HomeMy WebLinkAboutBuilding Application 2014-2-21 Electrical Permit Application • - DEPARTMENT USE ONLY
*,S`* y7ra '° ' .`hit,t ,N SPRINGFIELD /!
11 C IE�.'D, QREG:QN A..i Permit no.:.S/v OOnl
225 Fifth Street•Springfield.OR 974770PFIt541)726-3753*1 \X(541)726-3689
P+"`1;.,""^ OREGON '
Date: 00y I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 I
days of issuance or if work is suspended for 180 days. 1
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ({9-Yes ❑No Cost Total ections per item(1 Q t y-
. cost
CATEGORY OF CONSTRUCTION - ea
Residential,per unit,service included: Ii
❑Residential ❑Government sz-Commercial [
JOB SITE INFORMATION AND LOCATION 0000 sq.ft.or less(4) $147.50
W ✓ OL—vn - < Each additional 500 sq. .or portion
Job site address: I
1 C J� thereof $ 27.50 $
City: 5\y`1(1L, ,Q\ \ State: Uy ZIP: °�4-L,1 Limited energy(2) $ 35.00 I $
Reference: I t o 3 g S it 4' Taxlot.:Q 3G a Each manufactured home or modular $ 69.00 $
iRI)l,a(k DESCRIPTION OF WORK dwelling service or feeder(2)
s Rif Services or feeders:installation,alteration.relocation 1
IG. Q. Cx■SH1� NO-et-Mr- IIlt n ibsG.-1-ec'i I
1 X) 200 amps or less(2) $ 89.00 S t
'y V '-D✓ vv✓-(191 tw 127n Ask-
PROPERTY 10 400 amps(2) $ 104.50 $ i
d PROPERTY OWNER
Name: 401 to 600 amps(2) $174.00 S I
601 to 1,000 amps(2) $225.50 S I
Address: t
i
City: /�. - te: ZIP: — Over 1,000 amps or volts(2) $516.00 $f Reconnect only(2) $ 69.0D $ I
. Phone: - - .fry Fax: - -
E-mail: IY� Temporary services or feeders: installation,alteration,relocation I
This itvstallat'e is being made on residential or farm property 200 amps or less(2) $ 69.00 $
owned by e or a member of my immediate family.This 201.to 400 amps(2) $ 96.00 $ ■
propert• is not intended for sale,exchange, lease, or rent. OAR -
479.54 0(I)and 479.5600). 401 to 600 amps(2) $138.50 $
Over 600 amps or 1,000 volts,see services or feeders section above I
Signature: 1
CONTRACTOR INSTALLATION Branch circuits: newt alteration,extension per panel
a. Free for branch circuits with purchase of a service or feeder fee: I
Business name: ���- �hnI�.�, �,,�-lam j P 1
Address: S cl 9-1 s ni2Ufi C 'J Each branch circuit $ 6.50 $ '
City: Eu Q nz State: 0:0__ ZIP: 9.--b 02_ b.Fee for branch circuits without purchase of a service or feeder fee: 1
Phone:Si I - b-cz o-9 Fax:c(11 -yb5- 5-94G First branch circuit(2) 5 60.50 $ 1
E-mail b\ otoers .)-@e.so'SiEp'S. Cc.�+".- Each additional branch circuit $ 6.50 $ :
Miscellaneous fees:service or feeder not included
CCB license no.: 1� 7 L'7.`,rSBCD�IibC�t�e no.:Z(T JL13CL.( .
o O�. ,�s Each pump or irrigation circle(2) $ 69.00 $
Signing supervisor's IicgnSe no;:, /��(�
Each sign or outline lighting(2) $69:00;'$
Print name of sIPsnyng supermot7a�+jot5vlxs• : �fne5 Lures, 1 l l4�
Signatutiedf5fg9ipg aparesorr —411;„„.",,a,;e 90 /. U Signal circuit or a limit(d)energy panel, t,I0 I • '
_ - `�`"-� alteration,or extension 2 .lt,C" C4 ■
�\, 8 ,e 0e 0 0 'O \e. e \`\, Each additional inspection:(1) nc\ Is�$
(�� �Se Gp01 oP �r o
P o� or 01' ta$� otE .01 0.a\• 4 q
koSO`\. 2ti 0.0,.,obet. l�. ,23 1- c‘f•t% ,klitg Ott .'
OPQ.�o\N ere One acp- (A) BYr\\ d� ,,I �"�P41 $ 6 S 6 1
•$O 90, nor �`re.\S1' (Minimnrlt P,� } '8te�,)[\t�,, "r 1 i
0 xt` O it�l e/ 2(1;4a+7�OD• $ . if 1
<aJR\,cetGer�e� (B)EnteCV:1at t"v`(a
(C)Technology P$t '.o of[A)) $ 3 S L(
440-2584-1(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ 40,13 73
1
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SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Phone:541-726-3753
OREGON • Building / Commercial Permit - Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00387
www.springfield-or.gov permitcenter @springfield-cr.gcv
PROJECT STATUS: Issued ISSUED: 02/21/2014 EXPIRES: 08/20/2014
STATUS DATE: 02/21/2014 APPLIED: 02/21/2014
SITE ADDRESS: 2659 OLYMPIC ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703254403600 TYPE OF STRUCTURE: Commercial
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PROJECT DESCRIPTION: Interior illuminated sign lighting
OWNER: WAL-MART REAL ESTATE BUSINESS TRUST Phone Number:
ADDRESS: PO BOX 8050 •
BENTONVILLE AR 72712 •
L CONTRACTOR INFORMATION
. Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor E S&A SIGN CORP CCB 163470 03/16/2015 541-485-5546
INSPECTIONS REQUIRED
Inspections
4610 Electrical Sign
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 t5U Date
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Springfield Building Permit 2/21/2014 11:04:26AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
OREGON TRANSACTION RECEIPT Spnngfield,OR 97477
541-726-3753
811-SPR2014-00387
www.springfieldor.gov 2659 OLYMPIC ST perrnitcenter @springfield-or.gov
RECEIPT NO: 2 014000376 RECORD NO:8.11SPR2014-00387 _ DATE:02/21/2014
111141,9;11;46_03 v„ 3 1 p',54.'t _ rti7� ,C5i 3 rr}7'ACCOUNT CODEf6RANS.CODE _fi6„egge v ,
j3 _
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00
Sign or outline lighting 224-00000-426102 1037 69.00
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
P'AYMENTTTYPE i;_';F PAY.OR GASHlERaoEOWLSeY r: >'COMMENTS _al_ -.4?'r:.,.,= '' 'I-AMOUNTIPAID
Credit Card linda padilla 93.60
021592
TOTAL PAID: 93.60
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