HomeMy WebLinkAboutPermit Electrical 2013-7-31 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
A > " : Phone: 541-726-3753
-OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01723
www.springfieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 07/31/2013 EXPIRES: 01/26/2014
STATUS DATE: 07/31/2013 APPLIED: 07/31/2013
SITE ADDRESS: 1033 F ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703351402100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Change
OWNER: EVANSON DAVID Phone Number:
ADDRESS: 2652 RIVERWALK LOOP
EUGENE OR 97401
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor BRYAN L HURLEY COB 149937 12/26/2013 541-606-2797
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 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.
,{9G2T/�v h/!?/J �ll 7-3/-13
Owner or Contractor Signature Date
ATTENTION::Oregon law requires youltol
followrrul'es'adopted by the Oregon Utility/ NOTICE:Notificationtcenter. Those rulesare settforthl P1RE IF THE WORK
in OAR 952'001'-0010 through OAR 952-00.t THIS PERMIT SHALL EX
•0090. You may obtain copies of the rulesby AUTHORIZED UNDER THIS PERMIT IS NOT•
• .'+inn the center. (Note: the telephut COMMENCED OR IS ABANDONED'FOR
^,rr' i 'tiliy Notification
ci ANY 180 DAY PERIOD.
Springfield Building Permit 7/31/2013 3:05:26PM Page 1 of 1
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• SPRINGFIELD_-- CITY OF SPRINGFIELD
225 Fifth St
L,`o E�oN TRANSACTION RECEIPT Springfield,OR 97477
811-SP R2013-01723 541-726-3753
www.springfieid-or.gov 1033 F ST permitcenter @springfieid-or.gov
RECEIPT NO: 2013001675 RECORD NO: 811-SPR2013-01723 DATE:07/31/2013
ACCOUNT`CODELTRANStODE`r :;t'<=_.t;,r,.�,.: ,MjA
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
f?AYMENTAW18E P.AYOR ASweanesoN. . _ COMMENTS _ ll , AMOUNTtFAID
Check EVANSON DAVID 104.13
1021
TOTAL PAID: 104.13
•
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Electrical Permit Application DEPARTMENT USE ONLY
� -- r �.-� ='-"f= SPRINGFIELD
CITI OF GF[ELD J EGO t Permit no.: Pjl \ Zo l3 �1 z�
a °v:s:- :Al' : c..- z•. "Y
=� tt
225 fifth Street•Springfield,OR 974774 PHt541) 26-37534F 1\(541)726-3689 4 OREGON k
Date: 7/31/3 1
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 f
days of issuance or if wort: is suspended for 180 days. C
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes El ()No Number of inspections per item Qty. Cosea.t Totcost al f
CATEGORY OF CONSTRUCTION Residential,per unit,service included:
Residential ❑Government - ❑Commercial 1
JOB SITE INFORMATION AND LOCATION
1,000 s1).0.or tens(4) $147.50 $
L 0 33 r Sr Each additional 500 sq. ft.or portion $ 27.50 $
Job site address: r -7 thereof
CitycP2nbg12(� I State:CC ZIP:9 !�'/ Limited energy(2) $ 35.00 I $
Reference: lJ Taxlot.: Each manufactured home or modular $ 69.00 $ :
DESCRIPTION OF WORK • dwelling service or feeder(.2)
Services or feeders:installation,alteration.relocation i
S ece∎J c e� CAA 11u/9 200 amps or less(2) f $ 69.00 $ f
�P/ROPERTY OWNER 201 to400amps(2) I $ 104.50 S
Name: y/�rit, 7p1,+'r,�Sv—r 401 to 600 amps(2) 5174.00 $
Address: Z 6 c2 ,e c,r--L✓cclle, 601 to 1.000 amps(2) $225.50 S
City: i�yQn..e State: 6/C ZIP:
Over 1.000 amps or volts(2) $516.00 $
J Reconnect only(2) $ 69.00 $
Phone: - - Fax: - - t
E-mail: Temporary services or feeders:installation, alteration, relocation
200 amps or less(2) $ 69.00 $
This installation is being made on residential or farm property .
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 $ t
property is not intended for sale,exchange, lease,or rent.OAR L
479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $ !!f
Signature: Over 600 amps or 1,000 volts.see services or feeders section above l
1
CONTRACTOR INSTALLATION Branch circuits: new. alteration,extensionper panel
Business nnaame:. A '( ?^LECTC-((.-- a.Fee for branch circuits with purchase of a service or feeder fee: 1
1 ,
Address: D, [It ef/a3pOp Each branch circuit S 6.50 $ I
City: guy-eipte State: 04 ZIP: Q744 .b.Fee for branch circuits without purchase of a service or feeder fee:
! First branch circuit(2) ,5 60.50 $ 1
Phone:Syf (p0,b Z?f7 Fax: �-r- ( -.
E-mail: 0,46.es PDQ� Coot c4Fst , aJJ/ . Each additional branch circuit $ 6.50 $
CCB license no.: `2/'c 37 BCD license no.:2J-2(NG Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 10"J&S Each pump or irrigation circle(2) $ 69.00 $
i
Print name of signing supervisor: ataM ) L, /-Fucth'( Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80,00 $
Signature S a P � ration,ti nal inspection:ti
Each additional inspection:(1) $80.00 $ .
APPLICANT USE
• (A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x IA]) $
- (C)Technology Fee(5%of Al)[ $ '
440-2584-J(4I01120131COw) - TOTAL fees and surcharges(A through C): $ /09