HomeMy WebLinkAboutPermit Electrical 2013-8-12 SPRINGFIELD 225 Fifth St
hit' 1 -i CITY OF SPRINGFIELD Springfield,OR 97477
C� Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01790
www.springfield-orgov permitcenter @springfield-or.gav
PROJECT STATUS: Issued ISSUED: 08/12/2013 EXPIRES: 02/07/2014
STATUS DATE: 08/12/2013 APPLIED: 08/12/2013
SITE ADDRESS: 205 DORRIS ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1803020000802 , TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Service and 2 circuits for bathrooms
OWNER: WILLAMALANE PARK&REC DIST Phone Number:
ADDRESS: 250 S 32ND ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor BELLMAN GROUP INC GCB 194437 07/05/2015 541-357-6950
INSPECTIONS REQUIRED
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: Wien 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 he front of the property, and the approved set of plans will remain on the site at all times during
construe ,3,
'
Owner or acto `tI ure Date /
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by NOTICE: " '
calling the center. (Note: the teleph::lo
number for the Oregon Utility Notification THIS PERMIT SHALL EXPIRE IF THE WORK
Center is 1-800-332-2344). AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Springfield Building Permit 8/12/2013 1:59:27PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
ti d ..A!... 225 Fifth St
■ CAS',- TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
811-S P R2013-01790
www.springfield-or.gov 205 DORRIS ST permitcenter@springfield-or.gov
RECEIPT NO: 2013001744 RECORD NO:811-9PR2013-01790 DATE:08/12/2013
DESCRIPTION ,- " ACCOUNT CODEITRANS'CODE ______1_,:_AMOUNT DUE_ J
Branch circuits with service or feeder each circuit 224-00000-426102 1004 13.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 12.24
Technology fee(5% of permit total) 100-00000-425605 2099 5.10
TOTAL DUE: 119.34
PAYMENT TYPE_,. _PAYOR, -.cAswER:JLARSON _ , 1:,. COMMENTS , ..i,_21.:_-
-,_ . _
Check BELLMAN GROUP INC 119.34
5613
TOTAL PAID: 119.34
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I DEPARTMENT USE ONLY
Electrical Permit Application
nt ";C;`*'°.“- ^+ ;r..+ . ;vs ", SPRINGFIELD
'C '. SPRIN ilE!IEL t Q ' CiON.. 4 .� ..,,L"i Permit no.: i�t(Ze i 3 &(790
225 Fifth Street•Springteld.OR 97477♦PH(541) 26-37534F X(541)726-3689 rf oxEGON
Date: 8 /2A F
s
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 t
days of issuance or if work is suspended for 180 days. 1
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Number of inspections per item () Qty. Cost Total 1
ea. cost
CATEGORY OF CONSTRUCTION Residential,per unit,service included:
El Residential- ❑Government ['Commercial( I
JOB SITE INFORMATION AND LOCATION 1,000 sq.H.or less(p $147.50 $
Job site address: Each additional 500 sq. H.or portion 1
20 S Da✓,'s Ci f . thereof $ 27.50 $ t
City: J —. . I_ State: , I ZIP: - "1 ' Limited energy(2) I $ 35.00 I $ €
Referent : ,, Taxlot.: Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(?)
Services or feeders:installation,alteration,relocation
ooM -� 1- _. Loi-
s i
200 amps or less(2) ( $ 89.00 $ 6,
i
` PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name: ll-D,- \614..an...` (?auk,$ �..-. 401 to 600 amps(2) $174.00 S
Address: 2..5 0 z�2.., -1,4 . 601 to 1.000 amps(2) $225.50 S r
City: S i1� State: pc ZIP: `�7-1� Over 1,000 amps or volts(2) $516.00 S I
Phone: ` (j 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 fain ily.This 201 to 400 amps(2) $ 96.00 $
property is not intended for sale,exchange, lease,or rent.OAR -
479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts.see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new,alteration,extension per panel I
I
Business name: Se-((M^„v 6,01 .vlG • a.Fee for branch circuits with purchase of a service or feeder fee:
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Address: Po .-`(0vq-- t1 Each branch circuit I a $ 6.50 $ L3
City: . 'ice b.Fee for branch circuits without purchase ofa service or feeder fee:
, ,6,,„}„,,,...A._ State: O� ZIP: 1 0l-
Phone:S ' ?- 69S`O Fax: - - First branch circuit(2) $ 60.50 $
E-mail: (i 95 ( e._coo y „t,..Q, -F, v.-^ Each additional branch circuit $ 6.50 $
CCB license no.: (9..( 3"- BCD license no: r_-7 Miscellaneous fees:service or feeder not inchnded !'
Signing supervisor's license no.: b - 3 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: c2-04.., -, t L .J Each sign or outline lighting(2) $ 69.00 $
Signal circuit or a limited-energy panel, $ 80.00 S !
Signature of signing supervisor: _•� alteration,or extension(2) 1
ar Each additional inspection:(1) $80.00 $ I
APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00) /02---
. (B)Enter 12%surcharge(.12 x[A]) $ /2 24 I
(C)Technology Fee(5%of[A]) $ S t°—
440-25844(4/01/2013iCOM) TOTAL fees and surcharges(A through C): $ l(q 3-4 1
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