HomeMy WebLinkAboutPermit Electrical 2013-6-5 •
SPRINGFIELD -225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
''S\ OREGON 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax:541-726-3676
PERMIT NO: 811-SPR2013-01167
www.springfield-or.gov permitcenter @springfield-or.gov
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PROJECT STATUS: Issued • ISSUED: 06/05/2013 EXPIRES: 12/01/2013
STATUS DATE: 06/05/2013 APPLIED: 06/05/2013
SITE ADDRESS: 546 JANUS ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703341200700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Panel Replacement
OWNER: HENRY M LALICH TRUST Phone Number:
ADDRESS: 546 JANUS ST
SPRINGFIELD OR 97477 •
CONTRACTOR INFORMATION b
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor BELLMAN GROUP INC CCB 194437 07/05/2013 541-357-6950
L. 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 c- •. Is Iota ==_ �L- •nt of the property,and the approved set of plans will remain on the site at all times during
cons ction. //'�
• Cot � ,�
11
Owner or Conte. ! -ture� • Date
ATTENTION: Oregon law requires you to T IGE-
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth ;IS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- UTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by .;OMMENCED OR IS ABANDONED FOR
tailing the center. (Note: the teleph:.rr:: ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit 6/5/2013 2:12:57PM Page 1 of 1
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SPRINGFIELD- CITY OF SPRINGFIELD
fifth
' z 225 St
EGON TRANSACTION RECEIPT SErfthlSORg7477
541-726-3753
811-SPR2013-01167
www.springfeld-or.gov 546 JANUS ST permitcenter @springfield-or.gov
RECEIPT NO: 2013001128 RECORD NO:811SPR2013-01167 DATE:06/05/2013
�o] .Yo1;, 111[o]`E 4 ,d3 G.:st + , AA' . ° + 2'ACCOUNTCODE(TRANS:CODE„-";"--Wass. AMOUNT.DUE
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
-,P,AYMENTaT.YP.E i P-AXOR caSwEMAITiOR ,COMMENTS AMOUNT PAID i
Check BELLMAN GROUP INC 104.13
5591
TOTAL PAID: 104.13
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. Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
' CITYOFSPRINGFIELD, OREGON Permit no.: et( Z&I; DI ( o7 I
225 Fif ee t7 5 ) \ONEGON
Date: 6 75-A,
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
ea. cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
Residential ❑Government ❑Commercial
JOB SITE INFORMATION AND LOCATION 1,000 sq.ft.or less(4) $147.50 $
Each additional 500 sq.ft.or portion
Job site address: 51.4 (• 3 qv:,us St. thereof $ 27.50 $
City: „ ,-U(_tt�.,A1 State: 01— I ZIP: 97477 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ p
DESCRIPTION OF WORK dwelling service or feeder(2) I
( Services or feeders:installation,alteration,relocation i
F�`( 1�"~�� t 200 amps or less(2) / $ 89.00 $ 0q F'
PROPERTY OWNER
201 to 400 amps(2) $ 104.50 $ t
Name: 401 to 600 amps(2) $174.00 $
Address: 54 6 3 ao„, Lj.f-
601 to 1,000 amps(2) $225.50 $
City: ��- pI. 2 State: 04-. ZIP: ci7 if-77 Over 1,000 amps or volts(2) $516.00 $
Phone: _ 1r 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 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:new alteration,extension per panel
Business name: De L L_AAdsAJ A p.e c_. a.Fee for branch circuits with purchase of a service or feeder fee:
Address: p v 3aT •_1 ( 0 2} Each branch circuit I $ 6.50 I $
City: E J te....-- State: c),[r__ ZIP: 9 7'401 b.Fee for branch circuits without purchase of a service or feeder fee:
Phone411-35 7_ L icy I Fax: - - First branch circuit(2) $ 60.50 $
E-mail: ✓a(j Q 11R-tc.p n„�y/A ti.Q L; t, cq,a^ Each additional branch circuit $ 6.50 $ i
CCB license no.: t 9 yy 3\' _ I BCD license Ho.: C.7 (• (, Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 5--'(2 6 3- s Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: • , , _V,da.” Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: /- jab Signal circuit or a limited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees ''22 q
(Minimum Permit Fee$80.00) $ U I
1
(B)Enter 12%surcharge(.12 x[A]) $ 10 bsi I
i
(C)Technology Fee(5%of[A]) $ .Li 45—
440-2584.1(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ /0`02-