HomeMy WebLinkAboutPermit Electrical 2014-2-13 •
SPRINGFIELD 225 Fifth St
` ' CITY OF SPRINGFIELD Springfield,OR 97477
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i Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00321
www.springfield-or.gov permitcenter@sprin gfield-or.gov
PROJECT STATUS: Issued ISSUED: 02/13/2014 EXPIRES: 08/12/2014
STATUS DATE: 02/13/2014 APPLIED: 02/13/2014
SITE ADDRESS: 2500 CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703254400103 • TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service mast repair
OWNER: GREEN AUDREY R Phone Number:
ADDRESS: 530 FIGUEROA ST
EUGENE OR 97402
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JEM ELECTRIC INC CCB 161235 09/07/2014 541-729-1074
INSPECTIONS REQUIRED
Inspections
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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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ATTENTION: Oregon law require8 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).
Springfield Building Permit 2/13/2014 9:49:35AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-SPR2014-00321
www.springfield-or.gav 2500 CENTENNIAL BLVD pennitcenter @springfield-ar.gov
RECEIPT NO: 2014000305 RECORD NO: 811-SPR2014-00321 DATE:02/13/2014
(DESCRIPTION • = ACCOUNT CODE/TRANS CODE-.
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 COMMENTS___.„_; .1 AMOUNT PAID
Credit Card JEM ELECTRIC INC 93.60
328967
TOTAL PAID: 93.60
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, Electrical Permit Application DEPA. RTMENT.USE ONLY ' i
e SPNIHGRIELO
aCIT�Y OFFSPRING I LD,OREGONE, °` Permit no.: 5/i/ 43/
225 Fifth Streets•Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689 "` ..
Date: 2//,7// l
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.
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4,' .a.b;'1L`QCALCGOVERNMENTaAPP,ROVAGyh"'r�, agf 4:FEETISCHEDULE,q ,1^tt,,S;;i'Sr i
Zoning approval verified? ❑ Yes ❑ No Number of inspections peirtem]O Qty( ,w;Cost Total ii
;1fit -'CATEGOR1tF,OF,�CONSTRUGTION,.. . , -,, "' ' " ." ea rcost
Residential,per unit,service included:
esidential I ❑Government I ❑Commercial
1,000 sq.ft.or less(4) $147.50 $
JOB;[SITE.JNF.ORMATIOWAND`LOCATICIW;; ,.
� / ( Each additional 500 sq.ft.or portion
Job site address:
05OO (",e _- 'of C• ` thereof $ 27.50 $
City: Sp'L. l State: Or I ZIP:q'7N7 7 Limited energy(2) $ 35.00 $
Reference:/707 r/ ZcZC/ I Taxlo[ 8 f7/O 3 Each manufactured home or modular
''' ti-.NdIDESCRIP1,tION ;OF'WORK"o ?,W,x. ;itt"'"i"= dwelling service or feeder(2) $ 69.00 $
y) Services or feeders: installation,alteration,relocation
(/U(� � K2�(LtcP (,< cr e�
200 amps or less(2) $ 89.00 $
._,-:cl - lifT1 .iFROPERTA QWNER ZZa. `„ ,4r 201 to 400 amps(2) $ 104.50 $
Name: ill CUt / Greet. 401 to 600 amps(2) $174.00 $
Addre 570 4. 672m,4 ,/ 601 to 1,000 amps(2) $225.50 $
City L7A-4 I State: Or I ZIP: '7,5`-0,1, Over 1,000 amps or volt (2) $516.00 $
Reconnect only(2) I $ 69.00 $6�
Phone: - - Fax: - -
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
^1142`,.'fig xCONTRACTOR fdNSTALL'ATION .t tA,.",4 Branch circuits:new alteration, extension per panel
Business name: jai( C(PLM 2C a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 3r8I l L1 , b Each branch circuit $ 6.50 $
City: PG State: C)r ZIP:C'7y 7FS b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.:76,/925— BCD license n0..190—5a7t Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: G/7b& S Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: pt! L�tY2J, Each sign or outline lighting(2) $ 69.00 $
Signal circuit or a limited-energy panel,
Signature of signing supervisor: 6' l (�/�,(. alteration,or extension(2) $ 80.00 $
v / " Each additional inspection:(1) $80.00 $
tigni F ?APPL'ICANTs(USEi,(; ', s taiix ij
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $ 0)
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $ '170
440-2584-1(4/012013/C0M)