HomeMy WebLinkAboutPermit Electrical 2013-4- n P
SPRINGFIELD _. 225 Fifth St
'' .,� CITY OF SPRINGFIELD Springfield,OR 97477
[`tN Phone: 541-726-3753
' OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00791
www.springfield-or.gov permitce nter@s pringtield-or.gov
PROJECT STATUS: Issued ISSUED: 04/19/2013 EXPIRES: 10/16/2013
STATUS DATE: 04/19/2013 APPLIED: 04/19/2013
SITE ADDRESS: 3815 WINSLOW AVE,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702194101800 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Three circuits for HP/Furnace/receptacle
OWNER: SOOY JOHN R&MARY P Phone Number:
ADDRESS: 3815 WINSLOW
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor BURRELL BROS ENTERPRISES INC CCB 136446 08/20/2013 541-747-2724
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.
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
• ,A Notification Center. Those rules are set forth
NOTICE: In OAR 952-001-0010 through OAR 952-001-
THIS PERMIT SHAH.EXPIRE If THE WORK
THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
AUTHORIZED UNDER number for the Oregon Utility Notification
COMMENCED OR IS ABANDONED FOR Center is 1-800-332-2344).
ANY ISO DAY PERIOD.
Springfield Building Permit 4/19/2013 9:03:04AM Page 1 of 1
SPRINGFIELD - _. CITY OF SPRINGFIELD
lir 225 Ffih St O
OREGON
TRANSACTION RECEIPT 225 Springfield,OR 97477
541-726-3753
811-SPR2013-00791
www.springfietd-or.gov 3815 WINSLOW AVE permitcenter @springfield-or,gov
RECEIPT NO: 2013000783 RECORD NO:811-SPR2013-00791 DATE:04/19/2013•(DESCRIPTIONv_ , _, _ • : . 1.v"ACCOUNT CODE/TRANS r CODE -,_<,_,"__._— AMOUNT,DUEEJ
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 6.50
Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60,50
Branch circuits without service or feeder-each additional 224-00000-426102 1004 13.00
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
�.-PAYOR. CASHIER:CCARPENTER , . COMMENTS';;.',,, -; - • AMOUNT PAID
PAYMENT TYPE ' - ' � - . ... J
Credit Card BURRELL BROS ENTERPRISES INC i 93.60
005241
TOTAL PAID: 93.60
•
Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD '7�j
:e.gy''QJ'SPRt-NGFIELD, OREGON , ' Pe min no.: / /�
225 Fifth Street•Springfield.OR 97477•PH(541)726-3753•FAX(541)726-3689 = ?eoueaoN //� / 1
Date: /` / / 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 wort: is suspended for 180 days. 1
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:
i
Residential I ❑Government I ❑Commercial
JOB SITE INFORMATIQN AND LOCATION 1.000 sq.It.or less(4) $147.50 $
;3g W ins Old there additional 500 sq.ft or portion I.
Job site address- l 5 q thereof $ 27.50 $ ]
City:. 5 p l J I Stater Y e ZIP: q 7 97$ Limited energy(2) $ 35.00 $ -
Reference.- I Taxlot.: Y Each manufactured home or modular
dwelling service or feeder(2) $ 69.00 $
DESCRIPTION OF WORK
419 Services or feeders:installation,alteration,relocation i
f vPhgc,r rf,,,,h �c/ ,
r-evilY-P -e>Ctf yinf YI ( ?pi. 0 po �200ampsorless(2) $ 89.00 $ #
PRORTY OWNER 201 to 400 amps(2) $ 104.50 S 1
Name:d 0 h il O 401 to 600 amps(2) $174.00 S t
Address: 3¶J,� \\j s/0 60 601 to 1000 amps(2) $225.50 $
/�• Over t,000 amps or volts(2) $516.00 $
I
City: State: Or*�' ZIP:"/ 7�7 9j 1
Phone: - - I Fax: - - / eL•. Reconnect only(2) $ 69.00 $
Temporary services or feeders:installation, alteration,relocation
E-mail: {
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 $ t
Signature: Over 600 amps or 1,000 volts.see services or feeders section above I
CONT�.CTOR INST• LAT I J Branch circuits: rieut alteration,extension per pa nel
Business ny e: , --1 ` I OJ a.Fee for branch circuits with purchase of a service or feeder fee:
Addres`s, /e Q fJ 9�1/ Each branch circuit $ 6.50 $
City: VW 1 v✓) )q State: 0 Y't ZIPS 71 7 b.Fee for branch circuits without purchase if a service or feeder fee:
Phone: -� ,/,7 �`{ Fax: -79,2/ /c First branch circuit(2) $ 60.50 $(�c`- 1
v l t
E-mail: Each additional branch circuit a $ 6.50 $ CD 7 I
Miscellaneous fees:service or feeder not included {
CCB license no.: i i BCD license no.: 1 0:4171;C
Signing supervisor's license no.: 7 2' S - Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $
r t
Signature of signing su ervi5o •' Signal circuit or a limited-energy panel, $ 90.00 s
g o P �1 _ �� alteration,or extension(2)
4 Each additional inspection:(I) $80.00 $ 1
\.....____., APPLICANT USE
(A) Enter subtotal of above fees $ �
(Minimum Permit Fee$80.00)
q 4
(B)Enter 12%surcharge(.12 x[A])
$ /
(C)Technology Fee(5%of[A]) $ 44 c
l�l�?/r�. , , i
440-2584-J(410 1/2 0 1 31C0Ni) TOTAL fees and surcharges(A through C): $ J 1I
E