HomeMy WebLinkAboutPermit Electrical 2014-2-11 SPRINGFIELD 225 Fifth St
t ' 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-SPR2014-00274
www.springfield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 02/11/2014 EXPIRES: 08/10/2014
STATUS DATE: 02/11/2014 APPLIED: 02/11/2014
SITE ADDRESS: 1953 1ST,Springfield,OR 97477 SCOPE: Electrical Only •
ASSESOR'S PARCEL NO: 1703361203200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service mast repair
OWNER: PETERSON KEITH D Phone Number:
ADDRESS: 1953 1ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
. 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.
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Owner or Contractor Signature Date
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THIS PERMIT SHALL EXPIRE IF THE WORK auoyda!al ayl :al°N) '�alua° ayl bu!!I o
AUTHORIZED UNDER THIS PERMIT IS NOT Aq saw] ayl}o sa!doo u!elgo W no] '0600
COMMENCED OR IS ABANDONED FOR 1.00 Zg6 ayo ybnotyl 01.00 100-Z96>jVO u!
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Springfield Building Permit 2/11/2014 8:13:20AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
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•�- 225 Fifth St
�t " TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
811-SPR2014-00274
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www.springfield-or.gov 1953 I ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000260 RECORD NO:811-SPR2014-00274 DATE:02/11/2014
IDESCRIPTION __,:i __r ._, . . • W a. __._ACCOUNTCODE/TRANSC.ODE ,„ ,1 __ -_,AMOUNT.DUE
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) 821-00000-215004 1099 9.60
Technology fee(5% of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60 •
' _ PAYMENT TYPE:_:PAYOR_ CASHIER�CCARPENTER°J!,, COMMENTS AMOUNT PAID_:,::_:...,!___
Credit Card PETERSON KEITH D 93.60
230159
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENTUSEONLY
y.�.� vx'..`Y SPAINDPIELD .
yFJI 4+V.b.�t� tfr % `=��'�tK,� u i 4°3ah 'tG'X Ssi WITY PRED4OREG`ON- Permit nn.: 5/ 2 7 V
225 Fifth Street Springfield,OR 97477♦PH(o41)726-3753♦FAX(541)726-3689
Date:Z -//- /
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.
,� {wr a tJ .t,^11,�K 3,1F,EE ,SCHEDULEV4 -yrk ht li,r "rg5:1
' �»rLOCAL�„GQV,ERNMENT,�rAPPROVAL : _
Zoning oval verified? ' ”` nq r > ` }P'a` '-'y `r``
g p ❑ Yes ❑No number of mspechon MItem O 1 Qty '`rte ast �`t wick,'
osts. ".
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CATEGORY rOF`CCONSTRUCTION ei° r ` ,a
Residential,per unit,service included:
Residential ❑Government ❑Commercial
,.� 1,000 sq. ft. or less(4) $147.50 $
,,,,i? ;JOBwSITEJNFORMATION AND„L'OCATION; s
Each additional 500 sq.ft.or portion
Job site address: 953 ,/ Sf thereof -. $ 27.50 $
City: S PP q State: O IZ ZIP:9 N77 Limited energy(2) $ 35.00 $
Reference /703 J� 0?��
Taxlot Each manufactured home or modular
a15 -, . a, , s 044 dwelling service or feeder(2) $ 69.00 $
(() �, ;,c„��a"�"-,'aDESCRIP.TION;„,OF,�WORK`; , „-,��� ,. �.
/< e Gt+4.0.0 h S eN vice-- Services or feeders: installation, alteration,relocation
200 amps or less(2) $ 89.00 $
:w����� Jk a4 PRQPERTYOjNNER n . r�� : H uxr
201 to 400 amps(2) $ 104.50 $
Name: / e/-1
PC1ci' Sc�j 401 to 600 amps(2) $174.00 $
Address: 5 r9a`'L 601 to 1,000 amps(2) $225.50 $
City: State: ZIP: Over 1,000 amps or volts(2) $516.00 $
Phone: - - Fax: - - Reconnect only(2) ( $ 69.00 $6 7
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
479.5400)and 479.560(1). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
e "' siic."yCONTRACTOR;INSTAL'LATION., 1'"!'.. ti w [.' Branch circuits:new alteration, extension per panel
Business name: iJ C Wt € ft C• a. Fee for branch circuits with purchase of a service or feeder fee:
Address: '3¶/Stf Jci. t4 Per (Z Each branch circuit $ 6.50 $
City: cPf(d State: G re ZIP: q 7q 7 p p b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:Y'f- 72,9-/Can Fax: `{(.- First branch circuit(2) - $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.:(6(2Y5 I BCD license no.: _ Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 4706, S Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Cam- (.kLQycJ3 Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: )� it j Signal circuit or alimited-energy panel, $ 80.00 $
�- alteration,or extension(2)
Each additional inspection:(I) $80.00 $
s t "aii APPLICANT:E.USE;Sr- i 7 +wfl i"
(A) Enter subtotal of above fees $� Do
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[Al) - - $ 9 62
(C)Technology Fee(5%of[Al) $ U
TOTAL fees and surcharges (A through C): $ 30°
440-2584-1(4/01/2013/C0M) - /