HomeMy WebLinkAboutPermit Electrical 2013-10-30 •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
-C, Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02416
www.springfield-or.gov perrnitcenter@spdngfield-or.gov
PROJECT STATUS: Issued ISSUED: 10/30/2013 EXPIRES: 04/28/2014
STATUS DATE: 10/30/2013 APPLIED: 10/30/2013
SITE ADDRESS: 743 67TH ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702341103111 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Panel change
OWNER: CARPENTER GARY L&LAURA B - Phone Number:
ADDRESS: 743 67TH ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
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.
4 o� /6/. 1//3
Owner or C tractor Si ature Date
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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 COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification
Center is 1-800-332-2344). - ANY 180 DAY PERIOD.
Springfield Building Permit - 10/30/201 3:42:48PM Page 1 of 1
SPRINGFIELD - CITY OF SPRINGFIELD
225 Fifth St
,,yy TRANSACTION RECEIPT Sp dngfield,OR 97477
` � 541-726-3753
OREGON 811-SPR2013-02416
www.springfield-or.gov 743 67TH ST permitcenter @springfield-or.gov
• RECEIPT NO: 2013002389 RECORD NO:811SPR2013-02416 DATE: 10/30/2013
/ACCOUNT CODE/TRANSiCODE ial -tIt AMOUNTiUUE
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
lirPAYMENTraY. ZL'' PAYOR cnswea:i4 nasoN ,, <.)g_;:`'COMMENTS'e.g.!Vt 1" 1. "AMOUNT PAID
Credit Card CARPENTER GARY L& LAURA B 104.13
055126
TOTAL PAID: 104.13
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Electrical Permit Application ,:. DEPARTMENT,USE'ONLY `:::'.:SPRINGFIELD
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' kerfiVORSPRINGFIELWOREC-ON ! 4-$-=
Permit no g(t Lot', 0.2-L(
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225 Fifth Street•Springtield,OR 97477•1311(541)726-3753•FAX(541)726-3689
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.
.,i,:;c21;fiNtidiE()CALcIG ov,E RN m E N tiAp pRoVALlttVgA?,t 'r;:-AlattritilainIEEESQIIIEDUlitleAki4titAVN
Zoning approval verified? 0 Yes 0 No r,iAciP.;:iff-PMCIteattS;23g6i9lb01;xvr'0.- 4,0;CaliV;41iToti-R2
cebumberot.inspectaps- temfiNg 9.31., iotnre-arettil.:4.----ciiii
.0.1;C:ATEGtiRY.10ECONSTRUCTION:76-14-tikti, ''''s- '''‘i;.- ''-'' --"'"'''' ft--""'4•L'''..-' "F. "11 'nr'''''''cSI r'`''
Residential,per unit,service included:
0 Residential - 0 Government 0 Commercial
1,000 sq. ft. or less(4) $147.50 $
r:tk.iri:1/1fi7J 0 Brs ITE:a I N E 0 R MAT ION'ciAN D';' LOC AT 10 N',W',.:;W
Each additional 500 sq.ft.or portion
Job site address: ?it 6 P st,-ce7 thereof - $ 27.50 $
CitY,Sprtitirile-/ State:Z.)g_ ZIP: (729 75- Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular
dwelling service or feeder(2) $ 69.00 $
Vg52:geliDESCRIENIOWIOFSANORKWM,:i,:'9.. .r.;:.
Services or feeders: installation, alteration, relocation
fe14.re Se r aite g*Ile/
200 amps or less(2) $ 89.00 $
Ri:MitZZIMPSAPRoRERTIVQWNERin:: ::-,W1;-,.;:PW 201 to 400 amps(2) $ 104.50 $
401 to 600 amps(2) $174.00 $
Name: Clot. L Ccvrer,ir,.\ e..--
601 to 1,000 amps(2) $225.50 $
Address: 7 1-)3 7
c„7 i 1 sr
CitY:Sr i id■cl r i<A ti State: eg e ZIP: ci W./?3 Over 1,000 amps or volts(2) $516.00 $
Phone* -7X- 992,'j Fax: - - Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
200 amps or less(2)
This installation is being made on residential or farm property ( $ 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: 424,41/ ((e22,e44/7.,c--- Over 600 amps or 1,000 volts,see services or feeders section above
!iNvA,Rie N[CRACTI,ORTtINST VATICIN14:.3:itiPtlit ; 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 nor 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 $
Signature of signing supervisor: Signal circuit or a limited-energy panel,
$ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
914 MaillSTOKTaNTACFSEEMPARMdit*
(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): 5
/o'-//0%—
440-2584-i(4/01/2013/COM)