HomeMy WebLinkAboutPermit Electrical 2010-5-18
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753' FAX(541)726-3689
I, DfP ARTMENT USE ONLY
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Date: 6 -/t - 1-0
Electrical Permit Application
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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.
". . ':LOCAL': ~OVERNMENTAP,PROV AL'i..",,,''/i-'>, ;~/"'",:;';!1?:};t;~~~,~i(\'~::~:;0;;;t~'~'f.E_E_n:SGH E,pJj'IJ'E~,::)~~~~~~?fi!li~~ti?%~;'p,;::~W~~
Zoning approval verified? DYes DNo .., ',.-', ., Cost Total
,Numb.er" ~Jj~~peCtio'~sp~r it~.~~ (.). Qty.
.C -" .....;:CATEGORV,.OFCONSTRUCTIONU. . i.. .,' '. ,.,' "_.'.';..1 '. ,-,--. .. '-eit.; cost.
,
. . '-. --... .... . Residential, per unit, service included:
o Residential I 0 Government ~mmercial 1,000 sq. ft. or less (4)
'~Nn"d() "SITE 'INF()RMATIOW~N[j'uOCAtION'',;'''~' ',' $134.00 $
fl~ :fif;::1tW< " .B.;t_:_ :,.;," , ,'. __~ 1 i.'._ ~:' , >';;':'. <,,; !' " ;~'.:StK~~:VY' Each additional 500 sq. ft. or portion
Job site address: - ~t'-<.~o uiW- $ 25.00 $
7 /('1) thereof
City: /' J1.1) ,,~-/r-e-ill State: tJp I tiP: Limited energy (2) $ 32.00 $
Referen~e:1 \",,\n~} 1. '2D 1 Taxlot.:..- :\12 Each manufactured home or modular $ 63.00 $
.. DESCRIPTION OFWORK-,'c",:>'." :"';'. dwelling service or feeder (2)
/ / /, 1/ (\ <-1 W Cb/;'t.-L;;?- Services or feeders: installation, alteration, relocation
t 200 amps or less (2) $ 81.00 $
PROPERlY OWNER , 201 to 400 amps (2) $ 95.00 $
Name: 401 to 600 amps (2) $158.00 $
Address: 601 to ] ,000 amps (2) $205.00 $
City: I State: I ZIP: Over] ,000 amps or volts (2) $469.00 $
Phone: - - I Fax: - - Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, 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 20] to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR 40 I to 600 amps (2)
479.540(1) and 479.560(1). $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new, alteration, extension per panel
Business name: .......-('8 ~(-.-kru' -:r:;, /' . a. Fee for branch circuits with purchase of a service or feeder fee:
Address: t(6~.!> '72- / J~ r/ Each branch circuit $ 6.00 $
City: r-;;(.{.&lI~ I State: Are- I ZIP: ~ ytJ,2... b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: :~/' -~8'?~~'7~ I Fax: 5:7./1.....1(0.?.J7 .;l.9t First branch circuit (2) I $ 55.00 $0-.5
E-mail: e..1C'L. un ('- ./ ..L. ./. ~ Each additional branch circuit ,;;< $ 6.00 $ /2-
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CCB license no.: lo1/1:t9 BCD license no.: 3"7........-?- Miscellaneous fees: service or feeder '.lot included
Signing supervisor's license np,.: SI? 7;l 6 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervil \ <J;;/.." = / ,- Each sign or outline lighting (2) $ 63.00 $
or
Signature of signing supervislr;. ~'?f .--:7~ Signal circuit or a limited-energy panel, $ 63.00 $
'- alteration, or extension (2)
() Each additional inspection: (1) $58.00 $
\ ,t'f:;,~;;ifti~~t;~:~'~~"~2~i~~1~\AR~,_Lic.AJ~_T,~VS~Er-~;,~tt?{7l:U;t1s:t~~,,;?:;]t:~, ;~-_~
~ ~ (A) Enter subtotal of above fees 67 () f,J
0..: \ \) (Minimum Permit Fee $58.00) $
'b- ~-~ ~ (8) Enter ]2% surcharge (.12 x [AD $ 33
~ (C) Technology Fee (5% of [AD $ 6-cJ .f
TOTAL fees and surcharges (A through C): $ --1f'" -<s '1
-
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440-2584-) (9108/COM)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00632
ISSUED: 05/18/2010
APPLIED: 05/18/2010
EXPIRES: 11/18/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 980 KRUSE WAY
ASSESSOR'S PARCEL NO.: 1703222000912
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Wiring to chiller
Owner: , TREVQRS BREWERY LLC
Address: 3895 MEADOW VIEW DR
EUGENE OR 97408
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I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor
JB ELECTRIC
License
104929
BUILDING INFORMATION'
Expiration Date
03/14/2012
Phone
541-687-5770
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constrnction Type
Secondary Constrnction Type:
