HomeMy WebLinkAboutPermit Electrical 2013-10-24 SPRINGFIELD - _ 225 Fifth St
``A CITY OF SPRINGFIELD Springfield,OR97477
C&I Phone: 541-726-3753
OREGON Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02374
wwws pringfield-or.gov perm itcenter@springfield-ar.gov
PROJECT STATUS: Issued ISSUED: 10/24/2013 EXPIRES: 04/22/2014
STATUS DATE: 10/24/2013 APPLIED: 10/24/2013
SITE ADDRESS: 6300 THURSTON RD,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702341200500 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Stage Lighting
OWNER: SPRINGFIELD SCHOOL DISTRICT 19 Phone Number:
ADDRESS: 525 MILL ST
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
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
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.
Ow -r or C. tracto ignature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE:
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0030. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
th3 cent,r, (Vote: the telephone COMMENCED OR IS ABANDONED FOR
c.I . a r rr, y rcti ication ANY 180 DAY PERIOD.
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Springfield Building Permit - 10/24/201 1:10:50PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
<OREGON TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
811-S P R2013-02374
www.springfield-or.gov 6300 THURSTON RD permitcenter @springfield-or.gov
RECEIPT NO: 2013002349 RECORD NO:811-SPR2013-02374 DATE: 10/24/2013
(DESCRIPTION _ ACCOUNT CODE/TRANS CODE , AMOUNT,DUE - ?
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
L. PAYMENT TYPE PAYOR : CASHIER.JLARSON COMMENTS AMOUNT PAID
Credit Card SPRINGFIELD SCHOOL DISTRICT 1f 119.34
161822
TOTAL PAID: 119.34
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Electrical Permit Application
y
DEPARTMENT USE ONLY
"-y t n =p 0J pit"JA wk?F,21,4 ' . 7. 7-,„, $ lh1 ,v
CITYOFSPRINGlI LD OREG6Ns* u�
. , . ? in ezwn . mss_r s
Permit no.: Fit 17 (3 02-377
285 Fifth Street•Springfield,OR 97477•P11(541)726-3753•FAX(541)726-3689
Date: 7`°/Z `f/7'j
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.
"' ' ;1LQCAL :GOUERNMENTa'AFPROYAL_ Z: " "-s:( :47..fsfr", eFEE}SCAEDULE',4 „5§r _ ,
ui
Zoning approval verified? Yes No h'r`'W A'y nu fc 1CN . "7 eCostr Total.-
g pp ❑ ❑ Number of mspectwns per item O,. , Qty x, ea. . ; ,,r cost_..h.;
-`]] t rCATEGORY3OF„iCONSTRUCT;ION, , ,*?,, :;+,,,a_=,
''"'” Residential, per unit,service included:
❑Residential ❑ Government tgCommercial
JOB ;S ITE'<INFOMATIO N';�AND 3LOCATION" 1�,; 1,000 sq. ft. or Tess(4) $147.50 $
_"
Each additional 500 sq.ft.or portion $ 27.50 $
Job site address: 300 11u(5� -i thereof
City: Sc A IC nO I State:aj ZIP: ?7Y 7? Limited energy(2) $ 35.00 $
Reference: 1 - Taxlot.: Each manufactured home or modular $ 69.00 $
` 'm 'r`DESCRIPTION"„OF;.WORK': ytt {� F dwelling service or feeder(2)
...-, w I Services or feeders: installation, alteration,relocation
t A�lS Lls L� ,(,..1
200 amps or less(2) ( $ 89.00 $
rx ,,0,1:::i1;;ORORERTEYAQWNERn&niMMa 201 to 400 amps(2) $ 104.50 $
Name: ���Tr.- ]i 401 to 600 amps(2) $174.00 $
Address: sa_S (1 , \ St: 601 to 1,000 amps(2) $225.50 $
City: 5(4/..fiC .. State:6 _ ZIP: Th7y7?
Over 1,000 amps or volts(2) $516.00 $
Phone:5cf( 74y' 6 3 7s Fax:541/ 7c// 6,37 Reconnect only(2) $ 69.00 $
E-mail:�I -Si p ^, C•�� / Temporary services or feeders: installation, alteration, relocation
ht•• AA) ,5�2; rti a /�. oc.US
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
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479.540(1) and 479. 60( ). 401 to 600 amps(2) $138.50 $
Signature' rt. Over 600 amps or 1,000 volts,see services or feeders section above
” "" �'+�sl "yCONT ,.C�l?REINSTALLATION A 4 'tT?�r4•,`..ksl Branch circuits:new, alteration, extension per panel
Business me Q Li.),L, rf a.Fee for branch circuits with purchase of a service or feeder fee:
Address:/ ET 0 /J, Ca ' Each branch circuit ac.. +1{ $ 6.50 $
Citys(4/,tr9 ) State:Q,L ZIP: 27r'7? b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:scf-/ 7yq-4375 Fax57-/- 7`JY (37/ First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Q 73 f Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: L,to --'7 ^G� -1 Each sign or outline lighting(2) $ 59.00 $
Signature of signing supervise • alteration,circuit cuitextens on(d-energy panel, $ 80.00 $
Each additional inspection:(1) $80.00 $
!t :el/0aTer/NT US Egl, _
(A) Enter subtotal of above fees
$
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $
,440-2584-1(4/01/2013/COM)