HomeMy WebLinkAboutPermit Electrical 2014-2-14 SPRINGFIELD 225 Fifth St
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:t , . CITY OF SPRINGFIELD Springfeld,OR 97477
�± Phone: 541-726-3753
.OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00338 .
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 02/14/2014 EXPIRES: 08/13/2014
STATUS DATE: 02/14/2014 APPLIED: 02/14/2014
SITE ADDRESS: 290 23RD ST,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703361405600 TYPE OF STRUCTURE:
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PROJECT DESCRIPTION: Service Electrical-Emergency
OWNER: DEWIS ROBERT J&DENISE R Phone Number:
ADDRESS: 290 N 23RD ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
POLARIS ELECTRICAL INC CCB 191946 09/27/2014 541-343-0824
POLARIS ELECTRICAL INC (C)Electrical Cont C670 07/01/2014 541-343-0824
INSPECTIONS REQUIRED
Inspections
4220 Electrical-Service
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. ,
- 5z '`1 —iV
Ow o ntractor Signature Date
ATTENTION: Oregon law requires you to
It` foiiow rules adopted by the Oregon Utility
rHl$pO�: Notification Center, Those rules are set forth
ERMIT in OAR 952-001-0010 through OAR 952-001-
AUrHORI2ED SHAW EXPIRE 0090. You may obtain copies of the rules by
COA9ME UNDER THIS PE FTHE w calling the center. (Note: the telephone
ANY Ig DAY
p R IS ABANDD PERMIT IS NOT number for
3t2-2344�ification
PERIOD NED FDR
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Springfield Building Permit 2/14/2014 12:00:48PM Page 1 of 1
Electrical Permit Application DEPARTMENT USE ONLY
�[�� SPRINGFIELD I
�t,+..€5)1C . $ 4•h=-.fir,( r271r2,'.rry i=' -.. r ..-. l I T
ITY�.*irEM INGNI�:LD ORE43 P2Z® H" —33c7
ki t iwr , rr--. `e .x^ i rsc r i-.�.,,13;+a;. 74,--y. ::: 6:•'- Permit no..
225 Fifth Street♦5pringfield,OR 97477♦PH(541)726-3753•FAX(541)726-3689 •''�
Date: 2. — \4+ ' l y"
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.
i' <. ,aiEOCALOVERNMENT.APPROVALl ? (a,''', , -' '" s 4,?A.t!* MFEE[wSCHEDULE'i'' :fi r�w-Li
Zoning approval verified? III Yes ❑No Number ofyispec[mnj.per item O" _ .1 Qty, 'east " ."-c,---9-, ?1,,`4;
: '? ,, 1 CATEGORY10,F. CONSTRUCTION „� ,• ;°4; '
Residential, per unit,service included:
❑Residential ❑ Government ❑ Commercial
„iii` JOBfISITE.;INFORMATION"AND;;,LOCATION°1'. ,z°s 1,000 sq.fr. or less(4) $147.50 _$
Each additional 500 sq.ft.or portion
Job site address: 2d o 7 3 rc\ 5±- thereof - $ 27.50 $
City Sr■nsey'ey,\ State: OE ZIP: 9 71{77 Limited energy(2) _,plp, s$x35^000 $
Reference: Taxlot Each manufactured homlo?modulart ii,•pie inn llttld`.
i .r a • 4 dwellm`glser'vice orfeeder-(2)ed b) :_:)Ac.•.re SeiRShh$
ale 4 , r DESCRIPTION-OF WORI( _ ,,,.
i�„� cst r nnte:e, ni9- uhl,-
Services.or feeders: installation,alteration,relocation
SC-0111 le-/ El Pler'crA\ n,�,�d,.,_ y i,.., _` h'r
200 antps;or�les`,_.. �a r obtain copi s of ir$,seaio $ $4.co
_ „o, „JE
tur< F, .g,e ,-,PROPERTY QWNER <: <A ;iFrok 201 to Wi06^arnps`(2)1e center• rt 1I nip/ $ 10450cn5
Name: b ∎ • 401 to 60Atamps`.(2`°r Inris 1$00-3'iV2-2:4$;74.00 $
8o Der'S
Address: z0to 11Z3 r 4 Sir 601 to 1,000 amps(2) $225.50 $
City: Srh`Iy2`A State: 0 (_ ZIP: s L177 Over 1,000 amps or volts(2) $516.00 $
r
Phone:s'g[- r 1 35-6 - 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
479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
' nPF,r CONTRACTOR'INSTALLATION , ° '}"<a Branch circuits: new alteration, extension per panel
Business name: Vo 104'[S Fec tr co,.\ rinc. a.Fee for branch circuits with purchase of a service or feeder fee:"
Address: 3i.-I S rci is me_ D rte_ Each branch circuit `p' $ 6.50 $
• City: F ice_ State: Q(7. ZIP: CU LP 7 N onteET for branch c r ,, ;IEit)Fpa aseio?: -rvice or feeder fee:
Phone:A t-Sof Zv6-7 Fax: - - Tr1IS PEE4! • i.0 y:' ('V-US PERK .VI $ 60.50 $
E-mail: errctiv+rsC� oLri e.�c-1-✓'ico' •Lem 1\UTHA�p�•I ti rap, akltl�S $ 6.50 $
CCB license no.: a BCD license no.: co \1 5`?t ' lI�U riff U $vice or feeder not included
1419LI6 1670 ANY 1chr5um�oi irrigation (2)supervisor's license no.: 5.5-- (3 5
pump g ( ) $ 69.00 $
Print name of signing supervisor: . - �., ws Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: Signal circuit or;limited-energy panel, $ 80.00 $
alteration,or extension(2)
• Each additional inspection:(I) $80.00 $
"# ,Mt zr ''' $APPLICANT; USE r'.,? a**w ..x
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $ ?C(',r76
(B)Enter 12%surcharge(.12 x [.A]) $ /0 C71
(C)Technology Fee(5%of[A]) S U 4C
TOTAL fees and surcharges(A through C): $ i 64. 13
440-2584-1(4/01/2013/C0M)
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SPRINGFIELD—o CITY OF SPRINGFIELD
:I t 225 Fifth St
`` TRANSACTION RECEIPT
POREGON 541-726-3753
811-SP R2014-00338
www.springfield-or.gov 290 23RD ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014000322 RECORD NO:811-SPR2014-00338 DATE:02/14/2014
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:.`_.ACCOUNT`CODEITRANS CODE- ?, -1 „ AMOUNT,DUE` .
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
., __._ - - - - AMOUNT PAID
A:PAYMENT TYPE, �,";PAYOR,__cnsxlER:
Credit Card Reese Travers 104.13
209338
TOTAL PAID: 104.13
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