV'\ I Each additional branch circuit I $. 6.00 . $
I CCI3 license no.: 4'51 z.G I BCD license no,: 2.0" 2-1'(, I Miscdlaneous fees: service orJe.der no/ included
I Sil!lling supervisor's license no.: L\-'il''5S j I Each pump OT irriga.iOl1 cirele (2) I $ 63,00 $
I p. rint name of sil!lling supervisor~Il.tWD.L{ bvr V~I ~ ~ch si~1 o~ outlin~ li~hting (2) S 63.00 S
I Signaturcofsigningsuper\'isor: ~ 1 SlgnaJ.cm;;ullorall~l1Ited-energypanel. S
-,...--- /' /' ..,.... _ a1teratl()J}. OT ex1enSI0ll (2) S 63.00
U I Eacb additional inspKtion: (I) $58.00 l $
I": ";':'f:,S;~;;Af>PLlCANT:"USE:'
I (A) Enter subtotal of above fees
(Minimum Pt'nnil Fee $58.00)
I (B) Eat..... t2% surcharge (, 12 x (A))
(C) Technology fee (5% of IAn
TOTAL fees and surch.~es (A through C):
~~~~
W~~
~y
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..J.-lCl-2SB4-J (9/08iCOM)
I"~, ;". ".FEE"SCHEDUl.E; ,0 ""0
h~~'rij'~~;,~ririsP.cc~_~~.~~,.i~~,:f); ".,:l9~;.'t~:~!~,
I RE'Sidential, pe-r unit, Sl"rvice indu~ed:
,... ',,;>il
L!c~~":~l
$134,00
$
~56 ,f)
$ '::J 40
$ 6, '7(c:J
$ C~7-~
'~$....~'R.!N.'.G...'iI!i>L'~".. ,:. ".'.
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Pending
PERMIT NO: COM2009-01603
ISSUED:
APPLIED:
EXPIRES:
VALUE:
11/02/2009
06/01/20]0
$ ] 8,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspee(ion Line
SITE ADDRESS: 1100 SHELLEY ST
ASSESSOR'S PARCEL NO,: 1703270000902
Springfield TYPE OF WORK: Foundatiou
TYPE OF USE: Addition
PROJECT DESCRIPTION: Foundation for 8,900 gallon, eX,terior, Liquid Nitrogen Storage Tank
Industrial
Owner: MCKA Y COMMERCIAL PROPERTIES LLC
Address: 76 CENTENNIAL LOOP STE D
EUGENE OR 97401
I CONTRACTOR, INFORMATION I
Contractor Type
Ceneral
Contractor
JOHN HYLAND CONSTRUCTION INC
License
46071
Expiration Date
07/11/2010
Phone
541-726-8081
BUILDING INFORMATION I
JlA
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Bnilding:
29.71
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
S'I Ft Other:
Occupant Load:
256
# of Units:
Primary Occupancy Group:
Sel'ondary Ol'l'up"ncy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
H-4
No
I DEVEL?PMENT INFORMATION,I
Front yard Setback:
Side i Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Il11p~ovcmcl1ts:
~. ,:_....c \1("lU to
I PUBLIC Ii\1PROVEMEI't""~'N1'\ON', Oret~'~~';h;Orogo~ Ut;:i\\h
fOIIO.)l rules adop e 1~ e ruleS are oet or ,
N t'f'catio~a", T5p~, 11 OAR 952-001
o I \ n1-0010 \nfoug les by
In OAR 952rRi\'vni%~u~~/!;)raiO.:of the ru
0090 You may'" N;ie' the telephOne
caliing the center. ton Utility Notification
IIUmberlor the. or1e~O_332-2344).
Center II .
Storm Sewer Available:
Speciallnstruction:CE
I~U 1/ :
'-HIS PERMIT SHAL
UmORI7Fn IIMnc~ ~~~~R~_I~ THE WORK
[1/1"'1E"IC ' '. "V, '"'''''' " '\""
",'IIV " EDOR'C: 1 'I--"~' I
',\' j <::1 DAY PER:r(:8AJVDO ~~rua,(ion Descriotion .
$ Per Sq Ft
or multiplier
Notes:
Type of Construction
Square Footage
or Bid Amount
Value
Datc Calculaled
Descrillfion
'.:-...."
Page I of 3
._$F!Rl.NCil,~IIU.,D/""""l''' "
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Status
Pending
225 Fifth Street, Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Estimate
Estimate
Fee Description
Plan Review Comm/Ind/Public
+ 12% State Surcharge
+ 5% Tcchnology Fee
Add, Alter, Extend Circ
Minimnm/Adjustment Electrical
Total Amount P~lid
Fire Department Review
Planning Review
Public Works Review
I 1/0212009
11/0212009
11/0212009
Structunll Revien'
I 1/02/2009
Fire Dem"'tment Review
Structural Review
12/01/2009
12101/2009
$1.00
18,000.00
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-0I603
ISSUED:
APPLIED:
EXPIRES:
VALUE:
11/02/2009
06/0112010
$ 18,000.00
$ I 8,000,00
$ I 8,000.00
1 1/02/2009
Total Value of Project
Fpp<, P.ilLI
Amount Paid
Date Paid
Receipt Number
2200900000000001245
2200900000000001360
2200900000000001360
2200900000000001360
220090000001l1l001360
KLK
Incomplete submittal: I) Provide
Special Inspection Form signed by
all responsible parties, 2) Provide
, complete Site Plan, 3) Provide
manufacturer's specifications for tlH'
Storage Tank including lilIing and
dispensing requirements.
$139,10
$6.96
$2.90
$55.00
$3.00
11/2/09
12/9/09
12I9/1I9
12/9/09
12/9/09
KLK
KLK
New Revised Submittal
New Revised Plan Submittal and
Special Inspection Form submittal
$206.96
I Plan Reviews I
11/02/2009
WE
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 Ihe following
work day.
12/01/2009
12/1I1/211119
10
10
Rplllli"f1rJ: I n~IV}('tio~
Pa~e 2 of 3
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CITY OF SPRINGI'lJ!.LD .
Building/Combination Permit
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
'I'
PERMIT NO: COM2009-01603
ISSUED:
APPLIED:
EXPIRES:
VALUE:
11/02/2009
06/01/2010
$ 18,000,00
Status
Pe'nding
By signature, I state and agree, that I have carefully examiued the completed application and do hereby certify that all
infonnlltion hereon is true Ilnd correct, Ilnd I further certify thllt Ilny and all work performed shall be done in Ilccordllnce with
the Ordinllnces of the City of Springfield and tbe Lilli'S of the Stllte of Oregon pertllining to the work described herein, and
thllt NO OCCUPANCY will be mlldeof any structure without permission of the Community Services Division, Building Sllfety.
I further certify thllt only contrllctors Ilnd employees who lire in complillnce with ORS 701.005 will be used on this project.
I further Ilgree to ensure thllt Illl required inspections lire requested lit the proper time, lhat ellch address is relldllble 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
timrs during construction.
Owner or Contractors ,Signature
Dllte
.,
PIl2e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2200900000000001360
Date: 12/0912009
9:12:26AM
Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
55.00
3.00
2.90
6.96
$67.86
Job/Journal Number
COM2009-0 1603
COM2009-0 I 603
COM2009-0 1603
COM2009-0 1603
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 12% State Surcharge
Payments:
Type of Payment
CreditCard
Amount Pllid
JERRY GUCKENBERGER
NJM
015190 Phone
Payment Total:
$67.86
$67.86
i'.
1"
cReceinll
Page 1 of I
12/9/2009