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HomeMy WebLinkAboutPermit Electrical 2013-5-23 p i SPRINGFIELD rS 225 Fifth St CITY OF SPRINGFIELD Springfeld,OR97477 �t �o EGON Phone: 541-726-3753 Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01049 www.springfeldor.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/23/2013 EXPIRES: 11/18/2013 STATUS DATE: - 05/23/2013 APPLIED: 05/23/2013 SITE ADDRESS: 1128 5TH ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703263402700 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Everyone's Market-Service Change OWNER: SATNAM LLC Phone Number: ADDRESS: 1225 E GRANT ST • LEBANON OR 97355 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor STEVEN R GEISLER CCB 95472 11/23/2014 541-726-0618 INSPECTIONS REQUIRED - Inspections • 4210 Service Change 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. Owner or Contractor Signature Date o-n -� �e�f ''`C A- 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 in OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR 0090. You may obtain-copies of the rule by ANY 180 DAY PERIOD. calling the center. (Note: the telep:..;n number for the Oregon Utility Notifiou,un Center is 1-800-332-2344). • • Springfield Building Permit 5/23/2013 3:59:28PM Page 1 of 1 :1• SPRINGFIELD CITY OF SPRINGFIELD r1 / 225 Fifth St TRANSACTION RECEIPT Springfield,OR97477 OREGON 541-726-3753 811-SPR2013-01049 www.spdngfield-or.gov 1128 5TH ST permitcenter©spdngfield-or.gov RECEIPT NO: 2013001031 RECORD NO: 811SPR2013-01049 DATE:05/23/2013 L • ., .O -ACCOUNT CODE/TRANS CODE'"- C' .,F:AMOUNT DUE`i;S Services 201 to 400 amps - 224-00000-426102 1004 104.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 12.54 Technology fee(5%of permit total) 100-00000-425605 2099 5.23 TOTAL DUE: 122.27 PAYMEN7ITYPE? .r_: .'PAYOR'_I casRieRi.nRSOR sjxyM4.169 i.r -._„_.. .. -:4`,,,_7 cAMQUNT-P_AID' _ . . n--c Credit Card STEVEN R GEISLER 122.27 , T 531174 TOTAL PAID: 122.27 Electrical Permit Application DEPARTMENT USE ONLY HPgINGiIILD --n- :;':GITY'OF SPRINGFIELD,,OREGON '4—s"t. Permit no.: e(/Z613 010 cli 225 Fifth Street*Springfield,OR 97477•PR(541)726-3753,FAX(541)726-3689 Date: 13/23//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 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total CATEGORY OF CONSTRUCTION ea. cost Residential,per unit,service included: ❑ Residential ❑Government [gsCommercial $ JOB SITE INFORMATION AND LOCATION 1,000 sq. ft.or less(4) $134.00 Each additional 500 sq.ft.or portion Job site address: 7/Zo cril thereof $ 25.00 $ City: C,7-C/4. State: 0 /. ZIP: Limited energy(2) .. . $ 32.00 $ Reference: Taxlot.: Each manufactured home or modular $ 63.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) 1 / Services or feeders:installation, alteration,relocation EVPtria7NC5 gerffit — GK4N C c ewe;G 200 amps or less(2) $ 81.00 $ PROPERTY OWNER 201 to 400 amps(2) / $ 95.00 $ Name: cr/„r�Gt 401 to 600 amps(2) $158.00 $ Address: 601 to 1,000 amps(2) $205.00 $ City: State: ZIP: Over 1,000 amps or volts(2) $469.00 $ Phone: - - Fax: - - Reconnect only(2) $ 63.00 $ E-mail: Temporary services or feeders:installation, alteration, relocation This installation is being made on residential or farm 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 479.5600). 401 to 600 amps(2) $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: StEkEt\.13 SLC--CT1C, a.Fee for branch circuits with purchase of a service or feeder fee: Address:PO pO BOX b£3 Each branch circuit $ 6.00 $ City: f t_c{es vcNIT f+1(,L_. State:- ZIP: '7453 b.Fee for branch circuits without purchase of a service or feeder fee: Phone: 5111 719.-9-05-c) Fax:5 - 741-6—Q it1 9-- First branch circuit(2) $ 55.00 $ Each additional branch circuit $ 6.00 $ CCB license no.:9 S 47 9, BCD license no:-90-373 C. Miscellaneous fees:service or feeder not included Signing supervisor's license no.: i-}O q I-- S Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: l t0 cE(SL&, - Each sign or outline lighting(2) $ 63.00 $ -�-�i Signal circuit or a limited-energy panel, Signature of signing supervisor: V v' alteration,or extension(2) $ 63.00 $ /��h( �e�h;�09w Each additional inspection:(I) $58.00 $ a APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Permit Fee$58.00) (B)Enter 12%surcharge(.12 x[A]) $ (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): $) 1.Z3-1--7 440-2584-1(9/08/COM)