HomeMy WebLinkAboutPermit Electrical 2013-6-3 . SPRINGFIELD --
225 Fifth St •
CITY OF SPRINGFIELD Springfeld,OR 97477
S�+ �' Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone:541-726-3769
. Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01146
www.springfield-or.gov permitcenter @springfeld-or.gov
PROJECT STATUS: Issued ISSUED: 06/03/2013 EXPIRES: 11/29/2013
STATUS DATE: 06/03/2013 APPLIED: 06/03/2013
SITE ADDRESS: 1867 17TH ST,APT#C,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703252403800 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Adding branch circuits to garage conversion
OWNER: PAUL KWAKE TRUST Phone Number:
ADDRESS: PO BOX 238
CHESHIRE OR 97419
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
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 .
constructi` ? .
Owner or Contractor Signature Date
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ATTENTION: Oregon
law the Oregon Utility >''' '•
follow rules adopted by NOTICE: WORK
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IFTHE
in OAR 952-001 0010 through OAR 952-001-
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the telel L..:t. COMMENCED OR IS ABANDONED FOR
l-, .'/ Notific, , Jr ANY 180 DAY PERIOD.
1 number for the nre?I r' ,::1; `
Center Is
Springfield Building Permit 6/3/2013 3:58:39PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
' * -' - 225 Fifth St
TRANSACTION RECEIPT Spdngfield,OR 97477
541-726-3753
OREGON 811-SPR2013-01146
www.springfeld.or.gov 1867 17TH ST. APT C ' permitcenter @spdngfield-or gov
RECEIPT NO: 2013001095 RECORD NO:811-SPR2013-01146 DATE:06/03/2013
3e(xYol tl[o]:f°Ey ,.4 11 v {':z' x r ='' .-rr_ 'S4' :ACCOUNT CODELTRANS o o ?t }_'AMOUNTdDUE-
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00
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 6.50
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
AYMENTYPE PAYR Aswe iR ocAMOUNT PAID
Check PAUL KWAKE TRUST - 93.60
2054 •
TOTAL PAID: 93.60
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Electrical Permit Application DEP.ARTMNTUSE ONLY
ryy rSPFINGFIELD .
CI Y4®F SPRIN FIELD,ORE -ON 55 i Permit no.: 62)/( Lo(3 0(I K(-;
225 Fifth Street•Springleld,OR 9747744'11(541)726-3753*FAX(541)726-3689
Date: 61;( (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'IINE_`OCALcyGOVERNMENT AAPPROVAliii ° ' *,` _;y, iia, 1 `tr4FJEEE SCHEDULE+„=,r At ;t '} `"!1
Zoning approval verified? ❑ Yes ❑No ';�fi>tMiN ` ' ' A' "r" t.:Cost' ; 1ITotal-'
�Restdenhaltnspecdons perntero.�)a. ] Qty Yea.? ', 't,,;eost,r, t,•'" :rCATEGORY,bE. CONSTRUCTION „?" tpr r, Number o[ e,b
per unit,service included:
I Residential ❑ Government ❑Commercial
✓ JOB SITE:INF.QRMATION',AND LOCATION .w ., ;, 1,000 sq.ft.or less(4) $147.50 $
Each additional 500 sq. ft.or portion
Job site address: j 67 / 7-711 thereof $ 27.50 $
City:SIN Ir✓r—f, e/ State: a/ZIP: 9 7%77 Limited energy(2) $ 35.00 $
Reference: Taxlot.: / Each manufactured home or modular $ 69.00 $
'E` 'y "$D ESCRIPTION„,OE WORK`s t`7'`f�`„}t' t`,-Fria dwelling service or feeder(2)
(c N U t )j f /A ,p� /_ji Services or feeders: installation,alteration,relocation
7o /---l' a/ ,///7 9 I // C 200 amps or less(2) $ 89.00 $
,?�. = �t W"1` PPPROP„ERTYI Q NERF;;IM . ,;`"' "fly 201 to 400 amps(2) $ 104.50 $
Name:/0,( 0 G 1`M,/AA....„ 401 to 600 amps(2) $174.00 $
Address: r'6 7 /7-74/ 5-7-- 601 to 1,000 amps(2) $225.50 $
Over 1,000 amps or volts(2) $516.00 $Siy�� 1 �/f State: ZIP(/7/77
Phone
- 9`<67. 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 $
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 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
"ks' ax SCONTRACTOR'„INSTALLATION ,+*;*'y `(,'y;. ' Branch circuits:new alteration, extension per panel
Business name: O w"V,(55� 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) 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 alimited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
:nal __ E:rAPPLICANTws,USEIA `:MEaSt„
(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): $ 7? a0
440-2584-1(4/01/2013/COM)