HomeMy WebLinkAboutPermit Electrical 2014-6-18 •
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SPRINGFIELD __ 225 Fifth St
'" a CITY OF SPRINGFIELD Springfeld,OR 97477
tiy± Phone: 541-726-3753
-\ OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676 .
PERMIT NO: 811-SPR2014-01317
. wispringfield-or.gov permitcenter @springrield-or.gov
PROJECT STATUS: Issued ISSUED: 06/18/2014 EXPIRES: 12/14/2014
STATUS DATE: 06/18/2014 APPLIED: 06/18/2014
SITE ADDRESS: 1010 MAIN ST,Springfield, OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703354105200 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION: Circuits for elec. charging station
OWNER: LANE REGIONAL AIR POLLUTION Phone Number:
ADDRESS: 1010 MAIN ST •
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JK GUCKENBERGER ELECTRIC INC CCB 45129 04/24/2016 541-746-4656
INSPECTIONS REQUIRED I
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.
Owner or Contractor Signature Date
cp v
ATTENTION: Oregon law re(eul4you to NOTICE:MIT SHALL EXPIRE IF THE WORK
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth THIS PER
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).
Springfield Building Permit 6/18/2014 8:11.20AM Page 1 of 1
SPRINGFIELD-w-w CITY OF SPRINGFIELD
Wr14441- 225 Fi fth St
TRANSACTION RECEIPT Springheld,OR97477
OREGON 541-726-3753
811-SPR2014-01317
www.springfeld-or.gov 1010 MAIN ST permitcenter @spdngfield-or.gov
RECEIPT NO: 2014001329 RECORD NO: 811-SPR2014-01317 DATE: 06/18/2014
(DESCRIPTION, ,,. • ` ; ACCOUNT CODE/TRANS.CODEy__ , AMOUNT DUE •
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 6.00
Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 -62.00
Branch circuits without service or feeder- each additional 224-00000-426102 1004 14.00
Electrical Continuing Education fee 224-00000-425606 1032 2.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
ti PAYMENT TYPE - - ,:`_PAYOR - CASHIER:JLARSON 5 COMMENTS- __ AMOUNT PAID I
Credit Card JKG Electric 98.44
005982
TOTAL PAID: 98.44
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FROM ...1102 Electric Inc. (TUE)JUN 17 2014 13:27/ST. IS:27/No. 7600000271 P l
_.....-- ._-,._.. Hopi, or.usrasatolntaingf LIararyItlectJ1caI re1Tlat2_.
Electrical Permit Application f-Po st ie, DEPARTMENT USE ONLY
$PRINGFIELO
CITY OF SPRINGFIELI),.ORECON • • Permit nu.acfieZO/`T—O/ 5/ 7
Z25 Fifth Street*Springfield.OR974 77•PH(541)726-3753$FAX(541)72(3689 o CGON
Date: 6 /a//9
This permit is issued tinder OAR 918-309-0000. Permits nre nontransferable. Permits expire if work is not started within 180
days of issuance or if woric is suspended for 180 days.
L_OCAL GOVERNMENT APPROVAL FEE SCHEDULE __
Zoning approval verified? ❑ Yes ❑No Number of inspections per item () Qty. C:OSl Total
ca. �COSI
CATEGORY OF CONSTRUCTION — — ---
._.._. ....,_..._...._-_ ______ Residential,per unit,service Included:
LI Residential (�Government ❑Commercial — ----- -----
JOB SITE INFORMATION AND LOCATION OOOsj' f' nr less pl) 5147,50 5
Each additional 500 sq. II,or portion
loh site address: 10 D t thereof S 27.50 $
......... ..
Clue SprJ4UL_ Stale:Jr/ ZIP:Q 77 Limited energy(2) 535.00 5
Reference: `j Taxlot.: Each manufactured home or modular S 69.00 .'F
DESCRIPTION OF WORK DESCRIPTION service or leerier(2)
Services or feeders:installation.alteration,(elocution
eArcu(r5 off IPC�: °� hlci —2)
.__._. _ 200 amps or less(2) $ 89.00 $
... ... _.I_
PROP RTY OWNER — 201 to 400 amps(2) $ 104.50 $—
e / /_ 401 to 600 amps(2) • $174.00 S
Name: An., ra/ 4., po 1 -- ---
(— — r--- -- 601 to 1.,000 amps(2) $225.50 .4
Address: /U' /0 /444...; X/
—
> Over 1,000 amps or volts(2) 5516.00 $
City: /7.l, State:CA-, ZIP: P
Phone: - - Pax: Reconnect only(2) S 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) S 69.00 S
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 $
properly is not intended for sale, exchange, lease, or rent.OAR - - - - ------ --------
2179.540(I)and 2 179.5600), 401 to 600 amps(2) .$138.50 $
Signature; - Over 600 amps or 1,000 volts,see services or feeders section above
CONTRACTOR INSTALLATION I)rmlcll circuits: new, alteration.extension per panel
Business manic: a. Fee for branch circuits with purchase of a service or(ceder fee:
.._J-I� U LPI -ti U —
Address: Z.1 —1 —"On ST -, Each branch circuit $ 6.50 $
City: sr it Id State;O v' 1 ZIP: q,-r-frri b. Fec For branch circuits withoul purchase of a service or fierier fey
Phone: 5144 - -t4b AfG,S671 hax:544 -1 g55 First branch circuit(2) _—_ 1 $ 60.50 St.O.50
IL—mail: r :Thr . vsGe ec_.corn Each additional branch circuit S 6.50 $ (6
y 45(ZG— Miscellaneous fees:service or feeder tint Included
C'C[ license no.: J BCD license no.; Z�U-2.l"T(u -_-_ _
Signing supervisor's license no 146C1.S_ J— each pump or irrigation circle(2) 5 60.00 S ...
( Each sign or outline lighting(2) $ 69.00 $
Print name of signing supervisor: (2s 1 __..�cy
Signal circuit or n limited-energy panel. 5 80.00 S
Signature el-signing supervisor:�� alteration,or extension(2)
Each additional inspection:(1) $80.00 $ —""-
APPLICANT USE
• (A) Enter subtotal of above fees $ —"
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x(Al) S
(C)Technology Fee(5%of(A)) $
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.tap.1584-Ill'nl!_IOU;COM) TOTAL fees and surcharges(A through C): Sre 'a-
-
P.Q.rm 1 i i► C
nf I 4/8/2013 I I.18 Atv