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Permit Electrical 2013-8-8
SPRINGFIELD 225 Fifth St WCITY OF SPRINGFIELD Springfield,OR 97477 `9 Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01193 www.springfield-or.gov perm itcenter @ springfield-or.gov • PROJECT STATUS: Issued ISSUED: 08/08/2013 EXPIRES: 02/03/2014 STATUS DATE: 08/08/2013 APPLIED: 06/07/2013 SITE ADDRESS: 1863 LAURA ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703271003900 • TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: ELE-New dentist offices OWNER: STAMBAUGH DANIEL L Phone Number: ADDRESS: 1944 LAKEVIEW DR EUGENE OR 97408 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor JB ELECTRIC INC CCB 104929 03/14/2014 541-687-5770 Mechanical Contractor INNOVATIVE AIR INC CCB 161742 10/11/2014 541-746-1040 General Contractor MCINTYRE CONSTRUCTION INC CCB 3550 10/08/2013 541-687-2841 Plumbing Contractor HARVEY&PRICE CO CCB 77 10/31/2014 541-746-1621 INSPECTIONS REQUIRED Inspections 4225 Service or Feeder 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 perm'�-rd is located at the front of the property, and the approved set of plans will remain on the site at all times during • const9 • Owner or Contractor Signature - Date • ATTENTION: Oregon law requires you to •i < - follow rules adopted by the Oregon Utility NOTICE:ERM1T SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090: You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR . calling the center. (Note: the teleph tio, ANY 180 DAY PERIOD. number for the Oregon Utility Notification • Center is 1-800-332-2344). • Springfield Building Permit 8/8/2013 1:41:12PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St {,yeti TRANSACTION RECEIPT Springfield.OR 97477 '\ 541-726-3753 .OREGON 811-SPR2013-01193 w.vw.springfield-or.gov 1863 LAURA ST permitcenter @spdngfeld-or.gov RECEIPT NO: 2013001728 RECORD NO:811-SPR2013-01193 DATE:08/08/2013 DESCRIPTION .: ? 4. _`yli7`wgaE. .i.t ` :.-_ .ir,$i'°i ACCOUNTCODE/TRANS.CODE AMOUNT'DUE! ; Branch circuits with service or feeder each circuit 224-00000-426102 1004 208.00 Services 200 amps or less 224-00000-426102 1004 178.00 Services 201 to 400 amps 224-00000-426102 1004 104.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 58.86 Technology fee(5%of permit total) 100-00000-425605 2099 24.53 TOTAL DUE: 573.89 P.AYMENTw7YPE P.AYOR cASHIERa''ccARPENTER.. - COMMENTS AM_OUN3fiPAID nariMI Cash JB ELECTRIC INC 573.89 123791 TOTAL PAID: 573.89 Electrical Permit Application DEPARTMENT USE ONLY zg w c+,{r -ro e,a , '71 y six , , ;1 SPRINGFIELD - e.� h�4 ®I<}1 SPRINGFIELD� . R.�.'M° ` .a Permit no.: ��3 1�� I 1 �� Ml`FS."aa .. `e :TY . 225 Fifth Street•Springfeld,OR 97477•PH(541).26-3753•FAR(541)726-3689 Date: 7)/OREGON iii/j 3 666E i 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? 'es ❑No Number of inspections per item() Qty. Cost Total CATEGORY OF CONSTRUCTION f ID I ❑Government I Id't-ommercial Residential,per unit;service included: 1111 1,000 sq.ft.or less(4) $147.50 $ JOB SITE INFORMATION AND LOCATION /�� ��� Each additional 500 sq. ft.or portion $ 27.50 $ Job site address: thereof City: ..eire�(.c. State:©� ZIP: Limited energy(2) $ 35.00 $ Reference:_i Taxlot.: Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) ,�/ Services or feeders:installation,alteration,relocation /YC7 7a�utA>✓ i�61tF� i 200 amps or less(2) ca $ 89.00 $t/�g b PROPERTY OWNER 201 to 400 amps(2) / $ 104.60 $/Qy Name: / AX L �J) f.,j/4LG/L 401 to 600 amps(2) $174.00 S fI Address: I" 601 to 1,000 amps(2) - $225.50 S I City: I State: I ZIP: Over 1,000 amps or volts(2) $516.00 $ Phone: - - I Fax: - - Reconnect only(2) $ 69.00 $ I 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 $ I owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 96.00 $ E property is not intended for sale,exchange,lease,or rent.OAR 479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $ I Signature: Over 600 amps or 1,000 volts.see services or feeders section above I CONTRACTOR INSTALLATION T'',. Branch circuits:new,alteration,extension per panel Business name: Co< o r� u� ��®f�iz. cyi�-- a.Fcc for branch circuits with purchase of a service or.feeder fee: 1 Address: 4161, GLLt4 s Each branch circuit '3 $ 6.50 s I g7s!a� I City: j..�y1Q State: eic ZIp: b.Fee for branch circuits without purchase of a service or feeder fee: ' t Phone:ham//�-/v&/-577147 Fax: ...--- )2-94,2,4 First branch circuit(2) $ 60.50 $ 0 t E-mail: JDk, (s.d6.eleci •LG-(, c -cool Each additional branch circuit $ 6.50 $ CCB license no.: /01/0.9 I BCD license no.:3 .SiG Miscellaneous fees:service or feeder not included Signing supervisor's license no.: `??7.a 5' G Each pump or irrigation circle(2) $ 69.00 $ [ Print name of signing sup=t or: , OA/t... $/,'j91 " Each sign or outline lighting(2) $ 69.00 $ _Signal circuit or a limited-energy.panel, $ 80.00 $ Signature of signing supery • �..r alteration,or extension(2) Each additional inspection:(1) $80.00 $ APPLICANT USE . (A) Enter subtotal of above fees ``// (Minimum Permit Fee 580.00) $'J*9'— • (B)Enter 12%surcharge(.12 x[Al) $ 71?' } (C)Technology Fee(5%of[AD $ 2Y SJ TOTAL fees and surcharges(A through C): $ +/-73 t% 440-2584-J(4/01/2013/COM) 1 I