HomeMy WebLinkAboutPermit Electrical 2013-5-22 f
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f SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
hit Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
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PERMIT NO: 811-SPR201 3-01 01 7
www.springfield-ar.gov - permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/22/2013 EXPIRES: 11/17/2013
STATUS DATE: 05/22/2013 APPLIED: 05/22/2013 •
SITE ADDRESS: 519 16TH ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703362407000 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Reconnect-extending weatherhead
OWNER: FARNSWORTH KENNEY M&BONNIE Phone Number:
ADDRESS: 519 N 16TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor OWNER COB 000000 08/01/2025
L INSPECTIONS REQUIRED
Inspections
4200 Reconnect Service
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
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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.
1) JJ 1
Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE: - =
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
is OAR 552-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
f. Y3 il III ay obtain copies of the rules by :OMMENCED OR IS ABANDONED FOR
-- '.ry can'?r. (Note: the telepl-..,n;
.. • ' : -. (Ifl!ity Notification NY 180 DAY PERIOD.
"344).
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Springfield Building Permit 5/22/2013 9:20:50AM Page 1 of 1
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I SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
` E�oN TRANSACTION RECEIPT Sphngfield,OR 97477
541-726-3753
811-SPR2013-01017
www.spnngfeld-or.gov 519 16TH ST permitcenter @springfield-cr.gov
RECEIPT NO: 2013001011 RECORD NO:811SPR2013-01017 DATE:05/22/2013
;-!t,..4.. ._;� C ACCOUNT'CODElfRANS CODE ;-_._ .:_-AMOUNTrilli4tj.
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00
Service reconnect only 224-00000-426102 1004 69.00
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
PAYMENTZPIPE `AF!AYOR cASMIER:;JLARSON COMMENTS - _ AMOUNTjPAID
Check FARNSWORTH KENNEY M&BONNII 93.60
4289
TOTAL PAID: 93.60
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,1 Electrical Permit Application SPRINGFIELD DEPARTMENT USE ONLY
f OW allallarA
A. Permit no.:Yil1? Old, 0 1 CAR
225 Fifth StreectSpring6eld,OR 974774 PR(541)726-3753•FAX(541)726-3689 l
Date: 5/ Z2-4 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.
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,sen'ice included;
®Residential ❑Government ❑Commercial
JOB SITE INFORMATION AND LOCATION
1.000 sq.ft.or less(4) s134.00 $
Job site address:
519 1(y`rk Each additional 500 sq.ft.or portion
thereof $ 25.00 $
City:Svci0G � jg'� State: Q ZIP:q']477 Limited energy(2) $ 32.00 $
Reference: \.J ,II Taxlot.: Each manufactured home or modular
DESCRIPTION OF WORK dwelling service or feeder(2) $ 63.00 $
tfeu Services or feeders:installation,alteration,relocation
..d [ I�C �a �o
200 amps or less(2) $ 81.00 $ .
PROPERTY OWNER 201 to 400 amps(2) S 95.00 $
Name: ikennett M, Fay n<1/4 oo(' 11 h 401 to 600 amps(2) $158.00 $
Address: 8 i Vt. 601 to 1.000 amps(2) $205.00 $
City:C)pr ip'b£■C-5a I State:OR_ ZIP:qi 4T7 Over 1.000 amps or volts(2) $469.00 $
Phone: 5,4I-747-/33a Fax: (- -
Reconnect only(2) S 63.00 $
E-mail:T-r'3l NS Fa lnkbbP((Ism corn
Temporary services or feeders:installation,alteration,relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 63.00 $
owned by me or a member of my immediate family.This 201 to 400 amps(2) S 87.00 $
property is not intended for sale.exchange.lease.or rent.OAR
479.540(1)and 479.560(1). 401 to 600 amps(2) $126.00 $
Signature: i5 C44.y 02, atiowayrZE Over 600 amps or 1.000 volts,see services or feeders section above
ON TRACTOR INSTALLATION Branch circuits:rev;alteration,extension per panel
Business name: a.Fee for branch circuits with purchase of a service or feeder fcc:
Address: Each branch circuit $ 6.00 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - I Fax: - - First branch circuit(2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
Signature of signing supervisor: alteration_or extension(2)
Each additional inspection:(1) $58.00 $
APPLICANT USE
. (A) Enter subtotal of above fees S
(Minimum Permit Fee$58.00)
(B)Enter 12%surcharge(.12 x[A]) S
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $ ;/moo
440-2584-f(9%OS,COM) !