HomeMy WebLinkAboutPermit Electrical 2013-11-19 SPRINGFIELD- 225 Fifth St
CITY OF SPRINGFIELD Springfeld,OR 97477
(`tom'- Phone: 541-726-3753
` OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02537
www.springtield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 11/19/2013 EXPIRES: 05/18/2014
STATUS DATE: 11/19/2013 APPLIED: 11/19/2013
SITE ADDRESS: 1304 1ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703362202600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: 200 amp svc
OWNER: COLEMAN DANIEL G 8 SUSAN L Phone Number:
ADDRESS: 2959 UMPQUA HWY 99
DRAIN OR 97435
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor EVERYDAY ELECTRICAL SERVICE INC CCB 136371 08/12/2015 541-912-2957
INSPECTIONS REQUIRED
Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
4999 Final Electrical Final Electric: When all electrical work is complete.
4225 Service or Feeder
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.
Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE:
Notification Center. Those rules are set forth
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 ANY 180 DAY PERIOD.
Center is 1-800-332-2344). 0L✓
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Springfield Building Permit 11/19/201 12:38:22PM Page 1 of 1
Electrical Permit Application sPa„sir�,. ._,_- DEPARTMENT USE ONLY
CITY OF;SPRINGFIELDOREGON ,' t-;a."'° e Pert;tno.; glt z,�13 02s�7
225 Fifth Street*Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689
Date: /i//y//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 `iy'4'7 '.FEESCHEDULE 5 -
Zoning approval verified? ❑ Yes ❑No ,Number ofinspectioris per item-() .- Qty. ' Cost : Total-
ea. cost
CATEGORY:OF :CONSTRUCTION Residential,per unit,service included:
❑ Residential ❑Government ❑Commercial 1,000 sq. ft, or less(4) $134.00 $
r ;JOB;SITE. INFORMATIONAND'LOCATION Each additional 500 sq. ft. or portion
Job site address: / 3 dam/ L 5i- thereof $ 25.00 $
City: G pF/d' State: U C ZIP: Limited energy(2) . $ 32.00 $
Reference: Taxlot.: Each manufactured home or modular $ 63.00 $
DESCRIPTION. OF WORK `' dwelling service or feeder(2)
Services or feeders: installation, alteration,relocation
7 o o a S'vG 200 amps or less(2) / $ 81.00 $
• PROPERTY OWNER ; 201 to 400 amps(2) $ 95.00 $
Name: / Co�Crne q 401 to 600 amps(2) $158.00 $
�a =e q
Address: H�y If
601 to 1,000 amps(2) $205.00 $
2�s9 � �f��ti
Ci State: ZIP: Over 1,000 amps or volts(2) $469.00 S
Reconnect only(2) $ 63.00 $
Phone: - - Fax: - -
Temporary services or feeders: installation, alteration, relocation
E-mail:
This installation is being made on residential or farm property 200 amps or less(2) $ 63.00 $
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.5400)and 479.560(1). 401 to 600 amps(2) $126.00 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:new, alteration, extension per panel
Business name: Del 5l'e {1 C� a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Z�t{01 L ` gg P/a (..Q_ Each branch circuit $ 6.00 $
City: J V/,J�'t-0•n Cf(y State: OR_ ZIP:911/1/g b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:St([-chi �1 / Fax: - - First branch circuit(2) $ 55.00 $
E-mail: 7u�1 G=o^� -� Goy--s Each additional branch circuit $ 6.00 $
CCB license no.:j /701/ BCD license no.: 2-o—d/2f/C. Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Z/Qc 5 ^ + —iii Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: Wc,P:,t L. N JOY\ 3_ Each sign or outline lighting(2) $ 63.00 $
�j� / Signal circuit or a limited-energy panel, $ 63.00 $
Signature of signing supervisor: A/ A alteration,or extension(2)
I Each additional inspection: (I) $58.00 $
,, r"7 4- fry; i4,. ,r ,APPLICANT:USE
(A) Enter subtotal of above fees - $
(Minimum Permit Fee$58.00)
• (B)Enter 12%surcharge(.12 x[A]) $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): S/ot/ /77'
440-2584-J(9/08/COM)
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, SPRINGFIELD CITY OF SPRINGFIELD
It 225 Fifth St
TRANSACTION RECEIPT springfield,OR 97477
- ;T:C\C04-1 itEGON 541-726-3753
811-SPR2013-02537
www springheld-or gov 1304 I ST perrnitcenter@springtield-or.gov
RECEIPT NO: 2013002529 RECORD NO: 811-SPR2013-02537 DATE: 11/19/2013
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DESCRIPTION ACCOUNT OODE/TRANS CODE - 7; , ---_AMOUNT DUE ' I
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
L PAYMENTTYRE ,_ _ _PAYOR .CA61-1IER:JLARSON , _ COMMENTS . __•__ - _,AlylouNT PAID:__
Credit Card EVERYDAY ELECTRICAL SERVICE II 104.13
424724
TOTAL PAID: 104.13
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