HomeMy WebLinkAboutPermit Electrical 2013-6-10 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
t Phone: 541-726-3753
*OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01218
www.springfield-or.gov permitcenter(o3springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/10/2013 EXPIRES: 12/06/2013
STATUS DATE: 06/10/2013 APPLIED: 06/10/2013
SITE ADDRESS: 360 S 52ND PL,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702333400700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New Panel
OWNER: CHANEY NICHOLAS Phone Number:
•
ADDRESS: 360 S 52ND PL
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
4220 Electrical-Service
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
ATTENTION: Oregon law requires you to
NOTICE:
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by 'O(14(vIENCED OR IS ABANDONED FOR
calling the center. (Note: The telep'...: c: v
number for the Oreoo, ;'iltl.. 1.�.'-;fcz: on 180 DAY PERIOD.
itn• is 1-o:.J-s.,,2 r. +).
Springfield Building Permit 6/10/2013 2:17:12PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
• 14 -'+'>am.,iii 225 Fifth St
{ TRANSACTION RECEIPT Spdngfield,OR97477
.;OREGON 541-726-3753
811-SPR2013-01218
www.spdngfield-or.gov 360 S 52ND PL pennitcenter @springfield-or.gov
RECEIPT NO: 2013001183 RECORD NO:811-SPR2013-01218 DATE:06/10/2013
ill*.-iel:7r,A0(01'P . ''° ryt_'u ri rZA- 4.:z:SLAI ACCOUNT CODE/TRANS Co DE 2T ill 11'''AMOUN DUE ga
Branch circuits with service or feeder each circuit 224-00000-426102 1004 39.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 15.36
Technology fee(5%of permit total) 100-00000-425605 2099 6.40
TOTAL DUE: 149.76
PAYMENT�T
:YP-E PAYOR1ncaswERTWARSOR COMMENTS .AMMNTIP,AID.
Credit Card Nicholas Chaney 149.76
725556
TOTAL PAID: 149.76
Electrical Permit Application DEPARTMENT:USE ONLY
.:
Y
ft:„CIT+Y OF SPRINGN'I'�,LD OREG-8N 1 I z [ 1C13 0 ( 2]v
T�5}?:^xa:,.24'-*#-7,..ii .`4stat-:. �.it€,,.�.,.. -ts .:+e». ' -°'a- A`:`r *,: -.-s'.rw Permit no.: V
s 225 Fifth Streets Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 41w - R
Date: e//o // 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.
.,;, fLOCAU;GOVERNMENVAFP.ROVAL- -j 'E t < t.i§: 1:4 r ` TF,EE[wSCHEDLi LE? w'' l a
. .v i �t it+ i..t Y '',3
,, ,, ns„n� gyp, pat rY'' J t1. Asi'1''., r%1 t
Zoning approval verified? ❑ Yes ❑No KNumber of fr ecuons erItemp " t et:Cost c Total .
x .. 4 'a.i.,-.p . t._9 � ∎,, -. )s �.i�. Fir',ea;Y t_:COSt ',t
`;% ,,, n, CATEGORY,OF: CONSTRUCTION ; ,-s ti 3 : Residential
r . per unit,service included:
d •esidential ❑Government ❑Commercial
f „ 1,000 sq. ft. or less(4) $147.50 $
'JOB;SITE cINFORMATION 'AND LOCATION;sct-L;t
Job site address: '- Each additional 500 sq.ft.or portion
C7 �� I f C. C Q_ thereof $ 27.50 $
City: <3.lof, #.,' Q 0 State: ZIP: Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $
dwelling service or feeder 2
rr�, ,tf)ESt: IPTION QF WO 5, . !`:� zt g ( )
�A, \\ n Services or feeders: installation, alteration,relocation
1v Q,� ( A.�e. j, fJ Y'' 200 amps or less(2) I $ 89.00 $
S9°'' r a n°�. -,_ ,: (((. �,. 201 to 400 amps(2) $ 104.50 $
xt�"�'-,t,e.. .;is+;�,s°:d:PROPERT_Y/IOWNEfZ, ,. s ,.�,. '�•rdt
Name: N,'re GJi9-/L5'_l7 401 to 600 amps(2) $174.00 $
Address:e co S S2=� (CC_ 601 to 1,000 amps(2) $225.50 $
City: f\_34-:.-C. O J L ZIP: Over 1,000 amps or volts(2) $516.00 $
c-', %� State:
Phone:/--1jZ- 9 y g i Fax: - -
Reconnect only(2) $ 69.00 S.
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 -
479.5400)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
!?.v��fgSWCONT,RACTOR„INSTALLATION k e'ia�., Branch circuits:new alteration,extension per panel
Business name: t �'� r—=r—"r—”` a.Fee for branch circuits with purchase of a service or feeder fee:
Address: f , 1 t Each branch circuit c $ 6.50 $
City: 0(/ V` 1 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 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(I) $80.00 $
x "ua t, LAPPL'ICANT? USERNtleliatr�tal
(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): $I [ ? 7
440-2584-3(4/01/2013/C0M)