HomeMy WebLinkAboutPermit Electrical 2014-1-14 SPRINGFIELD 225 Fifth St
kCITY OF SPRINGFIELD Springfield,OR 97477
C i t '= Phone: 541-726-3753
` OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00096
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 01/14/2014 EXPIRES: 07/13/2014
STATUS DATE: 01/14/2014 APPLIED: 01/14/2014
SITE ADDRESS: 3033 GATEWAY ST,APT#,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703222003600 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: 100A service for DSL
OWNER: KKMH PROPERTIES LLC Phone Number:
ADDRESS: PO BOX 8099
PORTLAND OR 97207 •
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
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
ATTENTION: Oregon by he Oregon Util ty .
follow rules adopted by NOTICE:
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952 001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by CA UNDER THIS PERMIT IS NOT
calling the center. (Note: eN telephone
number Center is01e800-332-2344�ification ANY 180 DAY PERIOD.BANDONED FOR
Springfield Building Permit 1/14/2014 11:56:13AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
:1.1 .en.. 225 Fifth St
I` ��o OREGON TRANSACTION RECEIPT Springhe9d,0R97477
541-726-3753
811-S PR2014-00096
www.springfield-or.gov 3033 GATEWAY ST. APT permitcenter(olspdngfieId-or gov
RECEIPT NO: 2014000084 RECORD NO: 811-SPR2014-00096 DATE:01/14/2014
'DESCRIPTION; ��S__— .A000UNT_CODE/TRANS'CODE _ '__�_ _AMOUNT:DUE . 1
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
L;RAYMENTTYPET_ -PAYOR_ CASHIER:CCARPENTER „ . COMMENTS._,:: - %.•___. AMOUNT PAID.. .
Check TONY KOTH LITE ELECT 104.13
7653
•
TOTAL PAID: 104.13
•
•
•
•
Electrical Permit Application DEPARTMENT.;USE ONLY
• $PNINGiIELO¢ai (. �1
C1T7YOF SPRINGFI LD° ®REG-91v �_-. `' .5 •Permitno.: Si y— o�9G.
225 Fifth Streets Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689' /
Date: (7/1/7/ `f e
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.
t;^1LOCALfjGOVERNMENT4AP.FROVA1=6 a:; il :::.'1;`3, 14 F,EE,_SCHEDULEMIE4*~(„x_` t:.;
Zoning approval verified? ❑ Yes ❑No k r ° '' w� _,wp s 1 72 r-)` iW ”-Cost t Total
Number of mspecuons per rtemsO jz Qty ;„ Qa ". „_cost ,'
'3 ., 4CATEGORYItOF 'CONSTRUCTION 1 x P Viz, "`
` Residential,per unit,service included:
❑Residential ❑ Government I ommercial 1,000 sq. fr. or less(4) $147.50 $
s 4' JOBiy;SITE,ANF.ORMATION AND?-LOCATION; 4 .Y,;'
Job site address: /����� Each additional 500 sq.ft.or portion
s'33 L/"�� y thereof $ 27.50 $
' Cityadhy/) State: v)___- ZIP: 9 71'77 Limited energy(2) • $ 35.00 $
Reference /7D S J22.0 Taxlot :Z6OO - Each manufactured home or modular $ 69.00 . $
g" ? , n;&. +DESCRIPTIONOF.'r,.WORK, -, ,;ifr,,,.'r,Wrv, ,V dwelling service or feeder(2)
G o0 Olio he �� r�� /,��� Services or feeders: installation,alteration, relocation zu" s L �-(/ 200 amps or less(2) I $ 89.00 $
L/ it,it..
:tavai1 e4�PROPERTX DOWNER #` ti T `y 201 to 400 amps(2) $ 104.50 $
Name: ee/f-y7y�"Ate 401 to 600 amps(2) $174.00 $
(w
Address: - ryrx 5-5 601 to 1,000 amps(2) $225.50 $
City:fl7Zft Stater_ ZIP: 77107 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
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
479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
r;;;, °T gCONTRACTOR;,INSTALLATION , -'i' V?'! Branch circuits:new alteration, extension per panel
Business name: L.i TE 2-j2Z17Z/ c 5E &/ e.g. a. Fee for branch circuits with purchase of a service or feeder fee:
Address: `•p , /30X (//3 Each branch circuit $ 6.50 $
City: rfo //l-E State: D fil- ZIP: q7 9 Yo b.Fee for branch circuits without purchase of a service or feeder fee:
Phone5Y/-6SY- 511-4, Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: 5-179$ BCD license no.: 20'ZSc✓ Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 3 5 5 35 - Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: 7D N tr "co 7-1-i Each sign or outline lighting(2) $ 69.00 $
Signal circuit or a limited-energy panel,
Signature of signing supervisor: . �Le/
alteration,or extension(2) $ 80.00 $
' Each additional inspection:(I) $80.00 $
444c APPLICANT?HUSE' „ a 4 r w{
cr
(A) Enter subtotal of above fees $
(Minimum Permit Fee S80.00)
(B)Enter 12%surcharge(.12 x[A]) $ /0 ill
(C)Technology Fee(5%of[A]) $ (i41"
TOTAL fees and surcharges(A through C): S to [ t 3
440-2584-J(4/01/2013/COM)