Loading...
HomeMy WebLinkAboutPermit Electrical 2010-7-6 > E'ie'ctrical Permit Application 225 Fifth Street+Springfield. OR 97477+PH(541)726-3753+FAX(541)726-3689 Date: - b -fO 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. ~. rt\~~ \ ATTENTION: Oregon law requires you to ~ rI . \ follow rulea adopted by the Oregon Utility v( Notification Center. Those rules are set forth \9' In OAR 952.()()1.001 0 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone I\Umber for the Oregon Utility Notification Canter Is 1-800-332-2344). _...J. J 440.2584.) (9/08/COM) W""p.: W ~ ~~ ..1..0CAI..<iGOVERNMEN1"&,'AI'1I'1ROYAL!' Zoning approval verified? DYes D No /'~CAJ'EG(i)R'(,l{OF"CONS[RUCJ'IClN . o Residential Government D Commercial :;1l{l{'*~1.l0a~$I[EDiINI;ClRMA[10Nj 'f!..N[j~I.f(i)(;AJ'ION.' Job site address: S City: S ....:, ,,;'cr ZIP: Reference: '17y63 E-mail: This installation is being made on residential or fann property owned by me or a member afmy immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: ~"~;".:;.:;: ;t""J~'fCONTRAeTOR:tINSML:LA TION ; 3; :.,"/~ ':"'.: " Signing supervisor's license no.: Print name of signing supervisor: Signa~ure of signing supervisor: " .~ ;:,P,). .' iFEEtSC8EDtJI.fE';;'7-:.".J;;:;r,":;.; < ; "'Y' '. ........... .:........ ..J ':I::Cost; '1;'Total" ;i~g~~er,~:r m~pe~~tt~~sW~r:~t~!p'~2~;~ ,~; :!?~~Jb~~i:<ea'~?:-""I;:~>~~sf'C;:/ Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) / $ 81.00 $?JfCd 20 I to 400 amps (2) $ 95.00 $ 40 I to 600 amps (2) $158.00 $ 60 I to 1.000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) 201 to 400 amps (2) 40 I to 600 amps (2) $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel M p'o" ,,,,,,,,.mch circuits ,,;ith nurch"e :i~?y'{') "\'{Ier !ee: TlEl.ah=' c 1~ ~~t~ . II IS W,QllT !~~y!J2. iJ\lii~'J. '_' ci lFI~i~Q,j~~"""!~WFOOce;9rf,e'ederfee; U WD~vIC :v_':--_~. ~ -' " , FirstBranc"clf' .~- .;$;55.00 '$ ft_' ...""'h,, 1I11) .. q" '. ~111'..Ir'.,~_'_ each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited.energy panel, alteration, or extension (2) Each additional inspection: (I) ..........."".."., $ 63.00 $ $ 63.00 $ $ 63.00 $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $58,00 $ ;:..~ $;# $/1ff!!-. $'l?:2)" $/'i3,oS (8) Enter 12% surcharge (.12 x [AD (e) Technology Fee (5%of[AD . TOTAL fees and surcbarges (A through C): m;~ - 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line !..k,-I:- , CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00895 ISSUED: 07/06/2010 APPLIED: 07/06/2010 EXPIRES: 01106/201 I VALUE: Status Issued SITE ADDRESS: 522 HARLOW RD Bus Statiou ASSESSOR'S PARCEL NO.: ROW-MISC SPRINGFIETYPE OF WORK: Electrical Work Only TYPE OF USE: New PROJECT DESCRIPTION: Service and circuits for Pheasaut westbound LTD/EMX station Commercial Owner: LANE TRANSIT DISTRICT Address: PO BOX 7070 EUGENE OR 97401 ,.. ,;".. Phone Number: 541-682-6100 I."j.,' ~ J': , I CONTRACTOR INFORMATION ~ Contractor Type Electrical ' Contractor 'CAMP CREEK ELECTRIC LLC License 164877 Expiration Date 06/09/201 I Phone 541-746-1471 BUILDING INFORMATION i # of Stories: Heigbt of Structu're . . , I '''I Secondary Occupancy Group: , . ' Type of Heat; Primary Construction Type ,...: I' ater Type: Secondary Cj\mlil'ffi!Jlll:'OPJgon law requires you ge Type: # of Bedro't81lOw rules adopted by the Oregon ~t gy Path: Notification Center. Those rule~:~ ::2- B~~nkled Building: 0090 You may obtain copies 0 MENT INFORMATION caliing the center. (Note: the , ' . . er for the Oregon Utility Notification . Front yard sl!1Wa'~:Cl:lnter is 1_800-332-2344). 'OverhiyDlst: Side 1 Setback: #' Street Trees Rqd: Side 2 Setback: :faved Drive Rqd: Rearyard Setback: ' ',oio of Lot Coverage: Solar Setbacks: .,', # of Units: Primary Occupancy Group: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: n .",_ , ':,.,"'._ . .. "\'~~i>:,,:t.'~"~"~"';~t../"<.. Notes: NOTICE: \RE IF THE WORK , 'TH,~ PERMIT S~~~~;.x~S PERMIT IS NO~;} . ': . '.. r: MMENCED OR IS ValuatIOn Descr! tIOIY 180 DAY PERIOD. ..Y . ~.. _: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa!!e I of2 ,~, . \ .' .~;~:, L\.i :;-.,;. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM201O-00895 ISSUED: 07/06/2010 APPLIED: 07/0612010 EXPIRES: 01/06/2011 VALUE: "0"0 ., i.'''" r'." - L. d .j.:., Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid ~. Fee Description + 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 7/6/10 1201000000000000802 $8.25 7/6/10 1201000000000000802 $84.00 7/6/10 1201000000000000802 $81.00 7/6/10 1201000000000000802 Total Amount Paid $193.05... , , .,.':<.... ,1.' ',..t,.." .J~,l.l!n .Rllyjews 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. . '. Reouired Inspections ~ Rough Electric: Prior to Cover Electric Service: Approval required prior. to' ~tility company energizing service. Final Electric: When all electrical work is complete. .. i ., By signature, I state and agree, tbat I have carefully examined the completed application and do hereby 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 to the work described herein, and that NO OCCUPANCY will be made of any structure,witbo,ut permission of the Community Services Division, Building Safety. I further certify that only contractors and employee'S;.who.itreJri.compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspectioQS;~.3''''e:'"ifqiiested'at the proper time, that each address is readable from the c' .,,-,', ''''.' 1 '.'.: ~"I street, that the permit card is located at the front of it he prop"lity, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date 'i, ~ :-- . Paee 2 of2 225 Fifth Street Sprf~gfid~, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: ,: ), 1201000000000000802 Date: 07/06/2010 3:21: I2PM Job/Journal Number COM20 I 0-00895 COM20] 0-00895 COM20 1 0-00895 COM20 1 0-00895 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee Payments: Type of Payment Check Paid By CAMP CREEK ELECTRIC Item Total: Ch~ck Number Authorization Re~eived By, Batch Number Number How Received ". djb 6363 In Person Payment Total: Amount Due 81.00 84,00 19,80 8,25 $193,05 Amount Paid $]93,05 $193,05 ,;>1" ....;. "jll, , r , ~ ~:'1:"'j . ';\"<1' ~ ,- ".-i;,~'" e"I, cReceiot 1 Page 1 of 1 7/6/2010