HomeMy WebLinkAboutPermit Electrical 2013-7-19 , SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
,` Phone: 541-726-3753
'.OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01633
www.springfield-or.goy permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 07/19/2013 EXPIRES: 01/14/2014
STATUS DATE: 07/19/2013 APPLIED: 07/19/2013
SITE ADDRESS: 680 FERN WAY,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1802051203300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Reconnect
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OWNER: HANS THOMAS G&FRANCINE M Phone Number: .
ADDRESS: 680 FERN WAY
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor MARKHAM ELECTRIC INC CCB 128394 04/01/2014 541-942-8789
INSPECTIONS REQUIRED i
Inspections
4200 Reconnect Service
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. .
IS ilLat4 11-x— 1 Li1,) 13
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- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the teen' .to ;OMMENCED OR IS ABANDONED FOR
number for the Oregon entity Not.;IL n
or=r,h3r !; 1. *i, 3- - • , . 1 `1Y 180 DAY PERIOD.
Springfield Building Permit 7/19/2013 8:08:05AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
r•5„ __• ;,, 225 Fifth St
tcH,
OREGON TRANSACTION RECEIPT Spnngfield,OR 97477
541-726-3753
811-SPR2013-01633
www.springleld-or.gov 680 FERN WAY permitcenter @spdngfield-ar.gov
RECEIPT NO: 2013001573 RECORD NO: 811SPR2013-01633 DATE:07/19/2013
. :�, . .-�. ..-.�.�,.��,.., „r. �±.�1:�n,L,ACEOUNTGODE/TRAN$±CODE:a� t_ MOUNTIe 11
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00
Service reconnect only 224-00000-426102 1004 69.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
P4YMENTtTYPE' ' "..,-..___..�..� AMOUNT PAID PAYOR casNieR:�uRSDR .COMMENTS _ . .- '
Credit Card MARKHAM ELECTRIC INC 93.60
03673G
• TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT USE ONLY
�5yn� -;b5.�q SPFINGFIELO - _ :-' ._
!9PTM2"Gr'�Y -�Y°'^..d.�i�?w. ...ta]A"? ..T n1c�:Yb NtL�}I-.}I ��£G. �.� � 9
CIT Y OF SPRINGFIEL WOREYPG-91 ' - l I z 3 i
t 3;;As"i5 ::::k,,:14-n 1s, kw;+ ar cUPe,N 's;a ,24-:: z- n> " : Permit no.: o\ °
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 'ix''ll`-th'i"
Date: 7/ 94 7
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.
ii w 6"tLQCAL GOV,ERNMENT.;vAFPROVAL4_°; ,,,._. r ".ax-,FEEiSCFIEDULE;4xA ws'
Zoning approval verified? ❑ Yes ❑No Nop ws p � m O J? r Cost Total umbe`r f mc n eate . �hea _cot
a`
,<f ,5?-F, CATEGORY%OF CONSTRUCTION wttAr r " " i ; + ,y _, :
Residential, per unit,service included:
Z Residential ❑Government Cl Commercial
JOB-KSITE„:INFORMATION�AND�'LOCATION ;,.t t”. 1,000 sq. ft. or less(4) $147.50 $
s c} Each additional 500 sq. ft.or portion
Job site address: vg(3 \ U J _ thereof - $ 27.50 $
City:S c c_1 a State: b ZIP: 1-I 9 )g Limited energy(2) $ 35.00 $
Reference: Taxlot Each manufactured home or modular $ 69.00 $
t!" .8 `?u` DESCRIPIIONMQF',WORK 1 sx x T dwelling service or feeder(2)
Services or feeders: installation, alteration, relocation
C e Gd nncv
-- - 200 amps or less(2) $ 89.00 $
igli 1 aVi ;(PROPERTIVO.WNEF i ' , . "::,; ,Igt 201 to 400 amps(2) $ 104.50 $
Name: ` 0 m G,�y 401 to 600 amps(2) $174.00 $
Address: s c o..` c 5 R to 6Jt 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Reconnect only(2) - I $ 69.00 $
Phone:Syl--ut-` 555 Fax:t ax: - -
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 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
x%eft° ,i'^ie CONTRACTORONSTAEL'ATio , 7" ",f. ,,;i; Branch circuits:new alteration, extension per panel
Business name: n 0_k- -. C1 kr,, 5hC a.Fee for branch circuits with purchase of a service or feeder fee:
Address: cD"Q \J ex \ A 18 Each branch circuit $ 6.50 $
City:C o \c.S f C rq„c State: OR ZIP: 51`1.2`( b.Fee for branch circuits without purchase of a service or feeder fee:
Phone4{I-iii- g i ci Fax: - - First branch circuit(2) $ 60.50 $
E-mail: (V KL e.,-,. e.ketA-tic INC. OJy Na,',. co,'- Each additional branch circuit $ 6.50 $
CCB license no.:1135 '1 BCD license no.: 20-4)0G Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: id 11.01 I J Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: rc AA c Signal circuit or a limited-energy panel,A vv-k.r Lk.1 Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: -V.l. alteration,or extension(2) $ 80.00 $
Each additional inspection:(1) $80.00 $
AVISSITAIfiagetAINTACTigitealighl
(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 3 t 0
440-2584-1(4/012013/COM)