HomeMy WebLinkAboutPermit Electrical 2013-8-2 SPRINGFIELD 225 Fifth St
44 CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01736
www.springfield-or.gov permitcenter @spnngfield-or.gov
PROJECT STATUS: Issued ISSUED: 08/02/2013 EXPIRES: 01/28/2014
STATUS DATE: 08/02/2013 APPLIED: 08/02/2013
SITE ADDRESS: 862 G ST,Springfield,OR 97477 - SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703351207300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New Service
OWNER: LUCIER CHARLES V ESTATE OF Phone Number:
ADDRESS: 5441 RABBIT CREEK RD
ANCHORAGE AK 99516
CONTRACTOR INFORMATION .
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor OWNER CCB 000000 08/01/2025
• L INSPECTIONS REQUIRED
Inspections
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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CCJJlte
pi L 1'; (rl.�AT 2, jot'?
Owner or Contractor Signature Date
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• NOTICE: •
• ATTENTION: •Oregon law requires you to THIS PERMIT SHALL EXPIRE IF THE WORK
follow rules adopted by the Oregon Utility AUTHORIZED UNDER THIS PERMIT IS NOT
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR
• 0090. You may obtain copies of the rules by ANY 180 DAY PERIOD.
calling the center. (Nots;: the telenl,.sc:
number for the Crejoti ''cti ica..,;m
Curd ar is 1.o.. ;•.3 ' :)
Springfield Building Permit 8/2/2013 1:54:10PM Page 1 of 1
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SPRINGFIELD -— CITY OF SPRINGFIELD
225 Fifth St
OREGON TRANSACTION RECEIPT Springfeld,OR 97477
541-726-3753
811-SPR2013-01736
www.springfield-or.gov 862 G ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001690 RECORD NO:811-SPR2013-01736 DATE:08/02/2013•7 M- h�t ;; __: � r � _ o T � o o A . 12,. er
:AMOUNT DUE 3:11
Branch circuits with service or feeder ea ch circuit 224-00000-426102 1004 84.50
Services 200 amps or less - 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20.82
Technology fee(5%of permit total) 100-00000-425605 2099 8.68
TOTAL DUE: 203.00
t£s.PAYMEN7TYPE °�-.��`"PAYOR:i€:cnsHte �iesoN ,•fir-:�t.,,,,�:,.COMMENTS _'..,��;is:���...n3 AMOUNT PAID-rN
Credit Card OWNER 203.00
035805
TOTAL PAID: 203.00
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• Electrical Permit Application DEPARTMENT USE ONLY
W t, , - 'x„dn min SPRINGFIELD -
GITYOF SPRINGFIELD-, RECONy ! Permit nn.: et zo(3
225 Fifth Street•Springfield,OR 97477♦PH(541) 26-3753,F X(54t)726-3689 ' F \OREGON }
• Date: eb '7 I//
I
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 wort:is suspended for 180 days. ]
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ['Yes ❑No Number of inspections per item() I Qty. east TotaI
CATEGORY OF CONSTRUCTION
Residential,per unit,service included: I
Residential ❑Government ❑Commercial
JOB SITE INFORMATION AND LOCATION 1,000 q.0.ar less(4) Sta7so $ /C`�$(J " t
�62 t ! Each additional 500 sq. ft.or portion
Job site address: tl Ci- ", !1 p thereof $ 27.50 $
City.6'PRW6-—K I State L� ZIP: l}t.(17' Limited energy(2) $ 35.00 I $ 1
Reference: Taxlot.: Each manufactured home or modular 1
dwelling service or feeder(2) $ 69'00 $
DESCRIPTION OF WORK t
Services or feeders:installation,alteration,relocation
ki L 2.09 AA V7Gc 200 amps or less(2) $ 89.00 $ 8g i
PROPERTY OWNER 201 to 400 amps(2) I $ 104.50 $ I
Name: 5f frj r At Gib:pp4 j 401 to 600 amps(2) $174.00 S
Address: G Z 6/ S[I' , 7 601 to 1,000 amps(2) $225.50 $
City: gp i rv-Z� State:0k ZIP: ( M?! Over 1,000 amps or volts(2) $516.00 S
Phone03-5551 8334 Fax: - - Reconnect only(2) $ 69.00 $
E-mail: services or feeders:installation, alteration, relocation
This installation is being made on residential or farm property - 200 amps or less(2) S 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)an 7 .560 I). ,///J / 401 to 600 amps(2) $138.50 $
Signature- - lav � Over 600 amps or 1,000 volts,see services or feeders section above 1
CONTRACTOR' INSTALLATION Branch circuits: near, alteration,extension per panel
Business nainegjl.!/rie- — a. Fec for branch circuits with purchase of a service or feeder fee: ;
Address: . Each branch circuit 13 '$ 6.50 s j
I
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 $ i
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 - $
signal circuit or a limited-energy panel, j
Signature of signing supervisor: alteration,or extension(2) $ 80.00 $ I
Each additional inspection:(I) $80.00 $
APPLICANT USE I
• (A) Enter subtotal of above fees /��
(Minimum Permit Fee$80.00) l/7
Z
(B)Enter 12%surcharge(.12 x[A]) S A j,h2 17
(C)Technology Fee(5'%of[A]) - $ i% ,.0i
440-2581-J(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ ;
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