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HomeMy WebLinkAboutPermit Electrical 2014-1-9 SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 C Las '5 Phone: 541-726-3753 ,OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00040 www.springfield-or.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 01/09/2014 EXPIRES: 07/08/2014 STATUS DATE: 01/09/2014 APPLIED: 01/09/2014 SITE ADDRESS: 419 25TH ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703361417900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace 200A service OWNER: CHALMERS DOROTHY R Phone Number: ADDRESS: 419 25TH ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor STEVEN R GEISLER CCB 95472 11/23/2014 541-726-0618 INSPECTIONS REQUIRED Inspections 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. nronon law requires you to u;rry AtICS t ndbytnevicy' '' — Owner rCon/ractoRSignature Date but�. Notification Center. Those rules BAR 952-001 NOTICE: in OAR 952-001-o0bt in through of the rules by THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may THIS calling the center. (Note: the telephone number for the Oregon Utility Notification AUTHORIZED DOOR IS ABANDONED FOR N PERMIT IS Center is 1-800 332-2344)• ANY 180 DAY PERIOD. Springfield Building Permit 1/9/2014 8:24:05AM Page 1 of 1 . • SPRINGFIELD-aaskr CITY OF SPRINGFIELD NIThcf.4. ...‘ ' TRANSACTION RECEIPT Spnngfie 1410R 97477 OREGON - 811-SPR2014-00040 541-726-3753 www 3pm-19961d-or gov 419 25TH ST perrnitcenter@spnngfield-or gov RECEIPT NO: 2014000035 RECORD NO:811-SPR2014-00040 DATE:01/09/2014 [ptstmixrititiT:-- --:,.17, - ,-- 7c. 17•;,,,")"4-,,,,. ' IC , .ThodainifebbEnTRAia delbE-7 .,- .-Amouiit DIE.71. 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 LPAYMENTJYPE `PAYOR' ,;CASHIER:CCARPENTER :, -, COMMENTS -. k. '-. . AMOUNT PAID ' -- Credit Card STEVEN R GEISLER 104.13 305957 TOTAL PAID: 104.13 Electrical Permit Application DEPARTMENT USE ONLY HPNINGRwf n CITY OF SF RINGFIELD,tQREGON : Permit no.: SK— x(70 a.JW 225 Fifth Street•Springfield,OR 974774 PH(541)726-37534 FAX(541)726-3689 Date: //r-// /7 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 ost cotal CATEGORY OF CONSTRUCTION Residential,per unit,service included: sidential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq. ft.or less(4) $134.00 $ y7 / i C Each additional 500 sq.ft.or portion $ 25.00 $ Job site address: / ,3 thereof City: Sect o I State: 77-2._� ZIP: 7y77 Limited energy(2) _ $ 32.00 $ Reference: /74 3 / I Taxlot.: /75e0 Each manufactured home or modular DESCRIPT ON OF WORK dwelling service or feeder(2) $ 63.00 $ es-79G 26614 c✓� Services or feeders: installation,alteration, relocates{ U /` 200 amps or less(2) $„8x7t0)0_ $ 37 PROPERTY OWNER 201 to 400 amps(2) / $ 95.00 $ c ' Name: C4-0-L t7L.5 401 to 600 amps(2) $158.00 $ Address: 67/f 25'/L 601 to 1,000 amps(2) $205.00 $ City: $P6LQ State: 6/L ZIP:S7 y72 Over 1,000 amps or volts(2) $469.00 $ Phone: - - Fax: - - Reconnect only(2) $ 63.00 $ E-mail: Temporary services or feeders:installation, alteration, relocation This installation is being made on residential or farm property 200 amps or less(2) $ 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: SiL n E.LC12�C-• a.Fee for branch circuits with purchase of a service or feeder fee:. Address:PO 13 OX ,6 6,3 Each branch circuit $ 6.00 $ City: QLC49SftNF 11.)1,1.._ State:- ZIP::97451 b.Fee for branch circuits without purchase of a service or feeder fee: Phone: sly qi a- -%Sc) Fax:5' 74/1-6_0 g-1 R- First branch circuit(2) $ 55.00 $ E-mail: cc G i.E&H RN ) €l) VAS N ; co tin Each additional branch circuit $ 6.00 $ CCB license no.:1'c47 i, BCD license no.: O-373 C. Miscellaneous fees:service or feeder not included Signing supervisor's license no.: i-1-0 cf L}- S Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: I t J "i ce . Each sign or outline lighting(2) $ 63.00 $ Signature of signing supervisor: }}} adi/ Signal circuit or a limited-energy panel, $ 63.00 $ alteration,or extension(2) Each additional inspection:(I) $58.00 $ APPLICANT USE (A) Enter subtotal of above fees cy (Minimum Permit Fee$58.00) $ a / (B)Enter 12%surcharge(.12 x[A]) $ /Ob2: (C)Technology Fee(5%of[A]) $ ye,5- TOTAL fees and surcharges(A through C): $ /611Z-1-- 440-25844(9/08/COM)