HomeMy WebLinkAboutPermit Electrical 2013-4- •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
ltA Phone: 541-726-3753
/''''` `OREGON
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00847
www.springfield-or.gav permitcenter @springfield-or.gov
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PROJECT STATUS: Issued ISSUED: 04/29/2013 EXPIRES: 10/26/2013
STATUS DATE: 04/29/2013 APPLIED: 04/29/2013
SITE ADDRESS: 1056 CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703264410300 • TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Change
OWNER: SKURDAL HAROLD M 8 VIOLA L Phone Number:
ADDRESS: 1056 CENTENNIAL BLVD
- SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor.Name Lic Type Lic No Lic Exp Phone
Electrical Contractor MY ELECTRICIAN INC CCB 87506 11/20/2013 541-729-1454
INSPECTIONS REQUIRED
Inspections
4210 Service Change
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. •
sk
Owner or Contractor Signature • Date
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility
AUTHORIZED UNDER THIS PERMIT IS NOT Notification Center.1 hose rules are set forth
n OAR
COMMENCED OR IS ABANDONED FOR 0090. You may obtain through OAR 9 2-0 Z-
ANY 180 DAY PERIOD. • calling the center. (Note: the telephone by
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 4/29/2013 1:35:17PM Page 1 of 1
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SPRINGFIELD- CITY OF SPRINGFIELD
iF< St
Fifth
TRANSACTION RECEIPT S 225 Fifthld,OR97477
`OREGON 541-726-3753
811-SPR2013-00847
w ,w springfield-or.gov 1056 CENTENNIAL BLVD pennitcenter @springfieid-ar.gov
RECEIPT NO: 2013000835 RECORD NO: 811-SPR2013-00847 DATE:04/29/2013
Io1 .Ytl1111 o��f T: 'ar.t. ACCOUNTCODE/TRANSICODE. Tf- �. " AMOUNTDUE *.t
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.68
Technology fee(5%of permit total) 100-00000-425605 2099 4.45
TOTAL DUE: 104.13
PAYMENT PE P.AYOR casKIERaaLARSDN _ COMMENTS - _ _ AMOUNT PAID
Check MY ELECTRICIAN INC 104.13
3910
TOTAL PAID: 104.13
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• Electrical Permit Application DEPARTMENT USE ONLY
'c L fl OF'SP 0. aP0..,T ,rpR .gt-Os N-- -: Permitno.:S1/ 20/ 700QC'(--)
225 Fifth Street•Springtietd,OR 97477 a PH(e41) 26-3753*F X(541)726-3689 S OREGON c,
Date: ( 4.- 2.//'3
t
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 work is suspended for 180 days. I
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑Yes ❑No Number of inspections per item() Qty. Cost Total
ea. cost
CATEGORY OF CONSTRUCTION t
Residential,per unit,service included: i
❑Residential ❑Government ❑Commercial 1
JOB SITE INFORMATION AND LOCATION
1,000 sq. II.or less(4) $147.50 $ )
/O 5 Ca(s2Tt?MN j4l 13)J d $ 27.50 $ i Each additional 500 sq. ft.or portion 3I3
Job site address: thereof
City: Sp'-I C` I State: t ZIP: g 7 4 7 7 Limited (2)energy $ 35.00 I $ 1
g i
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ 1
DESCRIPTION OF WORK dwelling service or feeder(2)
Services or feeders:installation,alteration,relocation ?
SPIV lC2 C\it 200 amps or less(2) 1 $ 89.00 $ i
t
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 S
• Name: iti ey 3}cnAd4I 401 to 600 amps(2) $174.00 $ }
Address: 4e_
5 5 C,P�-y\ -.\ ' 601 to 1,000 amps(2) $225.50 $
City: S CC State: l K ZIP: Over 1,000 amps or volts(2) $516.00 $
—PhoneS{t- 36T 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 $ i
owned by me or a member of my immediate family.This 201 to 400 amps(2) S 96.00 $
property is not intended for sale,exchange,lease, or rent.OAR
479.5400)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: new,,alteration,extension per panel
Business name: u Y l Y pI C.L-` ' c j&c) l W C. a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 30.3 1 c, c. A)e\ C r- 4 e Each branch circuit $ 6.50 $
City D (�,-�fl�l0 State: 6 Q ZIP: 9 741;U b.Fee for branch circuits without purchase of a service or feeder fee:
PhoneSM I- lc{- Fax: - - First branch circuit(2) $ 60.50 $
E-mail: my elefitillti A 4l (pc_Q�{� .Co 4( Each additional branch circuit $ 6.50 $ 1
CCB license no.: B7 SO b I BCD license no.:c2 D--- .37C- Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 34, 35 a a. Each pump or irrigation circle(2) $ 69.00 $ -
Print name of signing supervisor: allattliraPPRI Each sign or outline lighting(2) $ 69.00 $
`1 Signal circuit or alimited-energy panel, 1
`S $ 80.00 s Signature of signing supervisor: �W�� �,CyVV alteration or extension(2)
77 Each additional inspection:(I) $80.00 $
• APPLICANT USE
(A) Enter subtotal of above fees $ I
(Minimum Permit Fee 580.00) ■
(B)Enter 12%surcharge(.12 x[Al) $ 1
(C)Technology Fee(5%of[Al) $ I
c
440-2534-J(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ /o y/3
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