HomeMy WebLinkAboutPermit Electrical 2014-3-12 •
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SPRINGFIELD - - 225 Fifth St
CITY OF SPRINGFIELD • Springfield,OR 97477
3; Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00525
• '4ww.springfield-or.gov permitcenter@sprfngfield-ar.gov
PROJECT STATUS: Issued ISSUED: 03/12/2014 EXPIRES: 09/08/2014
STATUS DATE: 03/12/2014 • APPLIED: 03/12/2014
SITE ADDRESS: 1218 1ST ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703263300524 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New service
OWNER: NOBLE STEPHANIE I M&CHRISTOPHER L • Phone Number:
ADDRESS: 1218 1ST ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor PHANTOM INC COB 109864 01/14/2015 541-688-2549
_ INSPECTIONS REQUIRED
Inspections
4220 Electrical-Service •
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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 c d is located at the front of the property, and the approved set of plans will remain on the site at all times during
constr ion.
Owner or Contractor Signature r Date
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wires you to
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Springfield Building Permit 3/12/2014 11:02:46AM Page 1 of I
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' SPRINGFIELD - - CITY OF SPRINGFIELD
TRANSACTION RECEIPT Sphngfield,OR 97477
''�""'� 225 Fifth h St
OREGON 5N 41-726-3753 1
. 811-SPR2014-00525
www.spririgfield-or.gov 1218 1ST ST permitcenter@springfield-ar.gov
RECEIPT NO: 2014000537 RECORD NO:811-SPR2014-00525 DATE:03/12/2014
I,gig:Jfd9lo7:L'a '+i:„-��+a,.='E` K; _� �_� �- ;.t'JACCOUNTdCODEIPRANS:CODE '.r.`?`mi:(AMOUNT'DUE:','
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
P,AYMENTTYP.E P-AYOR 6ASHIER: RSON COM-TETI AMOUNTiPAID
Check PHANTOM INC 104.13
2563
TOTAL PAID: 104.13
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Electrical Permit Application DEPARTMENT USE ONLY
SPNINGFIELG
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CITY OF"SPRINGFIELD; OREGON.4:6. s -,, ?, Permit no.J/��'db 5 Z S
m a'G:=- 43 'ru;:�.,D t+'^ ..."_�._:'3YYes4 « _- 3.,
225 Fifth Street*Springfield,OR 97477*PH(541)726-3753*FAX(541)726-3689
Date: 3/ 7 Z 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.
OCAL:GOVERNMENT`'ARP ROVAL `" t- •Tr- ,t'+' ;FEE I.,SC HEDULE„4", Et,; x.,:
Zoning approval verified? ❑ Yes ❑ No Number of inspections per.,item.( , Qty Cost Total-
CATEGORY,_OF,.`CONSTRUCT,ION ;- '
Residential, per unit,service included:
ip Residential ❑Government ❑Commercial
r .. E .���„�. 1,000 sq. ft.or less(4) $134.00 $
F „40McSITE INFORMATIOWAND_LOCATION
// / Each additional 500 sq. ft. or portion
Job site address: /e: n �ax,. r //�� thereof _, $ 25.00 $
City.. ly c0/J�/ // 3 0 7 ZIP:97h/7 Limited energy(2) $ 32.00 $
Refer ce: j 3 �b 3 3 Taxlot.0b Sr2 y Each manufactured home or modular $ 63.00 $
/// DESCRIPTION OF WORK' .,'. dwelling service or feeder(2)
/ 0 J S
.u) /aQ_t C� Services or feeders: installation, alteration, r ocation
200 amps or less(2) • $ 81.00 $
'PROPERTY OWNER 201 to 400 amps(2) $ 95.00 $
Name: (/W! 5 /we_ 401 to 600 amps(2) $158.00 $
Address: r, 601 to 1,000 amps(2) $205.00 $
City: /t � State: ZIP: 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:/ q C A 4 1 A . ( �/ -,��� a. Fee for branch circuits with purchase of a service or feeder fee:
Address: #a v2 S 7c)/7 Each branch circuit $ 6.00 $
City:4{ tZ f^& State: die ZIP?71#2 2— b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: Fax: 7/4/9 First branch circuit(2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no./O9F&V BCD license no.:, 79-e--' Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: ��-_-5-
Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor:, g/nie/j, 2ZS7(ea'6��. Each sign or outline lighting(2) $ 63.00 $
Signature of signing supervisor: �-C:-�.---C. Signal circuit or alimited-energy panel, $ 63.00 $
g g P �ivv+ alteration,or extension(2)
Each additional inspection: (I) $58.00 $
,: d>ggllll2 , hd?N APPLICANrUSE tx .;a` i} ' . 1
(A) Enter subtotal of above fees $ ��
(Minimum Permit Fee$58.00) O
(B)Enter 12%surcharge(.12 x [A]) $ I O (8
(C)Technology Fee(5%of[A]) $f 4 4S—
TOTAL fees and surcharges(A through C): $/O if II
440-2584-J(9/08/COM)