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Home My WebLink AboutPermit Electrical 2010-4-23 Electrical Permit Application p:;;~,~~" . "'~!%~"_"'( :;h"~"'" ~'..'--,~ ~~l "'"4h~:;,,;c:w,"_t;:i::f~ ,;:~-~~ ,;pCViM ~@I~Y, (i)l!@S;rRlN@E';fEJ!1t)-i1,6)REGON,', ,4 '1 ,~ '" ~ ~ i I . '" ',", '\t4dr*.A,\ ''''''''-J..:J_~'f''''''~",~iI Nt-~~ ~ -~~ 225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726-3689 ":'\'>"',"$ ..:..., :."::.:n,,,.~::'< :"._ _.: ''':'f,,;,DEPARTMENTUSE,0N'i:,Y 1fJ 4" 'i::-->-'''":~ .':- _:-'-":--i';;~i!:': ,;0"<'>:; <":-::.";: ; COIA-1 ~ao9- <::> <:;) 9Z J Permit no.: Date: t1 - z '> - / 0 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. ,,<), " ~kLOCAL;GO~ERNMENT::ApPR0VAb&; : iii;: it ~ ,fiiEESCHE[jlJl!.Ec"", "",. , '>it...~._ Zoning approval verified? DYes DNo ',' "~;:~it~';i't)~rIQiyeost,,;1 Total . ,. }";;;'CATEGORYc';OI;;;;lG.oNSTR\.ICJ;.IO/<l;;;G;tE",,,;,. ' ./. ..' . ,^,,, eri.i, "cost D Residential I KI Government I D Commercial Residential, per uoU, service included: . ;0;.', Joa'SI'l'E:!NI;ORMAiI0N"ANo;tOCATIONf'j,',1':1 1,000 sq. II. or less (4) $134.00 $ Job site address: . .J;f!f1;'PlOliil,ctiAft...1a.l..... ~c.( r- Each additional 500 sq. ft. or portion $ 25,00 $ thereof City: Springfield 601 I State': OR I ZIP: Limited energy (2) $ 32.00 $ Reference: ~()W 'WI, 5. L I Taxlot.: Each manufactured home or modular $ 63,00 $ ;.k,,'kp';':ili';';OESCRIf'J'ION 'OF dwelling service or feeder (2) ".:""(.,y,,,,;7'1; ..... .. .......i+.'.. .. '" ' Install Eleclrical Service and branch circuits for E Street Scnrices or feeders: installation, alteration, relocation EMX bus station. 200 amps or less (2) 1 $ 81,00 81.00 '.;;,';;",'., .",. 201 to 400 amps (2) $ 95,00 $ Name: Lane Transit District NU 11...1:: w;., '401 to 600 amps (2) ... $158.00 $ Address: 3500 East 17th Avenue THIS c~.".~;:; $205.00 $ City: Eugene I State: OR ~ c~l: )'~. $469.00 $ . R Phone: 541-682.6100 I Fax: ~~;unn ft'''' n y . $ 63.00 $ E-mail: nl\ll I U\I uru EI lJorary services or feeders: mslailatlOn. alteratIOn, relocatIOn This installation is being made on residential or fann property 200 amps or less (2) $ 63.00 owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $ Signature: Over 600 amps or 1,000 volts, see services or feeders section above Is";R<Dt;,'l!'.'CONTRACtOR'INSTACL:A.TI0N' "":.h Branch circuits: new/alteration, extension per panel Business name: Camp Creek Electric LLC a. Fee for branch circuits with purchase of a service or (eeder fee: Address: PO Box 41900 Each branch circuit 14 $ 6.00 84.00 City: Eugene I State: OR I ZIP: 97404 b. Fee for branch circuits without purchase of a service or feeder fee: Phone: 541.746-1471 I Fax: 541-741-6208 First branch circuit (2) $ 55.00 $ E-mail: mike@campcreekelectric.com Each additional branch circuit $ 6.00 $ CCB license no.: 164877 I BCD license no.: C81 '. ~ Misc"ellaneous fees: service or feeder not included Signing supervisor's license no.: 3023S Each pump or irrigation circle (2) $ 63.00 $ Print name of sigriing superVisor-: Dave Feiereisen Each sign or outline lighting (2) $ 63.00 $ Signature of signing supervisor: L> ~on lll'4'1r9C1U,"" ~ circuit or a limited-energy panel, $ 63,00 $ n, or extension (2) ~\2.~ "..~, acsopted IlY ,... lei'" ditional inspection: (1) $58.00 $ ~10'fI1U'e8 'tl\0&8 tV oAR No\IIicat1on ~~:;10~gt\ 0"'" ..'0'. 3' ',;fA" , 'G~ (\.