HomeMy WebLinkAboutPermit Electrical 2014-5-20 •
SPRINGFIELD
NO
225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
' °^' Phone: 541-726-3753 •
OREGON hBuilding I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01116
www.springfield-or.gov permitcenter @spnngfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/20/2014 EXPIRES: 11/15/2014
STATUS DATE: 05/20/2014 APPLIED: 05/20/2014
. SITE ADDRESS: 220 5TH ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703353101100 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION: Install four new circuits
OWNER: CITY OF SPRINGFIELD ' Phone Number:
ADDRESS: 225 5TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor RS ELECTRIC LLC GCB 149509 11/02/2015 541-359-1192
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INSPECTIONS REQUIRED II
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
constructio .
_______(.224.i...., .
Owner or Contractor Signature Date
•
ATTENTION: Oregon law requires you to
• NOTICE' . -
• .• follow rules adopted by the Oregon Utility
• - . Notification Center. Those rules are set THIS PERMIT SHALL EXPIRE IF THE.WORK n OAR 952-001-0010 th through OAR 952001-
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).
Springfield Building Permit 5/20/2014 3•34:26PM Page 1 of 1
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SPRINGFIELD — CITY OF SPRINGFIELD
225 Fifth St
r;
TRANSACTION RECEIPT Spnngfiel oR97477
OREGON 541-726-3753
• 811-SP R2014-01116
www.spnngfield-ar.gov 220 5TH ST permitcenter@spnngfeld-or.gov
RECEIPT NO: 2014001110 RECORD NO:811-SPR2014-01116 DATE:05/20/2014
°a` "{"w r s _ __ACCOUNT CODE/TRANSTCODEcaRIWANIOUNIntain ACCOUNT
Electrical Inspection For Which No Fee is Specifically Indicated 224-00000-426102 1075 80.00
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
FAY,MENTTYPE rPAYORa,`c`tarai°ccnriaEr+TERi' COMMENTS ',A 6 •- •?FAMOU,NT NPA W ,,;
Credit Card CITY OF SPRINGFIELD 93.60
090305
TOTAL PAID: 93.60
Electrical Permit Application DEPARTMENT USE ONLY
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225 Fifth Streets Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: 720//V
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.
Zoning approval verified? 0 Yes 71',-i:::,---:t3t7.71=cf-c•!".7-:;':-:2=,--;: tc/7';'n ,------....:'-'1fCeSt -Total
0 No - 'Nuniber of inspections per.item:() .11 Qi.y:41..-1....--- .7 i .:f, .--
CATEGORY: OF:..CONSTRUCTIciN::: :,:..::.°. :1':.1...ti:
Residential,per unit,service included:
D Residential D Government 0 Commercial
1,000 sq. fi or less(4) $147.50 $
:.,-±:-It{:::J 08},S ITE:AN FO RMATICiN,7AN D::toCATI ON ::,. ft
..:11:-.41 Each additional 500 sq.ft.or portion
Job site address: ...),2_ ' c -.F#-- c-7"-: thereof - $ 27.50 $
City: ....-e. _ e_ ,,, States ' ZIP: ""-) c 7 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular
dwelling service or feeder(2) $ 69.00 $
.1.-.?-1'Y:: :::•-::',:1:171.1,413 ESC RIP TI 0 NI':0 F;:"WO R IC::':',.:7'2,''':":i:'c:11-::74 L
elf C(teCt4 7 j-
Services or feeders: installation, alteration,relocation
1
. 200 amps or less(2) $ 89.00 $
'.:.5-:;?1,1. 1.1PIThe.}::=E1;PROPERINL'OWNERHY-:,:i :-::M.7::',2,TA:i 201 to 400 amps(2) $ 104.50 $
Name: CI T7 O. Sr it—,6"-S ___I / 401 to 600 amps(2) $174.00 $
Address: 2 2...5—b--7.- cr 601 to 1,000 amps(2) $225.50 $
/
City:-<S t_.2 6-6.iio , c_i _ 9
State:00 ZIP: 7277 Over 1,000 amps or volts(2) $515.00 $
Phone: 2,(L—a‘f-2,... t FaxiSill- ?nth-acle.I Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
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) 5 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::',..;.&:':'7-:i*‘'-;;;%.. Branch circuits:new alteration, extension per panel
Business name: F_ s I'le._C:F/CA C— a.Fee for branch circuits with purchase of a service or feeder fee:
Address: P.0. 6,-xr Vir,),,.2 Cz. Each branch circuit "2 $ 6.50 $
City: go&67,i.E., I State: tE42_ ZIP: 971-Aley b.Fee for branch circuits without purchase ofia service or feeder fee:
Phone: - - I Fax: - - First branch circuit(2) ( $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.:///96-0c)_ 1 BCD license no.:,, ,0-tit\C Miscellaneous fees:service or feeder not included
Each pump or irrigation circle(2) S 69.00 $
Signing supervisor's license no.: G./ 7 9 5 .
Print name of signing supervisor: , • ,Ajan i_414-0$2.
,
Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: e ,..,_toes?.
/
Signal circuit or a limited-energy panel,
alteration,or extension(2) $ 80.00 $
Each additional inspection:(I) , $80.00 $
TSWAtEid'AW-R18E171,-VtiiVli'W:ig:',
(A) Enter subtotal of above fees $ ,r
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $ C(t°
/ ---
(C)Technology Fee(5%of[A]) $ er 00
TOTAL fees and surcharges(A through C): $ {/
- 561°
440-2584-J(4/01/2013/COM)