HomeMy WebLinkAboutPermit Electrical 2013-6-3 •
SPRINGFIELD ..—, 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
^t Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2 01 3-01 1 41
NAM.sp ri n g fi el d-or.g ov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/03/2013 EXPIRES: 11/29/2013
STATUS DATE: 06/03/2013 APPLIED: 06/03/2013
SITE ADDRESS: 5593 B ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702334200900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Changing out meter and weather head
OWNER: FITZPATRICK RANDALL R Phone Number:
ADDRESS: PO BOX 11071
EUGENE OR 97440
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
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, ans the approved set of plans will remain on the site at all times during
construction.
/// / # • S 6 -3 -2-0/3
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
•
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
NOTICE: In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
THIS PERMIT SHALL EXPIRE IF THE WORK calling the center. (Note: the teleph,:n
AUTHORIZED UNDER THIS PERMIT IS NOT number for the Oregon Utility Notification
;OMMENCED OR IS ABANDONED FOR Center is 1-800-332-2344).
MY 180 DAY PERIOD.
Springfield Building Permit 6/3/2013 1:03:23PM Page 1 of 1
. SPRINGFIELD CITY OF SPRINGFIELD
it: . 225 Fifth St
`� ; TRANSACTION RECEIPT Spnngfield,OR97477
OREGON 541-726-3753
811-SPR2013-01141
www.springfield-or.gov 5593 B ST permilcenter @spnngfield-ar.gov
RECEIPT NO: 2013001091 RECORD NO:811SPR2013.01141 DATE:06/03/2013
b.r (e31:do7;Fail ---:�;±._.__It :.''�S ___ _._,_� 'ACCOUNT r�� : A MOUN7-DUE=4,
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
'
1.IPAYMENTITYPEd �' O'A::L.: v �l. <,n 2 ratt �AMO T F U;"± 1gX:4 'u
1�P.AYOR ' 'casillER:.1�aRSOR a ,.�, �., e�.COMMENTS 3, �:._ ,n�v-. .. . .—_ .,�8"�x. 1».
Check FITZPATRICK RANDALL R 104.13
506
TOTAL PAID: 104.13
Electrical Permit Application DEPARTMENTiUSE ONLY
SPfi1NGP1ELG:ss.
`i:::: :?!*,:x,.s-g.. t.3Y ^r-4 4remzkct " .,, , (' "5ir&n 'W' .... ,.
CITY OF;SPRINGEMLM4OREG=Ol� B. permit no.:g// Zc2( O■ 1 �l
• #e., - ■
225 Fifth StreeN Springfield,OR 97477•PH(S41)726-3753•FAX(541)726-3689
Date: C'J IS/ / 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.
< r45,LOCAL"GOVERNMENTvAPPRROVAL_W s„* :":,:-;0'iiViVatt,WE:TFEE,';SCHEgULE,i{ge -tlit:�,,r`.- s„'_`a
Zoning approval verified? ❑ Yes ❑No Nu nbi^af tnspeetions`per ttemvO - Q yf xf easy,,•4Total
�'i x ��—CATEGOR'flOF:CONSTRUCTION f =,r F,t t-:cost
"-'•``"-' "'" Residential,per unit,service included:
❑Residential ❑Government ❑ Commercial
JOB3 S!TEA NF.ORMATION''ANDD-LOCATION,3 W , ; 1,000 sq ft or less(4) $147.50 $
�
� GG Each additional 500 sq.ft.or portion
Job site address:
. ,� .?3 3 if. thereof $ 27.50 $
City::$ tc m,-U A;-tic( State: p(R ZIP:(774/7 5 Limited energy(2) $ 35.00 $
Reference: 4./ Taxlot Each manufactured home or modular
:Y3'e 1,a, `1D ESC RIPTION ,OF`tWORK •n°r„'K (tiw,'vie`,,-1 dwelling service or feeder(2) . $ 69.00 $
Ne v I.,,.ti C V- loa se '4 0 t 7 ea-- J ov
Services or feeders: installation, alteration, relocation
A e /l 200 amps or less(2) / $ 89.00 $
,4 sflo�;'-,1' •',k'PROPERTiY4OWNER, )1 ` , N, 201 to 400 amps(2) $ 104,50 $
Name: �a„�Jo,I/ ? -/-Z,Ib,`f-t”, CLc - 401 to 600 amps(2) $174.00 $
Address: c,5-y3 p,3 57,, _/.� 601 to 1,000 amps(2) $225.50 $
City: 5 pv;, c l,X State: 0 g ZIP:779-7g Over 1,000 amps or volts(2) $516.00 $
/ Reconnect only(2) $ 69.00 $
Phonerj/-52/- 3`T 75 Fax: - -
E-mail: V y Temporary services or feeders: installation, alteration, relocation
:1<2 4l"n<. / CO"-,
J 200 amps or less(2)
This installation is being made on residential or farm property $ 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, exchang , lease, or nt. OAR 401 to 600 am
479.540(1)
ig ature: an 479.56 ])n �{. /L —7 amps(2) $138.e0 $
Signature: G/,/ a`�.(� Over 600 amps or 1,000 volts,see services or feeders section above
' tu''. „' '. ;,CONTRACT,OF,ONSTALLA`T;ION 4t}'4 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 $
Signal circuit or a limited-energy panel,
Signature of signing supervisor: alteration,or extension(2) $ 80.00 $
Each additional inspection:(1) $80.00 $
"ra° 'au PPL`ICAN D- E .N '.`` ]xVIV
(A) Enter subtotal of above fees $
• (Minimum Permit Fee S80.00)
(B)Enter 12%surcharge(.12 x[A]) - $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $/0tl ti
440-2584-1(4/012013/C0M)