HomeMy WebLinkAboutPermit Electrical 2013-5-16 SPRINGFIELD 225 Fifth St
htCITY OF SPRINGFIELD Springfield,OR 97477
,(`v� Phone: 541-726-3753
' ` OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00977
www.springtield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/16/2013 EXPIRES: 11/11/2013
STATUS DATE: 05/16/2013 APPLIED: 05/16/2013
SITE ADDRESS: 6100 THURSTON RD,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702342100400 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION: Branch Circuits
- OWNER: WILLAMALANE PARK&REC DIST Phone Number:
ADDRESS: 250 S 32ND ST
SPRINGFIELD OR 97478 '
_ CONTRACTOR INFORMATION
ll
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
KENNETH D RANDALL (5)Electrician,Ge 40235 10/01/2013 541-736-4102
L INSPECTIONS REQUIRED
Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
4999 Final Electrical 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 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 or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any 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.
1 4Y/l 7P g di
5//�f Zo/-3
Owner or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility
AUTHORIZED UNDER THIS PERMIT IS NOT Notification Center. Those rules are set forth
"OMNlENCED OR IS ABANDONED FOR In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
°f ! 4Y PERIOD. calling the center, (Note: the telepl
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 5/16/2013 1:30:55PM Page 1 of 1
•
, SPRINGFIELD - CITY OF SPRINGFIELD
225 Fih St
TRANSACTION RECEIPT Spnngfield,OR 97477
OREGON 541-726-3753
811-SPR2013-00977
www.springfield-or.goy 6100 THURSTON RD permitcenter @springfield-ar.gov
RECEIPT NO: 2013000965 RECORD NO: 811-SPR2013-00977 DATE:05/16/2013
€DESCRIPTION "`- =_? - - .: :° AtCOUNTCODEITRANS1CODE,^° '-- AMOUNTuDUE''`'`
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 19.50
Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
; _PAYMENT-TYPE _ , :°PAY,OR a' °� COMMENT$ =AMOUNT PAID..,,
„
Credit Card KENNETH D RANDALL KENNETH D 93.60
047170 RANDALL
TOTAL PAID: 93.60
•
• Electrical Permit Application DEPARTMENT USE ONLY
t • SPRINGFIELD
CIi O MIOREGO1 `.: .rte e,,,, 3 ;
„t4 at e..., ..,; i ) permit
n5 Drill Sir'eet•Spriaefield,OR 97477•P1-1(541)726-3753•P\\($411726-1489 43:St,a,yeGDN //
Date: // / 3
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 •
days of issuance or if work is suspended for 180 clays.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Number of ins ections per item() Qty. Ccoas.t Total
cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
❑ Residential '$Government ❑Commercial
JOB SITE INFORMATION AND LOCATION
1,000 sq.ft.or less(4) $147.50 $
--- Each additional 500 sq.ft.or portion
Job site address: G(b�7T_0, �fr'rdc.J "b , thereof $ 27.50 $
City: F'f{(wc �(L,-,D i State:0g, ZlP:et7�78 Limited $ 35.00 $
Reference: Taxlot.: Each nwnu(aetured home or modular S 69.00 $
dwelling service or feeder(2)
DESCRIPTION OF WORK --
p _. _------ Services or feeders: installation.alteration,relocation
I W -ra( uhJ S 0O(' En r.»r,v, 51/41s-re",
200 amps or less(2) $ 89.00 $
Co ea'Se rTi>2-
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name:(,v y 1i MS(�J__c Fe,eic tJ isf • 401 to 600 amps(2) $174.00 $
Address: 7 50 S- 3a n,D. Sr 601 to 1,000 amps(2) $225.50 $
City:S QF�t `�Yi F(c („.p State:5 e_ ZIP:q 7`t77 Over 1,000 amps or volts(2) $616.00 $
I hone:5 Fax: - - Reconnect only(2) S 69.00 $
gl--/ qS 44 •
E-mail: Temporary services or feeders:installation, alteration.relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 69.00 $
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 S
property is not intended for sale,exchange,lease,or rent.OAR
479.540(1)and 479.560(1). 401 to 600 amps(2) S138.60 $
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:w 4 0.Fee for branch circuits with purchase of a service or feeder fee
Address: Each branch circuit $ 6.50 $
City: State: ZIP: b. Fee for branch circuits without purchase of a service or feeder fee:
PhoneS4l-7X5 ck to Pax: - - First branch circuit(2) $ 60.50 ScjjE
E-mail: ?•_(.._kaireb cranN<O get Each additional branch circuit S 6.50 S
CCB license no.: ( BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 1 O 2.3 S GG Each pump or irrigation circle(2) S 69.00 S
Print name of signing supervisor: _N --r-i b, S-A v,neyC!
Each sign or outline lighting(2) $ 69.00 $
p 7/� D -7, Signal circuit or n limited-energy panel, $ 80.00
Signature of signing supervisor: (� �C Signal car ui C r a li it
Each additional inspection:(I) $80.00 $ •
,
APPLICANT USE
(A) Enter subtotal of above lees $g0,1""
(Minimum Permit Fee$80.00) L7
(B)Enter l2%surcharge(.12 x(All clr 6 r
(C)'technology Fee(5%of IA)) £OO
44U-2584-1(4/0112013/COM) TOTAL fees and surcharges(A through (2): -