HomeMy WebLinkAboutPermit Electrical 2013-6-7 SPRINGFIELD -- 225 Fifth St
• ' — CITY OF SPRINGFIELD Springfield,OR 97477
' !o EGON Phone: 541-726-3753
Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01188
www.spdngfieldar.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/07/2013 • EXPIRES: 12/03/2013
STATUS DATE: 06/07/2013 APPLIED: 06/07/2013
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SITE ADDRESS: 1367 PIEDMONT ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703253204500 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Change
OWNER: TURLEY JACOB 0 Phone Number:
ADDRESS: 1367 PIEDMONT ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER COB 000000 08/01/2025
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 1 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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6/7/20 l�
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or Contractor Signature Date
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on law requires you to
ATTENTION: Dreg the Oregon Utility NOTICE WORK
follow rules adopted by THIS PERMIT SHALL EXPIRE IF THE
Notification Center. Those ruh OAR 952 00 h
in OAR 952-001-0010 throng AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may nlOr. Not copies terephIes by
carting the center ( COMMENCED OR IS ABANDONED FO
number tor the Oregon Utility Notification
ANY 180 DAY PERIOD.
n,9rrier is )-h60-332=2344).
- Springfield Building Permit 6/7/2013 8:12:20AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfeld,OR97477
. iOREGON 541-726-3753
811-SPR2013-01188
www.springfield-ocgoy 1367 PIEDMONT ST petmitcenter @springfield-or.goy
RECEIPT NO: 2013001154 RECORD NO:811 SPR2013-01188 DATE:06/07/2013
D Pi .IoN ___- . . , I._ �_. et ='a'_+ ACCOUNT.GOOEY'RAMS CODE = AMOUNTDUE •.
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
PAsEN7TTIPE PAO.R casRMR"S OR1 ENT *WA--.MOUNTgPAID
Check TURLEY JACOB O 104.13
1327
TOTAL PAID: 104.13
Electrical Permit Application ,• .,. DEIDARTMENT:USE ONLY.
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'AI,a;:zif*eg;,#:76:$41494.-i-evals.- 7)Pir;I:,,,-;:t1 ,E*):14-34AT2:4:.; !Of.-t., b -4; Pennit no.:0 i , - _.- // OS
• 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date:
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
.diJiqt4StLEOCAL];',GOVERNMENTZIA:FrkE).1312VALGM&APW:: 'grt-4tgiaaltar4WFEE.6"SC.HEDUCEMAY3*.n?W°.151
Zoning approval verified? 0 Yes 0 No ,}t,'-'i.4.:.ttal,..T.M7g;4 .:Tai:,elb.27FeVS,Z4T:..cr.Al.C4Sfirei c-i-iTofilz;
''..N9J.P4g0P?acloR -PT,qP;(9i-to yq- Itml-Ea‘t??.$ cos
ar.4cATEGORVibEtoNsTROcTIoNRAWIM,c ' "'''''''''''-- .--''''n'''''' 'u--- n6 - '- ----
Residential,per unit,service included:
0 Residential 0 Government 0 Commercial
1,000 sq.ft.or less(4) $147.50 $
.:./X:iii';',i",!;f:JOB..'.51T.E1NFORMATIONAN Eff, LIOCATION't,:ISN
Each additional 500 sq ft.or portion
Job site address: 13C"7 Pr1/4(1.4‘on 4-- ) t- thereof - $ 27.50 $
City: Sp 0 Oa la( State: CIE- ZIP: 7 f 77 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular
VitiaiNtInlID ESC RIETION c'.10F,MORK 41:',::.:S3E:Salaa dwelling service or feeder(2) $ 69.00 $
Services or feeders: installation, alteration, relocation
gt(e,.. dizt, ot- e(ecov-r&-i( „5.erv,z...e._
200 amps or less(2) / $ 89.00 $ Z 1,0
174.111Therinngae R 0 R.E R MO W N E 13F14241Mial4 201 to 400 amps(2)
$ 104.50 $
Name: ,),-,...ce L L-----1-c-, 401 to 600 amps(2) $174.00 $
Address: r3 C-7 Pf•cpe,---n r 5s--, 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: - - Fax: - - Reconnect only(2) $ 69.00 $
Temporary services or feeders: installation, alteration, relocation
E-mail: ? ii-c,t0L/h,Leie._• (.0,,c„54-.4.et
..;=--- 200 amps or less(2)
Thiljnitallation is being inade 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, 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
tiNinqr,PONTRAciterONsTAEtmiloniVAPWria: 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: . $ 80.00 $ •
_ , alteration,or extension(2)
Each additional inspection:(1) $80.00 $
0,17a:::#:74MTAtaffergWitaCiS Cat' :::::475eng
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $ $1.6v
(B)Enter 12%surcharge(.12 x[A]) $ (C,6I
(C)Technology Fee(5%of[A]) $ 44-S
TOTAL fees and surcharges(A through C): $iO 1, /3
446-2584-1(4/01.2013/C0M)