HomeMy WebLinkAboutPermit Electrical 2010-7-6
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E'ie'ctrical Permit Application
225 Fifth Street+Springfield. OR 97477+PH(541)726-3753+FAX(541)726-3689
Date:
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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.
~.
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 ~
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..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
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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
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Phone Number: 541-682-6100
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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
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00895
ISSUED: 07/06/2010
APPLIED: 07/0612010
EXPIRES: 01/06/2011
VALUE:
"0"0
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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... ,
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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,
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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
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7/6/2010