HomeMy WebLinkAboutPermit Electrical 2014-2-10 SPRINGFIELD 225 Fifth St
41 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-SPR2014-00260
www.springfield-or.gov pe rmitcenter @s pringfield-orgov
PROJECT STATUS: Issued ISSUED: 02/10/2014 EXPIRES: 08/09/2014
STATUS DATE: 02/10/2014 APPLIED: 02/10/2014
SITE ADDRESS: 320 21ST ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: '1703361306700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service mast repair
OWNER: WILKINS PAUL E Phone Number:
ADDRESS: PO BOX 1304
BEND OR 97709
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor MY ELECTRICIAN INC • CCB 87506 11/20/2015 541-729-1454
L 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.
Owner or Contractor Signature Date
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auo.03101 o sa d o!u!aig° l`ew no/, •0600 HIS PERMIT SHALL EXPIRE IF'RIE WORK
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Springfield Building Permit 2/10/2014 11:47:22AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
'; TRANSACTION RECEIPT SpringtieltlpR97477
• OREGON 541-726-3753
• 811-SPR2014-00260
www.springfield-or.gov 320 21ST ST permitcenter @springfield-or.gov
•
RECEIPT NO: 2014000247 RECORD NO: 811-5PR2014-00260 DATE:02/10/2014
(DESCRIPTION' _ _. ACCOUNT CODEITRANS CODE AMOUNT.
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) 021-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
2_.PAYMENT TYPE___,^PAYOR_ CASHIER:&CARPENTER COMMENTS - , AMOUNT PAID '-
Credit Card WILKINS PAUL E 93.60
024452
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT]USE ONLY ",
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225 Fifth Street•Springfield,OR 97477♦PH(41)726-37 3♦FAX(541)726-3689 r7
Date: 'IR R O // '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.
;; t-A;iLOCAL ,GOVERNMENT=,APPROVAL ;• <F , .. «r .3 'a i'll " `y:-.F,EE;SCHEDULE?(°`ta,,WI ' r ,:t
Zoning approval verified? ❑ Yes ❑No
p r OS 0v't Gos ei Toal:d]Vmber of n coo pitem Qty 'ea ost,`
`^ ., _',CATEGORY, OF:.CONSTRUCTION %aSa, Residential,per unit,service included: a - . ;
(.Residential ❑Government ❑ Commercial
?> JOBc SITEJNFORMATIONt AND';LOCATIdN 1,000 sq.ft.or less(4) $147.50 $
9� Each additional 500 sq.ft.or portion
Job site address: 3 9 O a� 5T0 ea- _ thereof - $ 27.50 $
City: *
1 l l e\& State: b 2 ZIP: 17 y» Limited energy(2) $ 35.00 $
Reference: v Taxlot.: Each manufactured home or modular
;',:Wile DESCRIPTION ',QF WORK; ",;;N:44 5 J,r,2.'4; dwelling service or feeder(2) $ 69.00 $
,('i n/1 GS-. Services or feeders: installation, alteration,relocation
(X. ' ' 1 200 amps or less(2) $ 89.00 $
S 4,;;M: ".,t+ ?'PROPERTX'_O NNER :P AC t 3 201 to 400 amps(2) $ 104.50 $
Name: kuka Ut 5 .\K i,\A S 401 to 600 amps(2) $174.00 $
Address: 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 -$
Phonen(=0 gds.-6 Fax: - -
Reconnect only(2) L $ 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
t'`i<1.1, %J CONTRACTOR1 INSTALL'A'TION fi tn,i",! syn Branch circuits:new alteration, extension per panel
Business name: my ?-I cr'C j A/Q / N c c a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 3en i V R I '4 f. A.4 . Each branch circuit $ 6.50 $
City: (� ooe 11„Q State: O ZIP:9 7�aa b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:Syl- % I y ( Fax: - - First branch circuit(2) $ 60.50 $ •
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.:V Spy I BCD license no�:Jr�^t�(�33 Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 3 7 93 D Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: �y - Each sign or outline lighting(2) $ 69.00 $
, .ry
Signature of signing supervisor: I / Signal circuit or a limited-energy panel, $ 80.00 $
o alteration,or extension(2)
Each additional inspection:(I) $80.00 $
��f ' glirnmt APPLICANT;.?,USEh`+'2I'k°:T*"'�`�k•,`s-`'y?�sa
(A) Enter subtotal of above fees $ C)-fr
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $ G W
(C)Technology Fee(5%of[A]) $ Cr
TOTAL fees and surcharges (A through C): $ 97�
440-2584-J(4/01/2013/COM)