HomeMy WebLinkAboutPermit Electrical 2013-6-4 Electrical Permit Application w.H� ;' DEPAfzT1V1 asKar
CITY OF SPRINGFIELD, OREGON i_ P 513 -011S-0
Permit no.:
225 Fifth Street+Springfeld,OR 97477+PH(541)726-3753•FAX(541)726-3689
Date: 0/ 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. e
Zoning approval verified? ❑Yes ❑No n f lnspea+ .s-.r.3' - - �9
u� ->, _ -
`�'' ' )10 ""'� Residential,per unit,service included:
►M Residential ❑ Government ❑ Commercial
1,000 sq.ft or less(4) 5134.00 $
;-;s"^-.-en -LT= tfs1FET 1fR T[z A 4aegir.-Aa Q -, '
Each additional 500 sq.R or portion $ 25.00 $
Job site address: /0 Z LA evtA - S thereof
City: SRS it I State:(e- I ZIP: /q 71'I 7 Z Limited energy(2) $ 32.00 $
Subdivision: 0 ' (.( .Lot no.:Q g00 Each manufactured home or modular $ 63.00 $
mss _9 a _i• Mz dwelling service or feeder(2)
A � i At rc-t CV GM; Services or feeders: installation,alteration,relocation
200 amps or less(2) $ 61.00 $
z. �-. ,xtz_ - 201 to 400 amps(2) 5 95.00 $
1� tig._ �z=z �O���V1EF�1€/Ed��k�.-�-' ��::wr-f.
Name: ,(-f-(.LS.1 - S/^T'" 401 to 600 amps(2) 5158.00 $
Address: /OZ Lc '(pis._ 5 601 to 1,000 amps(2) 5205.00 $
City: c.?, 2 1 State: er— _ I ZIP: /74 77 Over 1,000 amps or volts(2) $469.00 $
Phone: - - I Fax: - - Reconnect only(2) $ 63:00. $
E-mail. Temporary services or feeders: installation, alteration,relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 63.00 $
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 87.00 $
property is not intended for sale,exchange, lease, or rent.OAR
479.5400)and 479.560(1). 401 to 600 amps(2) $126.00 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
ra y dQfVT , etEf 1KST`,_oE fritt7 Q. - ra..: i %jtb'1 Branch circuits:new alteration, extension per panel
Business name: 5((M, - ,a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 335(7CJ hr 2C Each branch circuit I I $ 6.00 I $
City: � •} .A State: Or I ZIP: 9717-1 b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: -J 0 R-/d? j Fax: 61- 6 0727 First branch circuit(2) I $ � $( O ,.e
E-mail: Each additional branch circuit 3 $ Asla 1 $ / 7—
CCB license no.: /(0/a3 5 BCD license//no.: )(5 -576. Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: /QG•5 Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor. utr,Y-zi. Each sigh or outline lighting(2) $ 63.00 $
Signature of signing ervi:rr {> Signal circuit or a limited-energy panel, $ 63.00 $
gn !fig sup r alteration,or extension(2)
Each additional inspection:(1) $58.00 S •
/CL---1 A "W;:i v -r-7 ig 71E=
(A) Enter subtotal of above fees $
(Minimum Permit Fee$58.00)
(B)Enter 12%surcharge(.12 x[A]) • $ /G
6'"
(C)Technology Fee(5%of[Al) $ H
• TOTAL fees and surcharges(A through C): $
44nJCR4J ro/nvrnn.n
SPRINGFIELD 225 Fifth St
-'ti CITY OF SPRINGFIELD Springfeld,OR 97477
`L� Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01150
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/04/2013 EXPIRES: 11/30/2013
STATUS DATE: 06/04/2013 APPLIED: 06/04/2013
SITE ADDRESS: 1024 PLEASANT ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703264104800 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: ELE-Dry Rot Repair-Kitchen
OWNER: SHAW CHRISTINA M Phone Number:
ADDRESS: 1024 PLEASANT ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JEM ELECTRIC INC CCB 161235 09/07/2014 541-729-1074
General Contractor DAVIS BROS GENERAL CONTRACTORS INC CCB 63275 04/06/2014 541-501-0877
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.
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Owner or Contractor Signature Date
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num Oenter Is 1.800 P1\� i
•
Springfield Building Permit 6/4/2013 10:03:45AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
hi• 225 Fifth St
-'�`O EGON TRANSACTION RECEIPT Spiingfield,0R 97477
541-726-3753
811-SPR2013-01150
www.spnngfield-or.gov 1024 PLEASANT ST permitcenter @ springfield-or.gov
RECEIPT NO: 2013001105 RECORD NO:811-SPR2013-01150 DATE:06/04/2013
;DESCRIPTION_: . ' _'1,. ACCOUNT_CODE/TRANSCODE. -. ?AMOUNT DUE:: 1
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 19.50
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
LPAYMENTTYPE PAYOR=..`.CASHIER:oeoWLSev - COMMENTS`: ,w,' . "AMOUNT PAID ,y_`
Check DAVIS BROS GENERAL CONTRACT( 93.60
5597 INC
TOTAL PAID: 93.60