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HomeMy WebLinkAboutPermit Electrical 2013-11-20 4PRINGFIELDas• 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 4-1.0REGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02553 www.springfleld-or,gov permitcenter @springfield-or.gov • PROJECT STATUS: Issued ISSUED: 11/20/2013 EXPIRES: 05/19/2014 STATUS DATE: .11/20/2013 APPLIED: 11/20/2013 SITE ADDRESS: 1156 A ST,Springfield,OR 97477 • SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703354100900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Panel • OWNER: RICKELS PATRICK M Phone Number: ADDRESS: 1156 A 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 541-232-7305 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 construuctionn.. GI � / dal Owner or Contractor Signature D e • ATTENTION: Oregon law requires you to NOTICE: SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth THIS PERMIT 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 11/20/201 2:52:19PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Path St TRANSACTION RECEIPT Springfeld,OR97477 .OREGON 541-726-3753 • 811-SPR2013-02553 www.springfield-or.gov 1156 A ST permitcentergspringfeld-or.gov RECEIPT NO: 2013002547 RECORD NO:811SPR2013-02553 DATE: 11/20/2013 ]o1Y0 ilfri D.li�"� '= §'.Oiett;221i_ _ i= s_1 ='-A• ' o i, '' 0 9 iRANS,CODE I-E : s' : o r 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 PAYMENT.TYPE I-3-PAYOR'= CASHrEH ZRSONt > COMMENTS L;g1 :CT -„-AMOUNT PAIDFa, x ,•-_ Credit Card RICKELS PATRICK M 104.13 050150 TOTAL PAID: 104.13 Electrical Permit Application DEPARTMENT USE ONLY LiCI�'4X OF SPRINGFIEEDMIZE. .ON ,t Permit no.:U� l 2m( y 02 5'S� 225 Filth Sheet•Spiin{,field,-Olt 97477H'll( 41)7263753+F X(541)726-3689 • '•' ,OREGON Date: ///zc-12 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. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item ( ) Qty. Cost Total ea. cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION I.000 sq. ft.or less(4) 5147.50 $ ! Each additional 500 sq. ft.or portion 5 27.50 $ doh site address: t,6 �'ot ■ thereof City: Sc x p,5 -01G State: ©\\ ZIP: Cty0— Limited energy(2) $ 35.00 $ Reference: Taxlot.: Each manufactured home or modular 5 69.00 $ DESCRIPTION OF WORK dwelling service m seeder(2) ��1 , �`eC, „v C�` ` Services m feeders: ins(rdlnrior:,ohernlimr.relocaliou \"e /T'p \ GJ`>Ri 200 amps or less(2) / 5 89.00 $ PROPERTY OWNER 201 to 400 amps(2) / 5 104.50 $ a_.-ST c'c v< r�� 3 401 to 600 amps(2) 5174.00 $ Name: 1((p�� ��� ����ll _ Address: k\ (0 )�'y^\, GUI to 1.001)unups-(2) $225.50 S City: C�tiz5�i Stale: Q� ZIP:q { (1v`'' 1.00Iamps or volts(2) $616.00 $ Phonee' .Q-01i ._' -365 Fax: - - Reconnect only(2) 5 69.00 5 �/ ` Temporary services or feeders: insiu!Iafion. r/estaion. Mondian E-mail: ecc".k,(( S\C�� ^fr-v^on X.-CM/1/4- This installation is being made on re. ential 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 499.540(1) 0(I) 401to,600 amps(2) $138.50 $ Signature: �_ �- Over 6011 amps or 1.000 yolis,see services or feeders section above CONTRACTOR INSTALLATION Branch circuits:new alteration. extension per pane! Business name: a. Fee for branch circuits with purchase Of a service or feeder fee: Address: Each branch circuit I I_ $ 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 5 • E-mail; Each additional branch circuit $ 6.50 5 : CCB license no.: I BCD license no.: Miseellnneous fees:service a_feerier 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. s 80.00 $ Signature of signing supervisor: alteration.or CSlension(2) Each additional inspection:(I) $80.00 $ . APPLICANT USE . (A) Enter subtotal of above fees $ (Minimm Permit Fee$80.00) (B) linter 12%surcharge(.12 x[A]) $ (CI Technology Fee(5%of[A]) $ 440-2584-1(4/01/2013/COM) TOTAL fees mid surcliarge.s(A through C): $/Dy •