HomeMy WebLinkAboutPermit Electrical 2013-10-24 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
,OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02365
www.Springfield-or.gov perrnitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 10/24/2013 EXPIRES: 04/22/2014
STATUS DATE: 10/24/2013 APPLIED: 10/24/2013
SITE ADDRESS: 2156 L ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703254303000 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Reconnect to raise mast
OWNER: GARRETT THOMAS A • Phone Number:
ADDRESS: 2156 L ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor LEABURG ELECTRIC LLC CCB 198057 10/02/2014 541-510-9443
•
INSPECTIONS REQUIRED
Inspections •
4200 Reconnect Service
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.
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Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility IJOTICE:
Notification Center. Those rules are set forth
THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT -
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 10/24/201 9:27:40AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
:-et ..ANN— 225 Fifth SI
' '`OREGON TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
811 SPR2013-02365
www.springfield-or.gov 2156 L ST permilcenter @springfield-or.gov
RECEIPT NO: 2013002338 RECORD NO:811-SPR2013-02365 DATE: 10/24/2013
[DESCRIPTION ACCOUNT CODE/TRANS_CODE . AMOUNT DUE__
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
_ AMOUNT PAID:.. . •I. PAYMENT TYPE �PAYOR,' cAseiER:ccnRPEN7ER'.' -'; ;;COMMENTS .;„ , I
Credit Card Daniel Avalos 93.60
093611
TOTAL PAID: 93.60
•
•
Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD .,1
a" -c3z+°• ,i= "Mrity—n•,�„kx(P}°a - 'o^" Y-t.sp��4. ti>Ti Y" �,+4�.�,
'rCITY OFt SPRINGFIELD OREGONF �' t Pera[t no.: 5/5 -231,5
,a:n.+1 ?Actv,,z� . M,,,. . .c~t ,,:;.., ,.,,n4rr.a i_;3. .`tn`a#k i�
225 Fi fth Street♦Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689 '
Date: /v/ZY//J
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.
ti .,"'tLOCAL:„GOVERNon ENVAPPROVAL_ I ,*;' 4' e,iV,lt •.FEE`SCHEDULE , . , iAW:',
Zoning approval verified? Yes No �r1' i t a 7 `Yap+ tt?, -,7 r 3 VC: 4tCOSt Total
Zoning PP ❑ ❑ _Number of mspecnons O -; Qty -,, ,.,.- 3•v
}1 CATEGORY OF. ,CO,NSTRIJCT.ION k ,�} ° :a , ” ` ..Oc : s_, _o:ea..._ r.cost 4
�`r` Residential,per unit,service included:
esidential I ❑ Government I ❑Commercial
;ta 't JOBt!SITE INFORMATION' AND,.LOCATI ON Wit w"'s 1;000 sq. fr.or less(4) $147 50 $
o Each additional 500 sq.ft.or portion
Job site address: 2/ 6 ,L. 6'/. thereof $ 27.50 $
CitY1Cipa,,J A.e.4( I State:0& I ZIP: 97$"77 Limited energy(2) $ 35.00 $
Reference: I I Taxlot.: Each manufactured home or modular
r dwelling service or feeder 2 $ 69.00 $
a�=^' x ?n*„`xM,,'��DESCRIP�,TIONOFwWORK�, ,r.; �s��y� g (
4/�
, Services or feeders: installation, alteration,relocation
1fr/t fcen-V/Gr- E7v7J21-7>Ve.f-jM n-cr- 200 amps or less(2) $ 89.00 $
.k8 =3. ,:,,„1`µ's iY f'PROPERTf,OWNERr°'+',' , ,- [ pvm 201 to 400 amps(2) $ 104.50 $
Name: �..y__,:' �i_i_- i 1. 401 to 600 amps(2) $174.00 $
Address: 7:7S-6,---2.4_0, L c( 601 to 1,000 amps(2) $225.50 $
City: S e f LO I State:(id.--1 ZIP: 974172 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
?,.,'th c2 " .CON RACTORr 1NSTAL`IZATION "# tl n'4yrv+i' Branch circuits:new alteration, extension per panel
Business nam IC ez.. &al 17—/eco? I ✓ a. Fee for branch circuits with purchase of a service or feeder fee:
Address: jell -20y, /4/2a Each branch circuit $ 6.50 $
City:4fr f/tt a t//7/e State: £ ',C ZIP:97 r/i f b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:)64/-S/1' q93 Fax: - - First branch circuit(2) $ 60.50 $
E-mail: �J Each additional branch circuit $ 6.50 $
CCB license no./ 7 12S7 BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 1/7.,t, 5 Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisoDA tel a:, 4 V Ass Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor ✓ 0... ignal teration,circuit or or a limited-energy extension(2) panel, $ 80.00 $
i C¢ al
Each additional inspection:(1) $80.00 $
:" lige? .a``'7'APPLICANTIrUSE Mnel n
(A) Enter subtotal of above fees O
(Minimum Permit Fee$80.00) $ Uv
(B)Enter 12%surcharge(.12 x[A]) $ S tr_
(C)Technology Fee(5%of[A]) $ ov
TOTAL fees and surcharges(A through C): $ 9 ' Q
440-2584-J(4/012013/COM) rrr