HomeMy WebLinkAboutPermit Electrical 2013-7-10 •
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SPRINGFIELD 225 Fifth St
`' = CITY OF SPRINGFIELD Springfield,OR 97477
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Phone:541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01571
www.springfieIdor.gov • _ permitcenter @springfeld-or.gov
• PROJECT STATUS: Issued ISSUED: 07/10/2013 EXPIRES: 01/05/2014
STATUS DATE: 07/10/2013 APPLIED: 07/10/2013 •
SITE ADDRESS: 950 INTERNATIONAL WAY,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703153000201 • TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: EL-Remodel storage to office space
OWNER: GOLDEN TEMPLE OF OREGON LLC Phone Number:
ADDRESS: 950 INTERNATIONAL WAY
SPRINGFIELD OR 97477
OWNER: NORTHBANK PROPERTY LLC Phone Number
ADDRESS: PO BOX 529
EUGENE OR 97440
CONTRACTOR INFORMATION j
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JB ELECTRIC INC CCB 104929 03/14/2014 541-687-5770
INSPECTIONS REQUIRED 1
- Inspections
4220 Electrical Service Electric Service: Approval required prior to utility company energizing service.
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.
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Owner or Contractor Signature. Date you to
ATTENTION: Oregon law requires y
follow rules adopted by the Oregon Utility
DOII HO Ado 084 ANH h OAR 952 forth
and 43NO4Nd8d SI a0 o30N31NW00 Notification Center. Those rules are setfort
03ZIH0H1(1V' in OAR 952-001-00 ts n copies of the rules by
0090. You may he t,o
ION 91 llna3d 2114183Q calling the center. ( e:the Notification
moM3141
Al TtVHS IIW 3aticw number for the Oregon
Center is 1-800.332-2344)*
Springfield Building Permit 7/10/2013 10:41:48AM i Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
OREGON TRANSACTION RECEIPT Spdngfield,OR 97477
541-725-3753
811-SPR2013-01571
www.springfeld-or.gov 950 INTERNATIONAL WAY permitcenter @spdngfield-or gov
RECEIPT NO: 2013001481 RECORD NO: 811SPR2013-01571 DATE:07/10/2013
1B]x.Yol:trpuirt]`X ij -r t' " t o S:ACCOUNT4CODE/TRANS CODE : _ : %Pr-tank 0 g
Branch circuits with service or feeder each circuit 224-00000-426102 1004 91.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 21.60
Technology fee(5%of permit total) 100-00000-425605 2099 9.00
TOTAL DUE: 210.60
P.AYmarrlPE `P.AYORa CASHIERrCCARP.ENTER. s!. daC'OMMENTS AMOUNT�PAID ,
Check JB ELECTRIC INC 210.60
123729
TOTAL PAID: 210.60
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Electrical Permit Application DEPARTMENTUSE ONLX
SPNINGFIELD as�..
tiCIT- OF SPRINGFI E OREGON "- - S/3 — /_$77/
v Permit no.:
.a?:�r��.A..•4r.fr.w.,..;...,., �.w.t.as::ac*�:a?-tys s.�..i �sv_�br ,
225 Fifth Street♦Springfield,OR 97477.111(541)726-3753♦FAX(541)726-3689 �-7
Date: //10/13 .
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.
';,,r u"SiLQCAL CGOVERNMENTAPPF,2OVALf V„ t: .7:1"r*.flitealligeztEVISPIIIE0.1114EMMTITIgrtge9
Zoning approval verified? eigYes ❑No
Nuer of sp op esin -st Total-1 mber nann t (} 4 .4*- # •
.ri<:, .t� . , . 4:..4 . . .4. ac -ciea ?. .L cost
k„ taCATEG(50OF, CONSTRUCTION Ir y 4
Residential,per unit,service included:
❑Residential I ❑Government I %Commercial 1,000 sq.ft.or less(4) $147.50 $
,�i' ' JOBuiSITE,INFORMAT.10 AND, LOCATION"AM q ) -
Iob site address: /, Each additional 500 sq.ft.or portion $ 27 50 $
,� z'/A? Milk- k thereof
City: �/`iy y,(..%( _ State: CA J ZIP: Limited energy(2) $ 35.00 $
Reference: /703 /S3 tO I Taxiot.:CO2.0/ Each manufactured home or modular p,.a, rt r ,; - - t - yap;w„y,s dwelling service or feeder(2) $ 69.00 $
,ny,,_� `DESCRIPwTION_ OF WORKaI%.�` - {� _
7 teak r �` C� Services or feeders: installation,alteration,relocation
't' 200 amps or less(2) / $ 89.00 $F7.
l y"kp t"',dt;.�,itfa �g),RbURI-el:OWNER g'v��3 Z;tt `a 201 to 400 amps(2) $ 104.50 $
Name: >66/ .7cAy 401 to 600 amps(2) $174.00 $
Address: t-5---z) //VT 14_ C,(/✓4-> 601 to 1,000 amps(2) $225.50 $
City: 9p,/) IISState:a1., 1 ZIP: 5',8[77/ Over 1,000 amps or volts(2) ' $516.00 $
Phone: - - I Fax: - - Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders:installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 69.00 $
owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 96.00 $
property is not intended for sale,exchange, lease,or rent. OAR
479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
'','s. } CONitatTsORIINST alfkfiil0W l.i.ift'E:'iS Branch circuits:new alteration, extension per panel
Business name: LL .r A apcJn.Ci- p a.Fee for branch circuits with purchase of a service or feeder fee:
Address: g egg -Y.�'rtiel e�_ p Each branch circuit `/1/) $ 6.50 $'7/
City: State: [ism... ZIP:Mari.- b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:SW -4j57-�-i'7O Fax 39 - 30a-9a9, First branch circuit(2) $ 60.50 $
E-mail: 4OIyt•✓ ® ,11).Q/..QG/n c-/nG.,,,Co7Jv _ Each additional branch circuit $ 6.50 $
CCB license no.: /0171,89 1 BCD license no.: 37-5-91e, Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 3E74,2. Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervis r: ,BC_ Each sign or outline lighting(2) $ 69.00 $
7 ,_. yukt42,!
Signature of signing supervise Signal circuit or a limited-energy panel, $ 80.00 $
�1- alteration,or extension(2)
Each additional inspection:(1) $80.00 $
` r2,' t* . APPLICANT USEr ; `:,. ' `'
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(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $70
(B)Enter 12%surcharge(.12 x[A]) $ 'L(
(C)Technology Fee(5%of[A]) $ (2 of
TOTAL fees and surcharges(A through C): $ -V j
440-2584-7(4/012013/C0M)