\\ InOAR::maY~~' ter subtotal of above fees $165.00 ao:nln9 \tie :,~J:' ""I~~ m Permit F~~ $58.00) .. .. (B) Enter 12% surcharge (.12 x [A]) $19:80 \i2' mbtl' tor e . III QeO\er 1 (C) Technology Fee (5% o[[A]) $8.25 ~:O TOTAL fees and surcharg~s (A through C): $193.05 440.2584.J (9/08/COM) ~~ ~~ ~ CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00923 ISSUED: 04/23/2010 APPLIED: 06/25/2009 EXPIRES: 10/23/2010 VALUE: Jr.1'\' 'It, Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line " SITE ADDRESS: 601 PIONEER PARKWA YEAST Bu SPRINGFIETYPE OF WORK: Electrical Work Only ASSESSOR'S PARCEL NO.: ROW-MISC PROJECT DESCRIPTION: Electrical Conduit for L TD Station TYPE OF USE: New Commercial Owner: LANE TRANSIT DISTRICT Address: PO BOX 70.70 EUGENE OR 97401 . T.... " ;~_:I"l " : '~.:. < ' . I CONTRACTOR INFORMATION . '. Contractor Type Electrical License 164877 Contractor CAMP CREEK ELECTRIC LLC BUILDING INFORMATION' # of Units: # of Stories: Primary Occupancy Group: Height of Structu~e Secondary Occupancy Group: Type of Heat: Primary Construction Type Water Type: Secondary Construction Type: n laW lequileRlm~~;J:YP'e:. . . '.. # of Bedrooms: ATfENilot-t Olef~d by the o~ege\leX%~iVhi'" (o"?W r~les ~~~~l. ihose lules al~~!?2!tJ8~..Building: n/a . mOAR952-001-obtainco iDE "INFORMATION 0090 'fou may (Not' '. caliing the centel. on Uiility Notitica\lon. Fronty,"'d Setback: umbel tal the.Ole~OO_332_2340y.erlay DlSt: Side I Setback: l\ CentellS 1- # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: ,%.of Lot.Coverage: Solar Setbacks: '~-:;, :''",' ;~\':'" .,... ,,", ...~~:~:f" ,_. ~~. I PUBLIC IMPROVEMENTS ~ Phone Number: 541-682-6100 Expiration Date 06109/2011 Phone 541-746-1471 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: . . . ,-."i'..<~;'_'';'''';';~~;'~::)''':''''~'''r~, . ValuationD HALL EXPIRE lFTHE WORK::. AUTHQ~IZED NOER THIS PERMIT IS NOTV o~ ~~I~~I~etr cOM~j\jfMm\"~ ABANDOl'WfufOR.fi;~,I:'})ate Calculated ANY 180't\1..Y'"j9~MoD. ' .: . ., Description Type of Construction . Pa2e I of 2 CITY OF SPRINGFIELD 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line '.>. Building/Combination Permit PERMIT NO: COM2009-00923 ISSUED: 04/2312010 . APPLIED: 06/2512009 . EXPIRES: 10/23/2010 VALUE: Status Issued Total Valne of Project Fees Paid ~ , Fee Description + 12% State Snrcharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amonnt Paid $19.80 $8.25 $84.00 $81.00 Date Paid Receipt Nnmber 4/23/10 4/23/10 4/23/10 4/23/10 2201000000000000399 2201000000000000399 2201000000000000399 2201000000000000399 Total Amonnt Paid $193.05 I f.t<!nBeyj~w.~ .1 . -- ,.-;- 0.< l .,~; . ;::;~ 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. Reauired InSDections ~ Rongh Electric: Prior to Cover Electric Service: Approval reqnired prior to ntility company energizing service. Final Electric: When all electrical work is complete. By signatnre, 1 state and agree, that 1 have carefnlly examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify th~lt 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 of any strnctnre withont permission of the Commnnity Services Division, Bnilding Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 further agree to ensure that all required inspections;.~:re requested at the proper time, that each address is readable from the street, that the permit card is located at the front odh'e propefty; and'the approved set of plans will remain on the site at all times during construction. _ ".. , "~ ,(."i' ,.. " Owner or Contractors Signature Date Page 2 of 2 , ,j' " 225 Fifth Street Sprbgfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department. RECEIPT #: 2201000000000000399 Date: 04/23/2010 I :34:07PM Paid By CAMP CREEK ELECTRIC LLC Item Total: Check Number Authorization Received By Batch Number Number How ,Received Amount Due 81.00 84,00 19,80 8,25 $193.05 Job/Journal Number COM2009-00923 COM2009-00923 COM2009-00923 COM2009-00923 Description Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 12% Slale Surcharge + 5% Technology Fee Payments: Type of Payment Check Amount Paid djb 6124 In Person Payment Total: $]93,05 $193.05 .' :~.: , , " ~', . .' cReceintl Page 1 of ] 4/23/20 I 0