HomeMy WebLinkAboutPermit Electrical 2013-8-19 SPRINGFIELD 225 Fifth St
' CITY OF SPRINGFIELD Springfield,OR 97477
" fi Y`a Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01851
www.springfield-or.gov permitcenter @spnngfield-or.gov
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PROJECT STATUS: Issued ISSUED: 08/19/2013 EXPIRES: 02/14/2014
STATUS DATE: 08/19/2013 APPLIED: 08/19/2013
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SITE ADDRESS: 792 LAKSONEN LOOP,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702352203000 • TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Reconnect
OWNER: CANIZALES GILBERT F 8 L E Phone Number:
ADDRESS: 456 N 72ND ST
SPRINGFIELD OR 97478
• CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
JEM ELECTRIC INC (C)Electrical Cont 20-527C 07/01/2014 541-746-7174
INSPECTIONS REQUIRED
Inspections
4200 Reconnect Service
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 -II required inspections are requested at the proper time, that each address is readable from the street, that the
permit card is ocated 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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. ALL S R-13
Owner o •ntr-ctor .ignature Date
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ATTENTION: Oregon law requires you to
NOTICE: follow rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 Center. Those rules are set 001-
in OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
'.OMMENCED OR IS ABANDONED FOR calling the center. (Note: the teleph:;1'J
1 RQ DAY PERIOD. number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 8/19/2013 3:55:10PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
TRANSACTION RECEIPT 825 Fifth dtOR 97477
OREGON 541-726-3753
811-SPR2013-01851
www.spnngfeld-or.gov 792 LAKSONEN LOOP permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001801 RECORD NO:811-SPR2013.01851 DATE:08/19/2013
181 "bl-11Adto1 3
E�`i;,. m fa&5; v... . a- ,4CCOUNTiCODEIfRANS CODE rai4r�t��.. -AMOUNT PMWEN
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
l., . .-,� -. w aE.�r. � 1S1 wa i e AMOU P D.=
c-�'PAVMENTTYPE a-R�PAYOR:�casNlsR:'.liaresoN �a.�,t ,>'?.-,.'COMMENTS,..�:F,,-„ _.�.s=�r„�€�'-" __.-.
Credit Card JEM ELECTRIC INC 93.60.
367423
TOTAL PAID: 93.60
Electrical Permit Application OEPARTMENr USE ONLY '.:
p, SPFINGFlELO
CIT;Y;,OKSPRINGl+1'L+'LD; bRE'GON `e RI 2913 c�[ t�C
4tk 4,441. :7:x4 �5. ,�...vz• ,tla, -srrc_ '4iit`:*-A6 - 1. 1`'- Penn k
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225 Fifth S[reet•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: g//ph—s
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.
Vg:01414,1WOCALCGOVERNMENTAP,PROVAL:i:` ;ari„ ;, ,i Yr'};,..=5,-_ ,F„EE 5CHEDULEkaaltls”
Zoning approval verified? ❑ Yes ❑No Number otmspecttons perntem)' Q y. tiifCostf+' Tota13l
" sf.r,CATEGORY n0F, ,CONSTRUCTION vac 4 ?[ * , ,.. - ..x*.ea c._ cost
"[�"'' "" ' '' "` Residential, per unit,service included:
❑Residential ❑Government ❑Commercial 1,000 sq.ft. or less(4) $147.50 $
src' JOBSITE:INFORMATION',AND,iLOCATION`1.11 ?i.
+� / / Each additional 500 sq.ft.or portion $ 27.50 $
Job site address: ttl laizOfleJ. C..009 thereof -
City: I&, State: or ZIP: g7--/70 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $
.11141F4,WIIMIDESC RIPTION IDF'. °RicAsimuutv4 dwelling service or feeder(2) .
^ i/�/� Services or feeders: installation, alteration, relocation
200 amps or less(2) $ 89.00 $
if.i.1"iw� ;^.g : e ,� + : s,k..Y 201 to 400 amps(2) $ 104.50 $
#s�l� a�,+r�:t;�i,� 's r:P..ROPERTY.FOWNER :. - ''� .;:.w_irt*;ai.
Name: cot I Xi� Cat-,/L4 f,/�� / 401 to 600 amps(2) $174.00 $
Address: L/ S6 4/ 77 rer 5> 601 to 1,000 amps(2) $225.50 $
City: 5'p' /` State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: - - - Fax: - - Reconnect only(2) I $ 69.00 $
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
479.540(1) and 479.5600). 401 to 600 amps(2) $138.50 $
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Signature: Over 600 amps or 1,000 volts,see services or feeders section above
ll. ..11 t,}ir°t CONTRACT,ORE INSTALLATION t i,*'y t; `"z+ry;,",i Branch circuits:new alteration, extension per panel
Business name:, J 1✓ El,«ix,s-C, a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 3%s5 J RL Each branch circuit $ 6.50 $
City: `" AA State: or ZIP: 9 7c-/78) b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:`J- /727-1074 Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: /6/23 3— BCD license no.: aU-5 7 C Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Each 5 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: e. Gt,(e y-(2.7. Each sign or outline lighting(2) $ 69.00 $
Signal circuit or a limited-energy panel,
Signature of signing supervisor: j �� alteration,or extension(2) $ 80.00 $
Each additional inspection:(I) $80.00 $
s+ irf, MaTAPPLICA6li USE ' al"`q MIta
(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): $ , 6 D
440-2584-1(4/01/2013/COM)