HomeMy WebLinkAboutPermit Electrical 2014-4-10 •
SPRINGFIELD • 225 Fifth St
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CITY OF SPRINGFIELD Springfield,OR 97477
y,_.. it '4,4 • Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676 -
PERMIT NO: 811-SPR2014-00773
www.springfieldor.gov - permitcenter @springfieldor.gov
PROJECT STATUS: ,Issued ISSUED: 04/10/2014 EXPIRES: 10/07/2014
STATUS DATE: 04/10/2014 APPLIED: 04/10/2014
SITE ADDRESS: 5126 F ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702332400500 TYPE OF STRUCTURE: Residential
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PROJECT DESCRIPTION: Adding Circuit
OWNER: HANSEN ANDREW • Phone Number:
ADDRESS: 5126 F ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION R
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
( 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
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 Pate
ATTENTION: Oregon law requires you to ;> `
follow rules adopted by the Oregon Utility NOTICE:
SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth -
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 for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 4/10/2014 4:18:27PM • Page 1 of 1
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SPRINGFIELD —. CITY OF SPRINGFIELD
225 Fifth St
" `o EGON TRANSACTION RECEIPT . SpringfieldpR 97477
gf 541-726-3753
811-S PR2014-00773
www.spnngfield-ar.gay 5126 F ST permitcenter@spdngfeld-ar.gov
RECEIPT NO: 2014000782 RECORD NO:8115PR2014-00773 DATE:04/10/2014
DESCRIPTION .vs„ v tIffir 82.1 i+ F,Es. auvAGCOUNT.CODEITRANS'.CODE>ea."AMOUNT DUE
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 • 19.50
Branch circuits without service or feeder-1st circuit • 224-00000-426102 . 1004 60.50
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
li`PAYMENTxTYP.E JNE` PAY,ORr r casMER. uiSITNo'- ' :-`. '.1 C0@IMENTS e�1+'�,. '4 'a -a nv AMOUNTj t.:411
Check OWNER 93.60
6029
TOTAL PAID: 93.60
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Electrical Permit Application SPHINGFlELD DEO!ARTMENT USE ONLY
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CITY OF SPRINGFIELD OREGON - Permit Lt
225 Fifth Stree •Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: Lilo // `/
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.
1LOCAL ,GOVERNMENTaQFPROVAL,r,' `1, " ,,. " FEE SCHE pULE Y "a '
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Zoning approval verified? ❑ Yes c `- ` e Cost :.,Total❑No IIINumber oLinspechons�per nem0 if ty �:se st
f,,;CATEGORY`;OE::CONSTRUCTION
r r';t t.. ..
' Residential,per unit,service included:
❑ Residential ❑ Government ❑Commercial 1,000 sq.ft.or less(4) $147.50 $
' . JOB;SITE;INFORMATION AND'=,LOCAT ".14)& l ?_
s�„ _ _1 Each additional 500 sq.ft.or portion
Job site address: ^ ,pJ�[ _ thereof - $ 27.50 $
City:5F)y\s 12\n\ State: to [N ZIP:9‘TC-t-‘1g Limited energy(2) $ 35.00 $
Reference: Taxlot.: Each manufactured home or modular $ 69.00 $
7' 1. -;, f,'h,,, „ 1DESCRIPTIONMOFw;WORK- °"q, ',r',,� xiff: dwelling service or feeder(2)
G1!\ l I 1 vt� r Services or feeders: installation, alteration,relocation
200 amps or less(2) $ 89.00 $
h " ' :,PROP.ERTYi,;,lOWNER ,'„ , s , .:>r' '24 201 to 400 amps(2) $ 104.50 $
Name: Grtc (-eel 6 401 to 600 amps(2) $174.00 $
Address: • v. 601 to 1,000 amps(2) $225.50 $
� � 1 Over 1,000 amps or volts(2) $516.00 $
City:sp�lt Y1 'hY.�t,� State: (�� ZIP:q`(��
Phone r{f�� ( Fax: Reconnect only(2) $ 69.00 $
E-mail: ^ Temporary services or feeders: installation, alteration, re location
�tl 11$,J2- 200 amps or less(2)
This installation is being made on residential or farm property $ 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, le. -, or rent. OAR 401 to 600 amps 2
479.540(1)and 479. 0O) P (2) $138.50 $
Signature: e (� >-met t Over 600 amps or 1,000 volts,see services or feeders section above
`yt*e;swac,O CT,OR„IN' . -AL :T,ION m w.ia Branch circuits:new, alteration, extension per panel
Business name: a)✓lt.r - . - a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit $ 6.50 $
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 $
CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included
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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 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
_ __ __ _ alteration,or extension(2)
Each additional inspection:(I) $80.00 $
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u ° r _=APPLICANT, USE,' �` , ,. ` ;
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(A) Enter subtotal of above fees S
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $
(C)Technology Fee(5%of[Al) $
TOTAL fees and surcharges(A through C): - $ `j ?j.6....-t--
(4/01/2013/COM)