HomeMy WebLinkAboutPermit Electrical 2013-10-23 SPRINGFIELD i 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
`�o EGON
Phone: 541-726-3753
'
Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02355
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 10/23/2013 EXPIRES: 04/21/2014
STATUS DATE: 10/23/2013 APPLIED: 10/23/2013
SITE ADDRESS: 2275 9TH ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703261204307 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New Panel Box
OWNER: KLABO BRYAN L&KAREN M Phone Number:
ADDRESS: 2275 9TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Il
Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
4999 Final Electrical Final Electric: When all electrical work is complete.
4210 Service Change
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.
-1 - I. k -- lb---Z-_ /3 •
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth NOTICE:
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the telephone
number for the Oregon Utility Notification . OR IS ABANDONED FOR
Center is 1-s00-332-2344y ANY 180 DAY PERIOD.
•
Springfield Building Permit 10/23/201 10:21:54AM Page 1 of 1
SPRINGFIELD _.. CITY OF SPRINGFIELD
_A. „as_ ' 225 Afth St
"''``ORE GON TRANSACTION RECEIPT Springfield,OR 97477
591-726-3753
811-SPR2013-02355
www springfield-or.gov 2275 9TH ST . permitcenter@springfield-or.gov
RECEIPT NO: 2013002326 RECORD NO: 811-SPR2013.02355 DATE: 10/23/2013
DESCRIPTION M^_ __-. �__ ACCOUNT CODE/TRANS CODE_ ____Y _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
LPAYMENT TYPE ?AYOR • CASHIER:uuRSDR- - COMMENTSr = AMOUNT PAID'. C •--
Cash KLABO BRYAN L& KAREN M 104.13
TOTAL PAID: 104.13
•
•
Electrical Permit Application SPRINGFIELD : - DEOAFerMENTAISE
wimi-wfilew*.zo--ft.:.--7 ,;Itt5w.- :;,-vF:tvitsitit.r:-IfenviscVa,Piragilit-, ,„ ,... ',
geFWOFSPRMGHEMYOREGOWti- ' -
1.....atzaN
:4:::511: -.gintik.s-ALi:atttat,[4:14: :::4122-:-.:4nytv:th;oe.ir:Ai 77-,- 4% ts. Permit no: fj 2-e'13 o?3S5
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753*FAX(541)726-3689
Date: (c/a ;//—>
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.
=,:-L:',;';',g.AIEOCALI:OOVERNMENTiAPPROVAIZ;W:, ,t '',..'.:;..;:;Mg;i5:41:leatTT.E E it:5 C FIEDULEgeakSfAni.:0:[1
Zoning approval verified? 2 Yes 2 No
'C::.!q6I574.31PAT E 60 ROO EaC 0 N ST R U C T I CifeigtM --:-,Nrtci.mgr?fo:>”n:Vs,P Ee(-A-e,lt":l1ieo•Mniititwa 9''r'.z4ir4s:%Coe4,e:'Vk'' -.-io-rP,t-
. . 79!1 ; cn nt,'-,3t,
Residential,per unit,service included:
itesidential EI Government D Commercial
1,000 sq.ft.or less(4) $147.50 $
1::-.1;:ktJ 083:IS ITE1 N E 0 Et MAT I 0 WAN 62;10 CAT:IOW-11/4M
Each additional 500 sq. .or portion
Job site address: 2 27S 1-1.-4 5 t4 thereof ft - $ 27.50 $
City:spg id State:D12, ZIP:9/Li-r7 Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular
WW,DESCRIPTION'TVE-:VORK :.;g4tP:U.Z% dwelling service or feeder(2) $ 69.00 $
Services or feeders: installation, alteration, relocation
Al E vs( e es 14 a Z-- S o )1,
200 amps or less(2) 1 $ 89.00 $
WMPRitli:Mag,g R 0 R E RTao w N ERrt-051:34n9aN 201 to 400 amps(2) $ 104.50 $
Name: (312.1A A.( KLA bo 401 to 600 amps(2) $174.00 $
Address: 2_2:7 S- 94 4 5 1 601 to 1,000 amps(2) $225.50 $
City: Spild State:be_ ZIP: 9-7g 7 7 Over 1,000 amps or volts(2) $516.00 $
Phone:51a -7Z- Vb/-Z Fax: - - Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
amps or less(2)
This installation is being made on residential or farm property 200 amp $ 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.: 7_ C4A KAk ) Over 600 amps or 1,000 volts,see services or feeders section above
k:Naceldb NI; '•' ji NsME LAT I 0 N 4;!C1KVAI:-CO Branch circuits:new alteration, extension per panel
Business name: a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit $ 6.50 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: BCD license no : Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $
Signal circuit or a limited-energy panel, •
,
Signature of signing supervisor: $ 80.00 s
alteration,or extension(2)
Each additional inspection:(I) $80.00 $
trataci707t1-1C/11■1TfAig tiarfalfaSi
(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): irrt4°-
440-2584-1(4/01/2013/C0M)