HomeMy WebLinkAboutPermit Electrical 2013-9-12 •
`` SPRINGFIELD - 225 Fifth St
CITY OF SPRINGFIELD Spnngfield,OR 97477
Phone: 541-726-3753
" �OREGON Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02057 •
www.springfield-0cgov permitcenter @springfield-or.gov
•
PROJECT STATUS: Issued ISSUED: 09/12/2013 EXPIRES: 03/11/2014
STATUS DATE: 09/12/2013 APPLIED: 09/12/2013
SITE ADDRESS: 3693 GAME FARM RD,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703153301000 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: 100 amp power pedestal
OWNER: MML PROPERTIES LLC Phone Number:
ADDRESS: PO BOX 7668
SPRINGFIELD OR 97475
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor TONY KOTH CCB 59748 05/19/2014 541-688-8996
INSPECTIONS REQUIRED
Inspections •
4225 Service or Feeder
•
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.
h 2 %- /z - i3
Owner or Contra of Signature- 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:
EXPIRE If THE WORK
AUTHORI E
calling the center. (Note: the telephone
number for the Oregon Utility Notification ID UNDER THIS PERMIT IS NOT
Center is 1-200-332-23''.4).
COMMENCED OR IS ABANDONED FOR
SHALL
ANY 180 DAY PERIOD.
Springfield Building Permit 9/12/2013 3:00:08PM Page 1 of 1
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‘:*) SPRINGFIELD CITY OF SPRINGFIELD
}' �
TRANSACTION RECEIPT 225 Frith St Spdngfield,OR97477
OREGON 541-726-3753
811-SPR2013-02057
www.springfield-or.gov 3693 GAME FARM RD permilcenter @springfeld-or.gov
RECEIPT NO: 2013002021 RECORD NO: 811-SPR2013.02057 DATE:09/12/2013
nv e Px_=r'rt'"I . : asaialtt jACCOUNTACODE/TRANS=CODE':`" AMOUNT'DUE "3,'
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.68
Technology fee(5%of permit total) 100-00000-425605 2099 4.45
TOTAL DUE: 104.13
f-PAW THE FPAVO—R- CA5158t_ERSO __ _COMME MO D-
Check TONY KOTH 104.13
7577
TOTAL PAID: 104.13
Electrical Permit Application ,-,-- DE-PAFetMENTWSEONLY ':•= :;
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j,„MITUORSPRINGItIEUIVOREG-ON'N —a-- - -'.--We:::
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';S-alcitatx.7*-;,, ,7-,..-4. 24,inTaitcri,-,ttilt,thit.113;:aifacispv ,,,,,c2a,,t, * ::4.] Permit no s( [ lo( 3 0 Zoc),
225 Fifth Street•Springfield,OR 97477.1311(541)726-3753•FAX(541)726-3689
Date: 7 /it/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.
-,Pit$'ii,RiSEOCAli1GOVE RN M E NT,:rARP ROvAljOlig4„FiWt n:;,itt43,At3:;::4ln:IPFESCHEP.uaiEi:Rizt;::isktEkf:::t.:.NzKi
Zoning approval verified? ID Yes D No is,42.-nr,]]-3F:r.:-.: .S]]qw--']"].":“:'4'jx-']':]];]= :/. -']a-Cdif40]:]";:iToTal]]
}]N41"1"ifes!,140€1:0,qichPti -WY;,1:-.7c- eavO'; c6§1:7ts'
!;&.W4)Zk&CATEG'013Y10,E;t„CONSTRUCTIQVW:10,14,:cd, ' ,
Residential,per unit,service included:
D Residential 0 Government n Commercial
1,000 sq.ft.or less(4) $147.50 $
Atf4J 0 BIS ITE:.11N E0 RMATIO WAN D'AOCATIOI0t-As'
Each additional 500 sq ft.or portion
Job site address: 3(octi 3 Am e/).-4-pfi--) thereof . - $ 27.50 $
City: (4p pp . State: ZIP: Limited energy(2) $ 35.00 $
Reference Taxlot.: Each manufactured home or modular
:Mairi.§321 D ES C RI R;I:10 NIO FiWO RKW401-V,fn dwelling service or feeder(2) $ 69.00 $
Services or feeders: installation, alteration, relocation
PO a A-x-1 p 170 1-4) ---71-- per-V,t 5 I-71-e-
C .
_ <K 0 5 L
200 amps or less(2) U $ 89.00 $
L.,-- t,r-11'.4%11 t
Nil;tagantYgakkbEEkTiVOWNERM7SMP:MME413 201 to 400 amps(2)
$ 104.50 $
Name: 401 to 600 amps(2) $174.00 $
Address: 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: - - Fax: - - Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
200 amps or less(2)
This installation is being made on residential or farm property $ 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 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
;lillNingfeiCONirlF,(ACT,Ol2iiINSTALLATIONW.50;:,70.,4s, Branch circuits:new alteration, extension per panel
Business name: 4,..7 7 (:-:-.---,--zezq-- a. Fee for branch circuits with purchase of a service or feeder fee:
Address: p.u , oex it/3c7 Each branch circuit $ 6.50 $
City: elve State:04. ZIP:97 5 4 lee b.Fee for branch circuits without purchase of a service or feeder fee:
Eton &if -i(I-tilt.; Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: 5t7$i-S2 BCD license no.:2a--2.5j2J Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 3 e 5"3 5 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: 771//1-- /2o 1?-7/ Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor:
Signal circuit or a limited-energy panel, $ 80.00 $
(.. Signal or extension(2)
. Each additional inspection:(1) $80.00 $
.i.'fa.V.a.WnfgZgrfcf#:P:tfdXkt?rijgt:W1S1,4\R1,3tt1
(A) Enter subtotal of above fees
- $
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[AI) $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $icsy / ._,
440-2584-1(4/01/2013(COM)