HomeMy WebLinkAboutPermit Electrical 2014-2-26 •
SPRINGFIELD
225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
io EGO-1 Phone: 541-726-3753
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Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00422
www.springfield-or.gov permitcenterQspringfield-ar.gov
PROJECT STATUS: Issued ISSUED: 02/26/2014 EXPIRES: 08/25/2014
STATUS DATE: 02/26/2014 APPLIED: 02/26/2014
SITE ADDRESS: 3170 ORIOLE ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703221312100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: E-Circuit for water heater relocation
OWNER: DECKER LAURA J Phone Number:
ADDRESS: 3170 ORIOLE ST
SPRINGFIELD OR 97477
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CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor • OWNER CCB . 000000 08/01/2025
Electrical Contractor OWNER CCB 000000 08/01/2025
Plumbing Contractor OWNER CCB 000000 08/01/2025
L INSPECTIONS REQUIRED
Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
4999 Final Electrical Final Electric: When all electrical work is complete.
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
certifythat 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.
4/ 01 , x • 16 ly
Owner or Contractor Signature Date •
• ATTENTION: Oregon law requires you to
follow rules adopted by the.regon Utility NOTICE:
h
Notification Center. Those rules are set fort THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS-NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number the
Center is Oregon-8 Notification
00-332-2344�
Springfield Building Permit 2/26/2014 9:09:35AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT 225 Fifth
87477
" ' OREGON 541-726-3753
811-SPR2014-00422
wvnv.springfeld-or.gov 3170 ORIOLE ST permitcenter@spnngfeld-or.gov
RECEIPT NO: 2014000418 RECORD NO: 811 SPR2014-00422 DATE:02/26/2014
1,) g; l:hpaL _' i n 1 #3'=k .'niS;erA ACCOUNTCODE/TRANSICODEnit ,AMOUNT.DUE'A
Electrical Inspection For Which No Fee is Specifically Indicated 224-00000-426102 1075 80.00
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+TYP_E P.A I caSNIER:RCnRP rra - COMMENTS - AMOUNT PAID
Check RICK TURNER - 93.60
1507
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT USE ONLY
SUFI' O-P SP t GHELiD 1OREG®N . -, ... , 5 / v _ ti- z `..
f ,�h 1 Permll no.:
r II
225 Fifth Sbeel•Spungtield,OR 97J77•P11(541)726-3753♦Fx\(+4t)726-3689 ,.),O.tEGON
Dale: Z/ -c (( Y-
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
(lays 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. Cost Total
ea. cost
CATEGORY OF CONSTRUCTION
-- Residential, per unit,service included:
❑ Residential ❑Government ❑ Commercial
JOB SITE INFORMATION AND LOCATION 1;000 sq. II. or less(4) $147.50
g� -- Each additional 500 sq. II.or portion $ 27.50
Job site address: i/ '7U on- Ez. 7 thereof
City: Sr�n State: JL ZIP: �7y77 Limited energy(2) $ 35.00 $
Reference: Tax lot.: Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(2)
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,! �p PLHO �` Services or feeders: installation. alteration.relocation
-v.--- s. K- 200am>sorlcss 7
I (2) $ 89.00 $
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
401 to 600 mops(2) . $174.00 S
Name: (1�JUQ�} �nl'LCKK.I.�
Address: S 70 0✓?10 LI£. s7- 60 I to 1,000 amps(2) $225.50 S
City:e ),010FIFLI.tO State: 00- Z1ftg7y7, Over 1,000 amps or volts(2) $516.00 $
Phone: 5-tII -gs3-SSZ-`1 Fax: - -
Reconnect only(2) $ 69.00 $
Temporary services or feeders: installation, alteration, re/ocolion
E-mail:
rl e,4 4_,r,Aef 2_7 ®root_ co i'I 200 amps or less(2)
This installation is being made on residen al or farm property $ 69.00 $
owned by me or a member of my immediate family. This 201 w 400 amps(2) $ 96.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479540(1)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
CONTRACTOR INSTALLATION Branch circuits: neat alteration, extension per pane(
Business name: A../6-/-2--- a. Pee for branch circuits with purchase or a service or feeder Ice:
Address: Each branch circuit $ 6.50 5
City: State: ZIP: 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 5
CCB license no.: l3CD license no.: Ni iscellaneons fees:seance or feeder not included
Signing supervisor's license no.: Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $
Signal circoil or a limited-energy panel. $ 80.00 $
Signature of signing supervisor: • alteration.or extension (2)
Each additional inspection: (I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ �
(Minimum Permit Fee$80.00)
(B)Enter 12%,surcharge(.12 x IA I) $ Zirg,3(C)Technology Fee(59 o of IA I) $
440-2584-1(4/01/2013/COM) . TOTAL fees and surcharges(A through C): 5 90'
of