HomeMy WebLinkAboutPermit Electrical 2013-5-17 • SPRINGFIELD - 225 Fifth St
Ai CITY OF SPRINGFIELD Spnngfield,OR97477
u. + Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00990
www.springfieldor.gov permitcenter @springfield-or.gav
PROJECT STATUS: Issued ISSUED: 05/17/2013 EXPIRES: 11/12/2013
STATUS DATE: 05/17/2013 APPLIED: 05/17/2013
SITE ADDRESS: 755 60TH ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702342200502 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Changeing out Panel
OWNER: • TUTTLE WAYNE J 8 RACHAEL Phone Number:
ADDRESS: 755 60TH ST
SPRINGFIELD OR 97478
•
CONTRACTOR INFORMATION `
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
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.
,( ,--� 5=/7— /3
Owner or ntractor Signature Date
• ATTENTION: Oregon law requires you to
•
NOTICE: follow rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth
in OAH 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 teleph
ANY 180 DAY PERIOD. number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 5/17/2013 2:03:48PM Page 1 of 1
SPRINGFIELD----- are OF SPRINGFIELD
_ 225 Fifth St
rtO OREGON TRANSACTION RECEIPT Spnngfield,OR 97477
w 541-726-3753
811-SPR2013-00990
www.springfield-or.gov 755 60TH ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013000978 RECORD NO:811-SPR2013-00990 DATE:05/17/2013
lo]am:IaICoI:L.,"-„d;_._'_a"1:''_`._, �L4. i:W' at``°,ACCOUNTCODE/TRANSCODE s'-_r taxi. ' 0 I 'TxDUE 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
rszr.AY,MENTeTYP.E P,AY,OR caSNleR:,TA iti _ 'COMMENTS AMOUNT AID' -__aMIS
Credit Card TUTTLE WAYNE J&RACHAEL 104.13
H70992
TOTAL PAID: - 104.13
•
Electrical Permit Application DEPARTMENT USE ONLY
�^'. L SPNINGFtELO - -
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CITY`OF SPRINGr-1�LD t:VSJI 9Nz�"
' �4.8�t��y,._ st.�"-.....�sa i�_.,z�,�sY' rt-�___�',`x-i,�,"'z`�: €'-"`� i1 Permit no.: S(lzo-(3oO9
225 Fifth Street•Springfield,OR 97477•PH(341)726-3753*FAX(541)726-3689
Date: 57,""7 3
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.
,.L'OCAL,-GOVERNMENT"APPROVAL .: ' .. FEE;'SCHEDULE ,
Zoning q
g approval verified? ❑Yes No Number of inspections per item () Qty i east- cost-:'
CATEGORY;OF,- CONSTRUCTION $
-' - Residential,per unit,service included.
XResidential ❑ Government ❑Commercial
UOB'SIT.E ;INFORMATION-t AND LOCATION " 1,000 sq. fr.or less(4) $147.50 $
Each additional 500 sq.ft.or portion
Job site address: WS 6'° thereof - $ 27.50 $
City: 5pr;n ce[ State:.bZ ZIP: 7y7r Limited energy(2) $ 35.00 $
Reference: ".- Taxlot.: Each manufactured home or modular $ 69.00 $
` °DESCRIP.TIONI,,OF'WORK '�• -:•+ dwelling service or feeder(2)
Services or feeders: installation, alteration, relocation
200 amps or less(2) - $ 89.00 $
'i °r r .i _PROPERTY;OWNER , r♦z 201 to 400 amps(2) $ 104.50 $
Name: t paw/ t Q j -j-- I-e_ 401 to 600 amps(2) $174.00 $
Address: 7j5 //D-Lh- 601 to 1,000 amps(2) $225.50- $
City: 5Prinq Y`e ` 4 State: o(Z ZIP: C 79 f Over 1,000 amps or volts(2) $516.00 $
Phone:. t' Fax: - -
Reconnect only(2) $ 69.00 $
yl 913-egih
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 $
owned by me or a member of my immediate family. This 201 to 400 amps(2) g 96.00 $
property is not intended or sale, exchan lease, or rent. OAR
47 and 479.56 (1). '� 401 to feeders $
Sig-nature:/�/ Over 600 amps or 1,000 volts,see services or feeders section above
71;QRJ1 STALL'ATION: `? a i, 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 $
E-mail: - Each additional branch circuit $ 6.50 $
CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $
(B)Enter 12%surcharge(.12 x[A]) • $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges (A through C): $Jat/ .2?
440-2584-1(4/012013/C0M)