HomeMy WebLinkAboutPermit Electrical 2013-8-12 SPRINGFIELD 225 Fifth St
•I .1 , CITY OF SPRINGFIELD Springfield,OR 97477
c. Phone: 541-726-3753
ONEGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
• PERMIT NO: 811-SPR2013-01786
www.springtield-or.gov • permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 08/12/2013 EXPIRES: 02/07/2014
STATUS DATE: 08/12/2013 APPLIED: 08/12/2013
• SITE ADDRESS: 1882 YOLANDA AVE,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703243400305 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace service panel
OWNER: MCDANIEL PATRICK L&DEBRA S Phone Number:
ADDRESS: 1882 YOLANDA ST
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION II
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone .
Electrical Contractor OWNER COB 000000 08101/2025
• INSPECTIONS REQUIRED
Inspections
4210 Service Change
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
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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 al required inspections are requested at the proper time,that each address is readable from the street,that the
permitcard is'loca d at the front of the property, and the approved set of plans will remain on the site at all times during
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struct on.
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Owner or Contractor Signature Date
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Springfield Building Permit 8/12/2013 11:53:39AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
tf+ ..:++bi.. 225 Fifth St •
t `OREGON TRANSACTION RECEIPT Springtield,OR 97477
541-726-3753
811-S P R2013-01786
www,springeeld-or.gov 1882 YOLANDA AVE pennitcenter @springtield-ar.gov
RECEIPT NO: 2013001741 RECORD NO: 811-SPR2013.01786 DATE:08/12/2013
{DESCRIPTION, . L.,., _ _._ -_ . . .__ ACCOUNT CODE/TRANS CODE- _--_AMOUNT DUE-_'
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
AMOUNT PAID_ PAYMENT TYPE � PAYDR �cnswER;oeowLSSr__ __ COMMENTS �: –�. _ J
Credit Card _— MCDANIEL PATRICK L T 104.13
09000c
TOTAL PAID: 104.13
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Electrical Permit Application DEPARTMENT USE ONLY
.cam ,.., , ^e* '1. SPRINGFIELD
G a' {OG 4SPRLNGEIEGD, OREGONN - 4 ` •io5/3 ' O/ 7 SG ',
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225 Fifth Street♦S nn field.OR 97477♦PH541 263753*FAX(54t)7263689 n'.OREGON Date: C /?i/3
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 3
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? D Yes ❑No Number of inspections per item Q t Ceoast Total
cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
Residential ❑Government ❑Commercial t
JOB SITE INFORMATION AND LOCATION 000 sq.tr.nr less(p $1a7.50 $
/ 0 e 2 _ i /- � Each additional 500 sq. fl-or portion $ 27.50 $
Job site address: /yrJ/� thereof
City: S etc State:�L ZIP: 7 I
ty 5 ]q t Limited energy(2) $ 35.00 $ i
Reference:(7p 3 Z-4 St( Tax lot.:CO3O( Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(?)
SL,t.del.C. f e_1 7s/G--tc Services or feeders:installation,alteration,relocation {
200 amps or less(2) f $ 89.00 St?5 1
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $ #
7 , ),
Name:(-freirraic. L., iv 9t i 67._ 401 to 600 amps(2) $174.00 $
Address: l 601 to 1,000 amps(2) $225.50 $ 1
�dg��p�Nn.4 ��
City: S�,e7, �(d State: Op ZIP: fq�?7 Over 1.000 amps or volts(2) 5516.00 $
Phone ?V-41e Fax: - - Reconnect only(2) $ 69.00 $
` E-mail: , 'ler7'jGp®/,'I 5-N, C-0 10^- Temporary services or feeders:insrallnrion, 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 }
4795400)and 479.560(1). 401 to 600 amps(2) $138.50 $
Over 600 amps or 1,000 volts.see services or feeders section above
Signatu j
CONTRACTOR INSTALLATION Branch circuits:news alreratton. extension per panel
Business name: c L/n/L�� a.Fee for branch circuits with purchase of a service or feeder fee:
I
Address: Each branch circuit $ 6.50 $ i
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First blanch circuit(2) $ 60.60 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: BCD license no.: Miscellaneous fees:service orfeerler 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, $ 80.00 $ !
Signature of signing supervisor: alteration,or extension(2)
Each additional inspection:(I) $80.00 $
- _ .,APPLICANT USE
(A) Enter subtotal of above fees 8 4
(Minimum Permit Fee 580.00) $ 8 ( i
(B)Enter 12%surcharge(.12 x[A]) $ 06 ba
(C)Technology Fee(5%of[Al) $ If li
440-2584-1(4i0112013iCOM) TOTAL fees and surcharges(A through C): $ ,Oy I� (
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