HomeMy WebLinkAboutPermit Electrical 2013-6-26 SPRINGFIELD 225 Fifth St
- CITY OF SPRINGFIELD Springfield,OR 97477
c.%,v Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01389
www.springfieldbcgov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/26/2013 - EXPIRES: 12/22/2013
STATUS DATE: 06/26/2013 APPLIED: 06/26/2013
•
SITE ADDRESS: 1165 6TH ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703264311700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Electrical for Garage
OWNER: WILLS JACK FRANCIS&DONNA MARIE Phone Number:
ADDRESS: 1165 6TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
•
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
•
4225 Service or Feeder
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. . G/w),3
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
NOTICE: ATTENTION:
rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth
\UTHORIZED UNDER THIS PERMIT IS NOT In OAR 952-001-0010 through OAR 952-001-
2MMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
nn nAY PERIOD. calling the center. (Note: the telephu b
number for the Oregon Utility Notification
Center is 1-800-332-2344).
•
Springfield Building Permit 6/26/2013 8:45:43AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
OREGON 811-SPR2013-01389
wiw.springfield-orgov 1165 6TH ST permitcenter @spnngfield-or gov
RECEIPT NO: 2013001344 RECORD NO:811SPR2013-01389 DATE:06/26/2013
]eL o 1;175 . l'u,:7-11 3_M �.?.r a'9ACCOUNT_CODEITRANS.CODE — T AMOUNT DUE
circuits with service or feeder each circuit 224-00000-426102 1004 78.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20.04
Technology fee(5%of permit total) 100-00000-425605 2099 8.35
TOTAL DUE: 195.39
RAYMENT'rt TYPE;'; :?PAYOR a srneR ,irdiaOri COMMENTS AMOUNT&PAID,- III
Check WILLS JACK FRANCIS& DONNA MAI 195.39
5660
TOTAL PAID: 195.39
•
•
v
Electrical Permit Application �\ DEPARTMENT:;USE ONLY
y SPRINGFIELD � - .;.
C TRY,iOFzSPRINGEM;LD.OREG-ONJ " "
� � � r / 3 q
w � tt- x t,--71" ' � t f , ,--a- ��z:nt -,m'_ :4; Permit n°.: CJ� [rvT (3f3
225 Fifth Streets Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689
Date: 6 46//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.
OCAL,;GOYERNMENTiAPPRO,VAL 5 ,, '. r i a?;z?,sag FEEISCHEDULE,,, Al 3, ;;;
`s
14
Zoning approval verified? Yes ` wt " i £ - r'` k}SCost,t! ,.Total
Zoning PP ❑ ❑No :Number of tnspecttons per item (-, Qty ''!!��,,ia ,, cos ".:
.x Se �:.. .� ,1. r.aM uYi3
CATEGORY„§iOF,;,CONSTRUCTION �” ' ]r F' , ,
Residential, per unit,service included:
'OCResidential ❑Government ❑Commercial
JOBSITE:':INEORMATIOM AND;°LOCATION t;;c 1,000 sq. ft. or less(4) $147.50 $
Each additional 500 sq.ft.or portion
Job site address: //(Q j 6/...r33-, thereof -Q $ 27.50 $
City: /2/x,f/Lii State: &/Z ZIP:97g77 Limited energy(2) $ 35.00 $
Reference: Taxlot Each manufactured home or modular $ 69.00 $
rCiiii i'' `ii, 1D ESC RI PiT.10 10,0 Et5W0 Ikk: ;i5.tsti.:j.t:WIn dwelling service or feeder(2)
Services or feeders: installation, alteration,relocation
200 amps or less(2) I . $ 89.00 $
a= ' r r '" ,. PROPERTY,OWNER ,' -,;t;' 201 to 400 amps(2) $ 104.50 $
Name ,- ) —r W�/�S 401 to 600 amps(2) $174.00 $
Address: //(yam 62 5}f _ 601 to 1,000 amps(2) $225.50 $
City: �w/[-7y� State: 2 ZIP:?77f 77 Over 1,000 amps or volts(2) $516.00 $
Phone p (`(9� - o9 7(e Fax: . Reconnect only(2) $ 69.00 $
E-mail: w I L L-S [ " ��'�t/Acm I e /I_)� 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 79.5600). 401 to 600 amps(2) $138.50 $
Signature: �� /• /.(ids Over 600 amps or 1,000 volts,see services or feeders section above
lfilln1 +UCON�TRRANCCCT'ORR4N�STALL-"'ATION #'^1.X:l,i-t Branch circuits:net 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 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
•
` tr.4` k, ?tAPPLICANT;USE \Wa
(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): $/7.5.-
.°--
440-2584-1(4/01/2013/COM)