HomeMy WebLinkAboutPermit Electrical 2013-9-18 SPRINGFIELD •
k l 225 Fifth St
C ITY OF SPRINGFIELD Springfeld,OR 97477
' .i Phone: 541-726-3753
* OREGON Building / Residential Permit Inspection Phone: 541-726-3769 •
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02098
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/18/2013 EXPIRES: 03/17/2014
•
STATUS DATE: 09/18/2013 APPLIED: 09/18/2013
SITE ADDRESS: 2449 15TH ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703243301700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Single Circuit for DHP
OWNER: EMIL R KLYM TRUST Phone Number:
•
ADDRESS: 2449 15TH ST ,
SPRINGFIELD OR 97477
OWNER: RITA M KLYM TRUST Phone Number:
•
ADDRESS: 2449 15TH ST
SPRINGFIELD OR 97477
F CONTRACTOR INFORMATION 1
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JEM ELECTRIC INC CCB 161235 09/07/2014 541-729-1074
INSPECTIONS REQUIRED
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 .11 required inspections are requested at the proper time, that each address is readable from the street, that the
permit card i- ocated at the front of the property, and the approved set of plans will remain on the site at all times during
constructiol/
•
A srsIa I&A�._ _ -
r
Ow - Cow •. 'ature Date
ATT■ ON: 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
0090.OAR You m0 obtain through s OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 9/18/2013 9:56:28AM Page 1.of 1
SPRINGFIELD - CITY OF SPRINGFIELD
225 Fifth St
ivitt
-.. TRANSACTION RECEIPT Spnngfeld,OR97477
1iO RREGON 541-726-3753
811-SPR2013-02098
www.spnngfeldor.gov 2449 15TH ST permitcenter @spnngneld-or.gov
RECEIPT NO: 2013002057 RECORD NO:811-SPR2013.02098 DATE:09/18/2013
l� .thtinaftQZs ti, _-t. ttv =;°.S,: u. °`.ACCOUNTCODE/TRANSCODE :. 'f-51 'r:.'AMOUNTADUE
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 19.50
Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50
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: 93.60
�yu-AYM _•rte.. ,y n . .,.,MENT . q � i AMOUNT PA I
�:;a',PAXMENT.�STYPE P.AVOR�casNlER:,.ILnRSORkr�'�. COMMENTS' ,+�.� .k....(Da��3%° �
Credit Card JEM ELECTRIC INC ' 93.60
686504
TOTAL PAID: 93.60
•
•
•
Electrical Permit Application DEPARTMENT USE ONLY
RITE OF SPRINGFIELD OREGQN SPRINGFIELD
_I , '
< . . : �, x -- Permit no ca! 1 20(3 07�10
. ''j
225 Filth Street Spimgrield,012)7477*1'11(5411726-3753♦FAY(54I)726-3689 -\ OREGON
Date: 9// re/ 3
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
clays 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
- I I ( Q > ea. cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
❑ Residential ❑Government ❑Commercial
JOB SITE INFORMATION AND LOCATION MOO so. U.or less(4) $147.50 $
�q� C /I-
Each addilinnnl 51)0 sq. 11.or portion
Job site address: 7 / 5 J ' - thereof $ 27.50 5
City: tS')fc! State: pr ZIP: 97W77 Limited energy(2) S 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 5
DESCRIPTION OF WORK
dwelling service or feeder(2)
K U O Gt A L e LA.A.:4— Services or feeders: installations alteration.relocation
200 amps or Ices(2) Sr 89.00 $
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name: 401 to 600 amps(2) $174.00 $
/4 - /y� h r e-5 f. ______ ---- _
Address: zti get, / GUI to 1,000 amps(2) 5225.50 S
City: 5 /1 State: 0e, ZIP: Over 1.000 mops 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) 5 69.00 $
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 S
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 $
Signature: Over 60(I amps or 1.000 volts.see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new alteration.extension per panel
Business name: _MA( S(_e c. - a. Fee for branch circuits with purchase ofa service or ceder I6c:
Address: arcffil Ji, pa, Each brun:h cuuut I I. 5 6.50 L$
City: , r( State:Or ZIP: t 7"[7 b. Fee for branch circuits without purchase ola or feeder fee:
Phone: - - Fax: - - First branch circuit(2) I 5 60.50 5
E-mail: --- Each additional branch circuit $ 6.50 $
CCB license no.: /4/9.3% BCD license no.: go-59,70 tMiscellaneous fees:service or feeder not included
Signing supervisor's license no.: ooeo 5 Each pump or irrigation circle(2) $ 69.00 .$
Print name of signing supervisor: cst LAe cxJ Each sign or outline lighting(2) $ 69,00 $
Signature of signing supervisor: Signal circuit or a limited-merge panel. $ 80.00 $
I Each add or extension
inspection:ti
Each additional inspecting(I) $80.00 $
_ APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
(l3) Enter 12%surcharge(.12 x[A]) $
(Cl Technology Fee(5%of[A]) $
.140-2584-1(4/012013/CO\.p TOTAL fees and surcharges(A through C): $ 7-3(2)