HomeMy WebLinkAboutPermit Electrical 2014-4-22 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-SPR2014-00795
www.springfield-or goy permitcenter @spri ngfield-or.goy
PROJECT STATUS: Issued ISSUED: 04/22/2014 EXPIRES: 10/19/2014
STATUS DATE: 04122/2014 APPLIED: 04/14/2014
SITE ADDRESS: 200 S 32ND ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702310000502 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Branch Circuit for Espresso Machine
OWNER: WILLAMALANE PARK&RECREATION DISTRICT Phone Number:
ADDRESS: 250 S 32ND ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
KENNETH D RANDALL (S)Electrician,Ge 4023S 10/01/2016 541-736-4102
_ INSPECTIONS REQUIRED
• Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
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.
Owne r Contractor Signature Date
ATTENTION: Oregon law requires you to
NOTICE: • follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT 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).
I
Springfield Building Permit 4/22/2014 1:31:22PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
- �; 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
oRecoH 811-SPR2014-00795
www.springfieldor.gov 200 S 32ND ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014000888 RECORD NO: 811-SPR2014-00795 _ DATE:04/22/2014
DESCRIPTION a `M+ 7 .e N: .r ''._{ ° �a_"`?_ ACCOUNT CODE/FRANSiOODE €A_d;a'. r;R iAMOUNT DUE:4i
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 - 19.50
Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50
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
ea PAYMENT TYPE,.,. cV=PAYORr-,:CASHIER'JLARSONA�'2 +>_�:_.'.COMMENTS `:AMOUNT'PAID
Check WILLAMALANE PARK& RECREATIOI 93.60
98580 DISTRICT
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
CITY OF SPRINGF[ELD, OREGON . st.siettuddi
j Permit no.:j�iCte�Y— °798
225 Fifth Street*Springfield,OR 9747 7•PN(541)726-3753•FAX(541)726-3689 \OREGON /
Date: Y /ZZ.//r
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
CATEGORY OF CONSTRUCTION ea. cost
Residential,per unit,service included:
❑ Residential ❑Government ❑Commercial
JOB SITE INFORMATION AND LOCATION 1,000 sq.ft.or less(4) $147.50 $
Each additional 500 sq. ft.or portion $ 27.50 $
Job site address:2 oo 5. 32nco. ST • thereof
City: s?Rwc rtr%L-ID State: b K. ZIP:co S,77 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(2)
Services or feeders:installation,alteration,relocation
CcRc�cT5 Fo.l Cr,5t'Se.ls o A, .ec 6lr+°cr i
200 amps or less(2) $ 89.00 $ I
A t•->el waive.,Ne, NE Apt((:)l.S 1
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name: f(,,�r„,yL,L„c 1:7)4..e.1-1 Rte, (lter a- 401 to 600 amps(2) $174.00 $
Address: Loo 5 .32 o ST . 601 to 1,000 amps(2) $225.50 $
City:s?se NCS(C3f n I State: p g.. ZIP:97'77 Over 1,000 amps or volts(2) $516.00 $
Phone:S Fax: - -
Reconnect only(2) $ 69.00 $
yr-73c y(oz_
I Temporary services or feeders:installation.alteration,relocation
E-mail:
lCerore( ..,.U.eild ki0-ne -orb 200 amps or less(2)
This installation is being made on residential or farm property $ 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
CONTRACTOR INSTALLATION Branch circuits:new alteration,extension per panel
Business name: a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit $ 6.50 $
City: State: ZIP: b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) ] $ 60.50 $go.Sc
E-mail: Each additional branch circuit 3 $ 6.50 __$1 etisio
CCB license no.: I BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: <1023 S Each pump or irrigation circle(2) $ 69.00 $
Ku V^'F3''F Each sign or outline lighting(2) $ 69.00 $
Print name of signing supervisor:
Signal circuit or limited-energy panel, $ 80.00 $
Signature of signing supervisor: Onvx/ alteration,or extension(2)
Each additional inspection:(I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00) - SO.00
(B)Enter 12%surcharge(.12 x[A]) $ Cf.GO
(C)Technology Fee(5%of[A]) $ 4 ,00
440-2584-J(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ 43_64