HomeMy WebLinkAboutPermit Electrical 2010-1-11
i
CITY OF SP,RINGFl.Ii3LD, pREGON
225 rifth Street+Springfield, OR 97477. PH(541)726-3753+ FAX(541)726-3689
~~ I Permit no.: fJ'l-13/L(
. I Date: 11/ f~'?o
Electrical Permit Application
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 l80,days.
1~,ii~;['i:(,i!,~C:C>CA.Jj,GOVERNMENT:'fA.I?RROVAIl:;"',;",,(,1f~,iJ
I Zoning approval verified? 0 Yes 0 No j
li).{i,j,r$!,l,:I:(,;'(CAT:EGORy,l[()F,iCONST:RUC;nON!:\).s~':/i:~),:,',).,1::
I Residential, per unit, service included:
I 0 Residential ~ Government J 0 Commercial I
1:?Jf:!,1!,1!:r:;JOB)..SIT:E:;INFORMAT:lbN().AND).C:C>CAT:IC>N,).'ili,,' 11,000 sq ft. or less (4)
I \ .Lr^ '^, A I 1_ I Each additional 500 sq. fl.. or portion
, lob site address: \' :rlAUvlt;./lJ'i1k.Jv A l',\)l..1 thereof $ 25,00 $
1 City:,'") 0 n'lI\fJ r /vIJ ) State: 1 ZIP: I I Limited energy (2) $ 32,00 $
i"":;~~~:,~~~;j:1"f![;DESC~~:r~F:;;W~;~~~\ ' _ . I ~~~;t:~~ns~~~~r~~ ~~~:r (~)odular $ 63.00 $
I , I d I Services or fceders: installation, alteration, relocation I
1'15+0..1 reo i'f5f:rjf'LJ/) LJi.L-fVl"j I 1 200 a01ps or less (2) 1'1 $ 81.00 1 $;>) I l
i':~~~f~TIj:i:f'RRO"'ER1'YWOWNER":i3,;;j%j";ii'\[:':~""'"::,,,,",d I 20 I to 400 amps (2) $ 95.00 I $
Name: ~-I'..- IYnX1.,,:>1+ f)j'SIT"0" 1401 to 600 a01ps (2) I 1 $158.00 $
I Addresr vn ~ \ CI"\ a I 601 to 1,000 amps (2) I I $205.00 I $
: ~~:n~el\tl- I s,a;f?~ l_zlP~~ I ~:::~~::tOO:7:;2~rVOlffi(2) : : ~::::: : :
I E-mail: I Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property I 200 amps or Jess (2) I I $ 63.00 I $ I
owned by me or a member afmy immediate family. This I 201 to 400 amps (2) I [$ 87.00 I $ r
property is not intended for sale, exchange,lease, or rent. OAR
479.540(1) and 479.560(1). I 401 to 600 amps (2) I I $126,00 I $ I
Signature:' lOver 600 amps or 1,000 volts, see services or feeders section above J
lii:~~:~:::i'~::~NZa~~:~::~~'ONri'!~clj""f;;;':iii"ic~ : :r;:~o:i:~:,::: :i::~i::t:;:~::r:~::;~;a:~~::e~r feeder fee j
I Address: l ')'-1 ;=j,'Z, I -H W)A S'5? I I Each branch circuit I f I $ 6,00 I $ (, I
I City:F ~"i'_ . I ~tate: O~. \ ZIP: '1-~4D 5 lIb. Fce for branch circuits without purchase ofa service or-lceder fee: J
I PhoneS'-\f- -:rU,Ob5"1 I Fax::,'1l -=1413Lj Lj =t 1 1 Firsl hraneh circuit (2) I $ 5500 I $ I
I E-mail: t:aJ/1oJkJvook..@c..oVl-.l(a.st , ~ I Each additional hranch circuit 1 $ 6.00 1 $
I CCB license no.: ;\ '1(~ '7'1 I BCD license no.: 1D ~Z <, c- I Miscellaneous fees: service or feeder not included
I Signing supervisor's license no.: ,-)L( q:l:s J J Each pump or irrigation circlc'(l) $ 63.00 $
1 Print name of signing supervisoi'llVl(' ~::;z II Each sign orqull,ine ligbting (2) 'I $ 63.00 $
I Signature of signing superviso~ -1~ ._ I Signal circuit or a limit~d-encrgy panel,', $
_ alteration, or extension (2) $ 63.00
\ .1 Each additional inspection: (1) $58.00 J $
t~~\}OD
. ~\A..\O
. t. ~
$134.00
$
440-2584-J (9/0R/COM)
'00\0
""' ,,,,,.\D
\~~
\"L-\
I (A) Enter subtotal OfabOV, e fces
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [A])
1 (C)Technology Fee (5%0f[A]) I
I TOTAL fees and surcharges (A through C): .
