HomeMy WebLinkAboutPermit Electrical 2013-8-26 •
SPRINGFIELD 225 Fifth St
' CITY OF SPRINGFIELD Springfield,OR 97477
i a'' r `i Phone: 541-726-3753
OREGON Building I.Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01913
• www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 08/26/2013 EXPIRES: 02/21/2014
STATUS DATE: 08/26/2013 APPLIED: 08/26/2013
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SITE ADDRESS: 4455 CAMELLIA ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702323404415 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: DHP and Outlet • .
OWNER: LEWIS WANDA A Phone Number:
ADDRESS: 4455 CAMELLIA ST
SPRINGFIELD OR 97478
OWNER: WOODRING KEITH A SR Phone Number:
ADDRESS: 4455 CAMELLIA ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION Il
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor HARDING ELECTRIC INC CCB 132089 02/01/2014 541-688-5006
INSPECTIONS REQUIRED i
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
constru 'on.
Il 4
" ' AL- 1.r A '
or Contractor Signature
i Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE:
Notification Center. Those rules are set
in OAR 952-01 0010 through OAR 952-001- PERMIT WORK
AU HORI ED UNDER HISRPERMIT�IS NOT
- 0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the teleph(;r n
. number for the Oregon Utility Notification t,aY 180 DAY PERIOD.
Canter is 1-800-332-2344).
Springfield Building Permit 8/26/2013 1:42:28PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
:It*. - 225 Fifth St
_....L2saisii
let TRANSACTION RECEIPT Spnngfteld,OR97477
'— OREGON 541-726-3753
811-SPR2013-01913
www.spnngfield-or gov 4455 CAMELLIA ST permitcenter@spnngfeld-or.gov
RECEIPT NO: 2013001875 RECORD NO:811-SPR2013-01913 DATE:08/26/2013
1e1*.,it:llAtpfm7ti ='e i ?_.. _ 1 4.1 ..° . ACCOUNTCODE/TRANSiCODE-:—.j-?
. ki-i`-AMOUNT.DUE.'#s
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00
. Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50
Branch circuits without service or feeder-each additional 224-00000-426102 1004 6.50
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: 9160
WP/1YMENT*TYPEY, '#P.AY CA 1- ER JLnRrSON ,eCOMMENTS°r a _ AMOUNTIPAIP l
Credit Card HARDING ELECTRIC INC 93.60
02746D
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENTIUSE ONLY
SPNINGGIELO ��vnrct i ' '` y `
fiteq (-:,;:e;Sro"" yys ..a::tr -, r� ,F s"` a-:..tra*g:cfrt e.. X,"'a..
• CITY OF4;SPRI�TGI1 #D;OR,EGB1,, Permit no.: 8H&2 (3 6/9/3
225 Fifth Street♦Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 t.� , 072.72/4.3
. Date:
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.
` rIOCALY,GOV,ERNMENT°'APPROVAIS �'�'j _; "" °'
..t � ,. s �,4x�tES. �.'�.�F„EE<:SCHEDULE ,`,t�I°''”""t .A
Zoning approval ❑ Yes ❑No � `Ceoa st g�,,ti T
otsat i Rn , e i i Qtyi. z � 7
CATEGORYIOF,;;CONSTRUCTION r .. es detal peruni[,servicencluded�
esidential ❑ Government ❑Commercial
A' JOBaSITEaINF-.ORM ATION�AND4LOCATIONM t 1,000 sq. fr. or less(4) $147.50 $
Job site address: 27 4/55 CA_in cl-t h(_ 5{- — Each additional 500 sq.ft.or portion $ 27.50 $
hereof
City:5t'7JQj.Fc atL' State: Dit, ZIP: Limited energy(2) $ 35.00 $
Reference JJ Taxlot.: Each manufactured home or modular $ 69.00 $
ljD ESC RIPTION OFNORK;` .1 ;iq „?I a' vt";;1 dwelling service or feeder(2)
NW/ Turf 165 5 /'I - , Services or feeders: installation, alteration, relocation
¢.J�! l.� 200 amps or less(2) $ 89.00 $
W<< ' s, ,M TpROPERTYQNIINER ? ? ssi-=a, 201 to 400 amps(2) $ 104.50 $
Name: 14 cs'fh Woo cLr i4(. _ 401 to 600 amps(2) $174.00 $
Address: J 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: Fax: Reconnect only(2) $ 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
479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
'- 'a ICON,T,RACT,ORiINSTAL-L'-ATile v Yatn4- ;i- Branch circuits:new alteration,extension per panel
Business name: 'Warn cct-ri c- a.Fee for branch circuits with purchase of a service or feeder fee:
Address: at0 1 Bo 4.20 4.20 j Each branch circuit $ 6.50 $
City: .1 Cr Fjr)6 State: 07 ZIP: 9'74/o,j b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:�N1-1/43 Fax: - - First branch circuit(2) 47 $ 60.50 $
E-mail: TnclO 62 rdinj 54 EGt I.(- • Li Each additional branch circuit / $ 6.50 $
CCB license no.: 13, 0 9 T BCD license no.:_7Q—4137 -Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: ._K79-95 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: _ram e.. g QILt'o Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: Signal circuit or a limited-energy panel
g g p / 1 • $ 80 00 $
d alteration or extension(2)
Each additional inspection:(1) S80.00 $
"g . rtitA P.PLICA1VTt+USEM " ;, r aiNtl
(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): $77@-9--
440-2584-1(4/0120i3/COM)