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HomeMy WebLinkAboutPermit Electrical 2013-8-8 • SPRINGFIELD - 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 • �� Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone:541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01775 www.springfield-or.gov permitcenter @springfield-or.goy PROJECT STATUS: Issued ISSUED: 08/08/2013 EXPIRES: 02/03/2014 STATUS DATE: 08/08/2013 APPLIED: 08/08/2013 SITE ADDRESS: 488 W CENTENNIAL BLVD,APT#1,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703274403800 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Service for DSL cabinet OWNER: KOELLING JOHN A&ELINOR J Phone Number: ADDRESS: 1968 W 34TH AVE EUGENE OR 97405 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor TONY KOTH CCe 59748 05/19/2014 541-688-8996 INSPECTIONS REQUIRED Inspections 4225 Service or Feeder 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. Az - Owner or Contracto ignature Date ATTENTION: Oregon law ur you to NOTICE: follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK n OAR tlon enter. 0 through OAR s52 00th AUTHORIZED UNDER THIS PERMIT IS NOT oso. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR calling the center. (Note: the tele rules ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). • • Springfield Building Permit 8/8/2013 2:06:37PM Page 1 of 1 • SPRINGFIELD -- CITY OF SPRINGFIELD 225 Fifth St • TRANSACTION RECEIPT Springfield,OR 97477 OREGON 541-726-3753 811-SPR2013-01775 www.springfieldor.gov 488 W CENTENNIAL BLVD. APT 1 permitcenter @springfield-or.gov RECEIPT NO: 2013001730 RECORD NO:.811SPR2013-01775 DATE:08/08/2013 {o1�cIo1;71• 01, .,,�,,� . _- _� 1nr,�.",�, 'R 3. '2;f:'.,ACCOUNT CODE/TRANS CODE 21 �.. "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 �aAMNrLPE " AtO Rt„n° EZEr pR ENTER - COMMNTS 'ati ANIO TPAID ` Check TONY KOTH 104.13 7533 TOTAL PAID: 104.13 • • t Electrical Permit Application DEPARTMENT USE ONLY ran s :n s.. . E."S:! .--E=.mssx[ a`5E.0 axr=_^7 t•% SPRINGFIELD .. :CITY OItSP;I7;:MGM:F f D;O GoN Permit no.: Sl 3' 777C 225 Fifth StreeHSpnngfield,OR9,477•PH(.41)7?637536F,t..\(SJl)7?63689 \tp OREGON IE Date: 1 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. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total ea. cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑Residential ❑Government 'Commercial 1,000 sq. II.or less(4) $147.50 $. JOB SITE INFORMATION AND LOCATION g l L�� �� �/ h Each additional 500 sq. ft.or portion $ 27.50 $ Job site address: T t %�//7 ' thereof Y �prL/FAG /�/L�7,Lj `f77 € City: Sate: Q/Z ZIP:q7 Limited energy(2) $ 35.00 $ Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) Services or feeders: installation,alteration,relocation 1 1L�lvlwle-y t-/o-//c 0 S L CA-13 1 200 amps or less(2) / I $ 89.00 $7. PROPERTY OWNER 201 to 400 amps(2) I $ 104.50 S Name: 4/ELL ! N ,/ 401 to 600 amps(2) $174.00 $ Address: /I6,( 7 Gu 3 ep/, ,c76...--- 601 to 1.000 amps(2) 5225.50 S .1 A 9,7149 Over 1,000 amps or volts(2) $516.00 $ City: [( State: GY<— ZIP: 7 / ? Reconnect only(2) S 69.00 $ Phone: - - Fax: - - E-mail: Temporary services or feeders:installation,alteration, relocation ! �Y This installation is being made on residential or farm property ro et 200 amps or less(2) $ 69.00 $ owned by me or a member of my immediate family.This 201 to 400 amps(2) 5 96.00 $ F property is not intended for sale,exchange, lease,or rent.OAR 479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $ t 1 Signature: Over 600 amps or 1,000 volts.see services or feeders section above I CONTRACTOR INSTALLATION Branch circuits: new,alteration,extension per panel Business name: C,J 6i' �72(G .a.Fee for branch circuits with purchase of a service or feeder fee: ! Address: p•o . 6o x (/ / 3j ` Each blanch circuit $ 6.50 $ City: w� ,(�.., State:©- ZIP:976/941) b.Fee for branch circuits withota purchase of a service or feeder fee: I Phonesc((-(od d `cr5 6 Fax: - - First branch circuit(2) $ 60.50 $ 1 E-mail: Each additional branch circuit $ 6.50 $ CCB license no.: 5 7 yg BCD license no 20-ze G Miscellaneous fees:service or feeder not included Signing supervisor's license no.: 3 , of 3 S Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: 77) p y k0 ri-( Each sign or outline lighting(2) $ 69.00 $ {�./pppoA Signal circuit or a hunted-energy panel, Signature of signing supervisor: leis alteration,or extension(2) $ 80.00 s Each additional inspection:(I) $80.00 $ i APPLICANT USE (A) Enter subtotal of above fees I . (Minimum Permit Fee$80.00) $ ( (B)Enter 12%surcharge(.12 x[Al) $ /0°C / i /Z (C)Technology Fee(5%of[AI) $ ! 440-2584-1(4101/2013iCONq TOTAL fees and surcharges(A through C): $ 701(1 3 I ■