HomeMy WebLinkAboutPermit Electrical 2013-10-8 SPRINGFIELD - 225 Fifth St
' CITY OF SPRINGFIELD Springfield,OR 97477
` ,�i Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02258 •
www.springfield-or.gov permitcenter @springfield-or.gav
PROJECT STATUS: Issued ISSUED: 10/08/2013 EXPIRES: 04/06/2014
STATUS DATE: 10/08/2013 APPLIED: 10/08/2013
SITE ADDRESS: 1865 OLYMPIC ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703253107400 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Branch circuits for Hawaiian Time
OWNER: NADINE L BURGE EXEMPT MARITAL TRUST Phone Number:
ADDRESS: 830 MCKENZIE CREST DR
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION III
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
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.
Owner or Contractor Signature Date .
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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- '®TIME:
0090. You may obtain copies of the rules by THIS PERMIT SHALL EXPIRE IF THE WORK
calling the center. (Note: the telephone 1UTHORIZED UNDER THIS PERMIT IS NOT
number for the Oregon Utility Notification
Center is 1-800-332-2344). COMMENCED OR IS ABANDONED FOR
. ANY 180 DAY PERIOD.
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Springfield Building Permit 10/8/2013 2:44:57PM Page 1 of 1
SPRINGFIELD=—� CITY OF SPRINGFIELD
ka.r,_
'49,--t3/4:21,... 225 Fifth St
r\4, TRANSACTION RECEIPT Spdngfield,OR 97477
"` OREGON 541-726-3753
811-SPR2013-02258
www.springfield-or.gov 1865 OLYMPIC ST permitcenter @springfield-or gov
RECEIPT NO: 2013002242 RECORD NO:811-SPR2013-02258 DATE: 10/08/2013
(DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE
Branch circuits without service or feeder- 1st circuit • 224-00000-426102 1004 60.50
Branch circuits without service or feeder-each additional 224-00000-426102 1004 123.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 22.08
Technology fee(5%of permit total) 100-00000-425605 2099 9.20
TOTAL DUE: 215.28
, AMOUNT PAID -: '"
,PAYMENT..TYPE_S PAYOR .`cnsRiER:ccprtrENrER mu COMMENTS `
Credit Card STEVEN. R GEISLER _ — W.... ...._ � -216 28 .
510011
TOTAL PAID: 215.28
•
Electrical Permit Application SPRINOFlELD DEPARTMENT USE ONLY
CITY OF SPRINGFIELD, OREGON Permit Sj 3- 22 S�
225 Fifth Street•Springfield,OR 974774 PH(541)726-3753•FAX(541)726-3689
Date: 40-711( 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 '°="a FEE:4SCHEDULE l S 1' a.,-.';rgr'
g approval ❑ ❑ .Number of inspections per item O Qty.
Zonin a royal verified? Yes No Cost ';, ,Total
., ,. .Number. :.. .. . . ..... . item cosh ..
.. CATEGORY;OF :CONSTRUCTION ,
Residential,per unit,service included:
❑Residential ❑Government ❑ Commercial,t�; 1,000 s q ft.or less 4 O $134.00 $
JOB,`'SIT.E INFORMATION`ANEFAQICATIONT.n=� P.
Each additional 500 sq. ft. or portion $ 25.00 $
Job site address: /TT,1. O7 ./211'1 G thereof
City: ,lyrt State:(,� . ZIP: ! tf 1) Limited energy(2) $ 32.00 $
Reference: / 2.53 I Taxlot.:59410O Each manufactured home or modular $ 63.00 $
DESCRIPTION OF WORK +, dwelling service or feeder(2)
Services or feeders: installation, alteration,relocation
! w") 11-C4t< ri(2/'U' id 200 amps or less(2) $ 81.00 $
PROPERTY OWNER . 201 to 400 amps(2) $ 95.00 $
Name: N(-? � '\ i`zi-&s' 401 to 600 amps(2) $158.00 $
Address: .c7 f✓�.�ke'�21 e- c U!-es'r 601 to 1,000 amps(2) $205.00 $
City: p Et t) State: (-pc ZIP: 9-2Y 77 -Over 1,000 amps or volts(2) $469.00 $
Reconnect only(2) $ 63.00 $
Phone: - - Fax: - -
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 INST�ALLLATTIIIOON� Branch circuits: new, alteration, extension per panel
Business name: OS t_+u-c[t\12.. a. Fee for branch circuits with purchase of a service or feeder fee:
Address: R 15 /( t63 Each branch circuit $ 6.00 $
City:-PO ] I Virg State: Ole.-. ZIP: q7f b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: fig cp 9,-ao.s-0 F.:944 7 -54/a First branch circuit(2) / $ $ 060"
Each additional branch circuit $ $ 'Ip Q SQ
E-mail: %� / � �{'-'
CCB license no.: 675479 BCD license no.:pZO-J T3 C Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 140745 Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: /Stet,�'/j 6ei S L2- Each sign or outline lighting(2) $ 63.00 $ •
Signature of signing supervisor: Signa);on,or or nsioned-energy panel, $ 63.00 $
!m � g P v ~` alteration,or extension(2)
Each additional inspection: (1) $58.00 $
,MIQ vAPPLICANT`USE: ..
(A) Enter subtotal of above fees `
(Minimum Permit Fee$58.00) $ l/
(B)Enter 12%surcharge(.12 x[A]) $ Z OS
(C)Technology Fee(5%of[A]) $ t'2
TOTAL fees and surcharges(A through C): $ 215----
440-2584-1(9/08/COM)