$ g' -=;.. I
$ it.) .'-/4 I
$ Lnsj
$161.1',/ I
'y'
simlNOPlaJoD. .
_..:.,'''', ~"-,,,; -....,'",'
,
Status
Issued
225 Fifth Street, Spriugtield, OR
54 J -726-3 753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-013l4
ISSUED: 09/04/2009
APPLIED: 09/04/2009
EXPIRES: 03/21/2010
VALUE:
SITE ADDRESS: III INTERNATIONAL WAY Bus St SPRINGFIETYPE OF WORK: Electrical Work Only
ASSESSOR'S PARCEL NO,: ROW"MISC
PROJECT DESCRIPTION: Elect. Svc for bus' station
TYPE OF USE: New
Commercial
Phoue Number: 541-682-6100
Owner: LANE TRANSIT DISTRICT
Address: PO BOX 7070
EUGENE OR 97401
Contractor Txpe
Electrical
I CONTRACTOR INFORMATION I
I License ~
I 164877
Expiration Date
06/09/20 II
Phone
541-746-1471
Contractor
CAMP CREEK ELECTRIC LLC
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# '01' Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I BUILDING INFORMATION I
/~-:-'::~T;_,,'i: uregon law reqUires you to
,; .':,"" ,,;i-1s aC#.loftSidtieshe Oregon Utility
i~i;t.i!(,i';:.J!l CerHeigil'l1o'flstltll!63lf!\fe set forth
in O,,1i 852-001T-yp6Jd/1ffil:1~ OAR 952-001.
0090, You may WlIflifl']:f;'~s of the rules by
calling the celf.WigdtF9 ',the telephone
number for thEEQ~lWPfl ~ity Notificallon
Center ~"i!lHPa386i'i~fe)' n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
. REQUIRED PARKING
Total:
Handicapped:
Compact:
... .~:. -.'
.. ,.' Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd: '
~OT!GE: % of Lot Coverage:
HIS PERMIT SHALL EXPIRE IF THE WORK
,UniO~ piiBUiG~MPROVEMENTS J0 NU I
;OfvHvlEJIS\....L'U Vll Iv nUIII"UUI>lL..t l!JR
..\.NY 180 DAY PERIOD, Sidewalk Type:
Downspoutsffirains:
I Va,luatlon DescriDtio~ I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Description
Type of Construction
Value
Date Calculated
Page I of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01314
ISSUED: 09/04/2009
APPLIED: 09/04/2009
EXPIRES: 03/21/2010
VALUE: .
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,Total Value of Project
-',
Fee. Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add; Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee'
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$19,80
$8,25
$84,00
$81.00
$10.44
$4,35
$6.00
$81.00
9/4/09
9/4/09
9/4/09
9/4/09
1/12/10
1/12/10
1/12/10
1/12/10
1200900000000001031
1200900000000001031
]200900000000001031
1200900000000001031
2201000000000000027
2201000000000000027
2201000000000000027
2201000000000000027
Total Amount Paid
$294,84
I 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. ,..:i.., . ,
R,eo,!ired Tn.necti,on.'
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
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 (orther ce.rtify 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 to the work described herein, and
that NO OCCUPANCY will be made ofany 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 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
. rt~
Date
Page 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
itjl
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1314
COM2009-01314
COM2009-01314
COM2009-0 1314
Payments:
Type of Payment
CreditCard
cReceiotl .
RECEIPT #:
2201000000000000027
Date: 01/12/2010
Description
Penn Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add,
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
TIFFANY LANTZ-HALBROOK
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc
02510c In Person
Payment Total:
Page I of I
II :22:08AM
Amount Due
81.00
6.00
10.44'
4.35
$101.79
Amount Paid
$101.79
$101.79
1112/2010