# of Bedrooms:
# of Stories:' .
Height of Strnctnre
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
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION ~
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
O~hlaYDist: :
. ,'\ "- .
-#'Street,Trees Rqd:
". Paved Drive Rqd:
% 'of Lot Coverage:
REQUIRED PARKING
,Total:
Handicapped:
Compact:
011\0
I PUBLIC IMPROVEMENTS II 0\'1' Olego" la~ne Olego" t :orth
~ll !Nil ~p\ed t>'l lilIeS ale se" 00"
'OlloVl rulell cell{'e'f. 'fl1~lIgh O,t>.f\ 9~III~S '0'1
t-loti\\Ca~~~_~"Ii~W~fi\illJll 0\ th~9\'\O"e
,Ill O,t>.f\ '(Ollllla'! obtaI 1\'I0te'. .Ihe ~?oti\iCalion
0090. cenlel. \ UI\IIt'l \'
calli1l9 I~e 1\'\8 orego~_'33"_2'344).
Ii- " 1I11ll1ber ~~Ier is \ -80
f'lU . HJl.LLE ' ~'I'lU\ ' , I
!HIS PERMII ~NDEfnH\S pER tion Description I
A\J!HORlZtD R IS MlM-lOON
D 't'~. OMM;;'~Ir,E~? ... t' $ Per Sq Ft Square Footage
escnp IOn) '. V'J)e 1I,",,'u~ IOn I' I' B'd
NY i 80 OIX 1:1'\\' or mu tIp ler or I Amount
JI. . ,
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Value
Date Calculated
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Pa~e I of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00632
ISSUED: 05/18/2010
APPLIED: 05/1812010
EXPIRES: 11/18/2010
VALUE:
....it',:.> i," .'i':'
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
, '
" , ,Total Value of Project
- I.., '
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
2201000000000000526
2201000000000000526
2201000000000000526
2201000000000000526
$8.04
$3.35
$55.00
$12.00,.'1\'"
, .~,...~-
5/18/10
5/18/10
5/18/10
,\"~,, 5/18/10
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Total Amount Paid
$78.39 V",' ,;.,.
Plan Reviews ~
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.
LReouired Inspections I
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 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, ~tate of Oregon pertaining to the work described herein, and
tbat NO OCCUPANCY will be made of any structure:.witlioul'j)ermis~ion of the Community Services Division, Building Safety.
1 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 inspecti"fi','''re req'';'ested at the proper time, that each address is readable from the
street, tbat the permit card is located at the front odh~ property, and the approved set of plans will remain on the site at all
times uri ust uctiou.
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Date
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Page 2 of2
225 Fifth Street
),' '
Sprmgfield, Oregon 97477
541-726-3759 Phone
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RECEIPT #:
2201000000000000526
P;I~'"':' .
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 05/18/2010
1:29:27PM
Job/Journal Number
COM20 I 0-00632
COM20 I 0-00632
COM2010-00632
COM20 I 0-00632
Payments:
Type of Payment
CreditCard
cReceiotl
Description
Add, Alter, Extend Clrc
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
JB ELECTRIC
Check Number
Received By . Batch Number
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Page I of I
Item Total:
Authorization
Number How Received
Amount Due
55.00
12.00
8.04
3.35
$78.39
Amount Paid
07173 I In Person
Payment Total:
$78.39
$78.39
5/18120 I 0