HomeMy WebLinkAboutPermit Electrical 2013-8-27 •
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SPRINGFIELD - 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
.te .H) Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01921
www.springfeld-or.gov permitcenter @springfield-or.gav
PROJECT STATUS: Issued ISSUED: 08/27/2013 EXPIRES: 02/22/2014
STATUS DATE: 08/27/2013 APPLIED: 08/27/2013
SITE ADDRESS: 1249 PARKER ST,Springfield,OR 97477 SCOPE: Electrical Only
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ASSESOR'S PARCEL NO: 1703264416600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service Change -
OWNER: BAILEY BARBARA L Phone Number:
ADDRESS: 4226 SCOTTDALE ST
EUGENE OR 97404
CONTRACTOR INFORMATION •
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor MY ELECTRICIAN INC CCB 87506 11/20/2013 .541-729-1454
L. INSPECTIONS REQUIRED
Inspections
4210 Service Change
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.
US-3-0-1 0- ki "3-1/4-1".:c/A oicTi
Owner or Contractor Signature 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 forth THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the teleph.1sc. COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
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Springfield Building Permit 8/27/2013 8:31:17AM Page 1 of 1
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, SPRINGFIELD CITY OF SPRINGFIELD
".a °y: 225 Fifth St
TRANSACTION RECEIPT Springfeld,OR 97477
541-726-3753
OREGON 811-SPR2013-01921
www.spnngfield-or.gov 1249 PARKER ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001880 RECORD NO:811-SPR2013-01921 DATE:08/27/2013
DESCRIPTION :{,r-skein 4(F °, -F- --.cs ii* At ACCOUNThCODE/TRANS CODE iCZu'IAMOUNTTDUE_j1
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
�,,xv._._F.-,-- �,.�. .-.,. „�,.'°'�" ," AMOUNTdPAID: Y •PAYMENTivTeYPE: - <�PAYOR �ticASNiEIt:,:ILARSON ii:..�" ��••.� �.� � .�� � - ..� -. -. - . �., ?'�,'.;'f.
.tr�?s._,MCOMMENTS m.�i..x sdri�:�i. ?�'-1:.
Check MY ELECTRICIAN INC 104.13
3949
TOTAL PAID: 104.13
Electrical Permit Application DEPARTMENTUSE ONLY
SPFINGPIELO w
gCITYYOF SPRLNGFI ED GREG-6N. Permit no.: �n- p
r :Y..7. r ,..==' +-41.1:.s. i:riiE7144:ftilklr.3^.'ts�y W':AC Acs r�4v°.. r t( ZO 13 U' ( l Z.1
225 Fifth Street•Springfield,OR 97477.1:T(541)726-3753e FAX(541)726-3689
Date: m/Z 7 / ( 3
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.
41f0CAL GOVERNMENT;APP.ROVAGYO 5 `",, r > }`
.J "vxlk JF�'hEx`�`�c,k'#�.FEE,:SCHEpULE,x ; t: g i ..."^ .v=
Zoning approval verified? :5 ,A ""`,I .s- 7�.4'"s t s n+Cost :Total
Zoning pp El ❑No iNumberrof inspections perntem Off' Qty %yea .7 }-_e'cik c'.
CATEGORYIIOF,„CONSTRUCT;ION ,w? ; Mello; " "' '
a
-" Residential, per unit,service included:
❑Residential ❑Government ❑ Commercial yu 1,000 sq.ft.or less(4) $147.50 $
JOB`;SITE,:INFORMATION AND OCAT10/0 ,5,;_.
Each additional 500 sq.ft.or portion
Job site address: /24 cl rGnKalt ...9 thereof - $ 27.50 $
City:Sp+tc\ I State: 02 I ZIP: 9 74 77 Limited energy(2) $ 35.00 $
Reference: I Taxlot.: Each manufactured home or modular $ 69.00 $
,"1. , �n ,, 1D ESC RIP.TION 40 Fr,WORK'; tr Vsz"wssfiN; dwelling service or feeder(2) -
,54-11 V-i-e. C-\N Services or feeders: installation, alteration, relocation
v 200 amps or less(2) I $ 89.00 $
;Hi'g <.,` h.5 i] ', =PROP„ERTY.rIQWNER+;,:;';; ;n.".+ .�,t;hrW.^4.Y 201 to 400 amps(2) $ 104.50 $
Name: ac-No 0,_ •f $ 401 to 600 amps(2) $174.00 $
Address: q(.p G ,.3 A, i • 601 to 1,000 amps(2) $225.50 $
City: C -V - State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: I 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
479.540(1)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
n WhaCONlirnc OR,?INSTAIEI ATION x i3'.'hy?'-!ter al Branch circuits: new alteration, extension per panel
Business name: My &eE r"I '�O"\ l tit C- a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 3 air)000% 16 K e (_f.4.Q 'f Each branch circuit $ 6.50 $
City: O State: ' ( ZIP: 1r 74 a y b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:91I-7- c q Fax: - - First branch circuit(2) $ 60.50 $
E-mail: My pied yy c o.0{ NL P. q0 ..Q , Co vA Each additional branch circuit $ 6.50 $
CCB license no.: ?7 S-0 I Q 6 BCD licensYno.: a 0—7.37c... Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 31(a 3 5 Each pump or irrigation circle(2) $ 69.00 $
//1 a Each sign or outline lighting(2) $ 69.00 $
Print name of signing supervisor: _ 0uys12 n Ci-k is
Signature of signing supervisor: $ — – g, _`�� �� ” Signal
ationcui extens of(d-energy panel, $ 80.00 $
Each additional inspection:(1) $80.00 $
tax P akallICANE USE - N
(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): $ /r0 Y-11---
440-2584-1(4/01/2013/COM)