HomeMy WebLinkAboutPermit Electrical 2013-12-18 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
t Phone: 541-726-3753
`" OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02698
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/18/2013 EXPIRES: 06/16/2014
STATUS DATE: 12/18/2013 APPLIED: 12/18/2013
SITE ADDRESS: 1025 G ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703351103500 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Low voltage for Data
OWNER: CATHOLIC COMMUNITY SERVICES LANE CO LLC Phone Number:
ADDRESS: 1025 G ST
SPRINGFIELD OR 97477 •
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor ASTRO TECH INC COB 111175 i 03/04/2014 541-683-5719
INSPECTIONS REQUIRED
III
Inspections
4550 Limited Energy
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.
j2/ a----- 1 2—// 99/3
Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to :DUCE: . .
follow rules adopted by the Oregon Utility ..HIS PERMIT SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth UTHORI7ED UNDER THIS PERMIT IS NOT •
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by [COMMENCED OR IS ABANDONED FOR .
Calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 12/18/201 10:06:15AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
f 1 225 Fifth St
TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
811-SPR2013-02698
www.springfield-or.gov 1025 G ST permitcenter @springfield-or.gov
RECEIPT NO: 2013002696 RECORD NO:811-SPR2013-02698 DATE: 12/18/2013
(DESCRIPTION : w _ACCOUNT CODE/TRANSCODE AMOUNT DUE
Data/Telecommunications 224-00000-426102 1004 80.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
PAYMENT _PAYOR �:casHlEa CCARPENTER : :.v COMMENTS , .;- • AMOUNT PAID
Credit Cardv _ SCOTT WALTERS 93.60
018346
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT USE ONLY
NEiwr =...get m.aa i ,f'ansv,sr .F y, SPRINGFIELD Z���
�CITX OF SPRINGFIELD rQREG0I�T . + r �zi S. _
4 ... ' Th.-a z s;;,€ --473%s&?r,Fi _ { ` Permit no.:
225 Fitch Strect•Sptmg field,01297477.1'li(041)7263753•IAX( 41)7263689 '` OREGON
Date: !2/i 1/i 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 FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Number of inspections per item () Qty. Cost Total
I I Cfl. loot::
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
❑ Residential ❑Government [/1 Commercial
JOB SITE INFORMATION AND LOCATION 1.000 sq. ft or less(1) $147.50 $ •
Each additional 500 sq. ft.or portion $ 27.50 S
job site address: . 1 025- G- 5t. thereof
City: 5I CI d State: c9R ZIP: 974E 7? Limited energy(2) / S 35.00 $
Reference:/ 70 757 1 Taxlot.:63 S-20 Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(?)
/ Services or feeders: installation.alteration.relocation
200 amps or less(2) $ 89.00 $
PROPERTY OWNER 5 201 to 400 amps(2) _ $ 104.50 $
Name: C o(t 9C C OmMt-h i ty ,St/ VI C e ✓ 401 m GUO amps(2) $174.00 $
Address: / o } 5-- C— Sr. 60110 1,000 amps(2) $225.50 $
City: g "4 / j State: l/ A ZIP: 9 7<47? Over 1,000 amps or volts(2) $516.00 $
Phone: - - Fax: - - Reconnect only(2) S 69.00
E-mail: . . Temporary services or feeders: insialation, akeratiou. relocation
This installation is being made on residential or farm properly 200 amps or less(2) S 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 479.560(1). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1.1)00 volts.see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:neat alteration. e.vtens iou per panel
Business name: /451-1r0 trc,11 Fte/N c_ a. Fee for branch clrcuils with purchase of a service or feeder fee:
Address: cc,octgg old 1-0,411 e r d• Each branch circuit 1 J .$ 6.60 $
City: FvyPhC State: Ok ZIP: 97p{o b. Fee for brooch circuits without purchase of a service or feeder fee:
Phone: !�-cti - d 53 5-7/ Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Airlrofpch Whirl 0,9414 `. Corn Each additional branch circuit $ 6.50 $
CCB license no.: /1 It 7 r I BCD license no.: C 10 j I miscellaneous fees:.service or feeder not included
Signing supervisor's license no.: 2{(J if 7 L" ci e�4 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: 5 C o'C'r vy f-1 1 rv. Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: 7�U"�"w — Signal circuit or a limited-energy panel. s 80.00 $
signing P alteration.or extension(2)
Each additional inspection:(I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees
sip(Minimum Permit Fee$30.00)
(B)Enter 12%surcharge(.12 x[A]) $ 7 lee)
d
(C)Technology Fee(5%of[A]) $ Yd
440-2584-3(4/01(2013/COi1) TOTAL fees and surcharges(A through C): $GJ2U%
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