HomeMy WebLinkAboutPermit Electrical 2014-2-25 •
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SPRINGFIELD 225 Fifth St
'' • CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
r OREGON
Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00413
www.springfieldor.goy permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 02/25/2014 EXPIRES: 08/24/2014
STATUS DATE: 02/25/2014 APPLIED: 02/25/2014
SITE ADDRESS: 3377 RIVERBEND DR,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703220004102 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Service and circuits for LTD bus station
OWNER: PEACEHEALTH Phone Number:
ADDRESS: 1115 SE 164TH AVE
VANCOUVER WA 98683 -
CONTRACTORINFORMATION '
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OREGON ELECTRIC CONSTRUCTION INC CCB 203 07/01/2014 503-234-9900
INSPECTIONS REQUIRED
Inspections •
4150 Underslab Electric Underslab Electric: Prior to cover
4225 Service or Feeder
4500 Rough Electrical Rough Electric: Prior to Cover
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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.
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wner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- 'ERR! SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by • ORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the telephone }ENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification 80 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 2/25/2014 10:21:47AM Page 1 of 1 •
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LL SPRINGFIELD -' CITY OF SPRINGFIELD
1 _- 225 Fifth St
TRANSACTION RECEIPT Spnngleld,OR97477
541-726-3753
811-SPR2014-00413
wviw.springeed-or.gov 3377 RIVERBEND DR permitcenter @spnngfeld-or.gov
RECEIPT NO:. 2014000406 RECORD NO: 811SPR2014-00413 DATE:02/25/2014
1ef�cto al.i.. goRVI:: 3 =ate " ir , _±. .: ACCOUNTtCODEP RANS.CODE a. 1 i o r e
Branch circuits with service or feeder each circuit 224-00000-426102 1004 78.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20.04
Technology fee(5%of permit total) 100-00000-425605 2099 8.35
TOTAL DUE: 195.39.
PAYMENSrTMEE WI PAY.OR ' cnswER:,ccAW rER COMMENTS AMOUNTPAID
Credit Card OREGON ELECTRIC CONSTRUCTIO 195.39
090352 INC
TOTAL PAID: 195.39
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Electrical Permit Application DEPARTMENT USE ONLY !
SPRINGFIELD c/
CITY OF SPRINGFIELD, OREGON `(� Permitno.: S 1 Gi /�
225 Fifth Street•Springfteld,OR97477♦PR(541)726-3753•FAX(541)726-3689 OREGON
Date: 2/2 _ (i -2'
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. ki
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE f
Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Coast Total
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
❑Residential I ❑Government I Commercial
JOB SITE INFORMATION AND LOC ION 1,000 sq.ft.or less(4) $147.50 $
` Each additional 500 sq.ft.or portion § 27,50 $
Job site address: 6 a. /1JJ Le .Q 22'Y/ KILT' thereof
City: $'Ppi.c State: n,(� ZZIIP�-°-�] ITI Limited energy(2) $ 35.00 $
Reference: .'I[Taxlot.: Each manufactured home or modular § 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(2)
Services or feeders:installation,alteration,relocation
taw 11-- 4 LU ]=o2 kie9..J LTD
200 amps or less(2) ' $ 89.00 $ gq
. PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name: Ct O S tr C t e.[,Q 401 to 600 amps(2) $174.00 $
Address: I ` lJ" zzc S 1-` 5411sa-r 601 to 1,000 amps(2) $225.50 $
City: 41689— I State: p2 I ZIP: 17'7 7) Over 1,000 amps or volts(2) $516.00 $
Phone: - - I 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
CONTRACTOR INSTALLATION Branch circuits:rnem alteration,extension per panel
Business name:D t^ot k7 b.?Tie rt. (0snip a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 4p, 5 (..514E-7../ tne S f Each branch circuit I i Z I $ 6.50 I $ 20e-
City: Spitz,D I State: 0,E. ZIP: O/,747-7 b.Fee for branch circuits without purchase of a service or feeder fee:
Phone/- 7C/7- o S / 1 I Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: 2D5 BCD license no.: 09(0-9 rr: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: z&43 S Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: bp..q &-TS Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: ✓ Signal circuit or a limited-energy panel, r $ 80.00 $
g g B P . alteration,or extension(2)
Each additional inspection:(I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $/ 2
(B)Enter 12%surcharge(.12 x[A]) $ ��f�y j
(C)Technology Fee(5%of[A]) $ /%�
440-2584-1(4/012013/COM) TOTAL fees and surcharges(A through C): $ 'ASS a _