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Home My WebLink AboutPermit Electrical 2013-4- r SPRINGFIELD- - 225 Fifth St 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-SPR2013-00810 . www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/22/2013 EXPIRES: 10/19/2013 STATUS DATE: 04/22/2013 APPLIED: 04/22/2013 • SITE ADDRESS: 386 55TH ST,Springfield,OR 97478 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702331303801 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace 200 A service OWNER: HUNT TERRY L&SANDRA L Phone Number: ADDRESS: 625 WILBUR RD ROSEBURG OR 97470 CONTRACTOR INFORMATION Contractor Type "Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 4225 Service or Feeder . 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 orefontractor Signature ate • kTTENTION: Oregon law requires you to Illow rules adopted by the Oregon Utility EwDR1( 3tification Center. Those rules are set forth DT OAR 952-001-0010 through OAR 952-001- tyQT�CE: HALL�0 PO; �S N 1T S THIS 190. You may obtain copies of the rules by Au1THORl ED D R IS DNED FDR calling the center. (Note: the telephone GED DR IS pgAND • lumber for the Oregon Utility Notification SDI�MEN ER)DD. Center is 1-800-332-2344). ANY 1S0 Oh P Springfield Building Permit 4/22/2013 11:42:59AM Page 1 of 1 Electrical Permit Application DEPARTMENT USE ONLY :. i - 7 SPRINGFIELD . LCITY.O.P SPRINGFIELD, OREGON { Permit no.: SI3 —710 C 225 Fifth Street•Springleld.OR 97477•114(541)726-3753•F AX(541)726-3689 "' IOREGON S �I Date: '"1 / Z f) 3 t I This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 I days of issuance or if wort: is suspended for 180 days. ] LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total CATEGORY OF CONSTRUCTION ea. cost Residential,per unit,service included: `Q Residential ❑Government ❑Commercial 1,000 sq.ft.or less(4) $147.50 $ JOB SITE INFORMATION AND LOCATION 1 Each additional 500 sq.ft.or portion Job site address: 3 6 SS'"�- A thereof $ 27.50 $ #- City: -A ,e( I State: Ott ZIP: /79, Limited energy(2) $ 35.00 $ @. (-) Reference: O2_7J73 Taxlotr7enbJ Each manufactured home or modular DESCRIPTION OF WORK dwelling service or feeder(2) $ 69.00 $ s ffel° Cn n Services or feeders:installation,alteration,relocation GX�c 200 amps or less(2) c, [ P (- l $ 89.00 $�/ E PROPERTY OWNER 201 to 400 amps(2) $ 104.50 S i it , p O 401 to 600 amps(2) $174.00 S Address: L'r� L. tf) Address: qJ,>_,17,,,. 601 to 1.000 amps(2) $225.50 $ City:/se' a .1qq ,,,�Statr�er: gj e ZIP: el 74/70 Over 1,000 amps or volts(2) $516.00 $ Phone�f'f/-G73- J$(e Cdicax:/��F at-1 gG 3 Reconnect only(2) $ 69.00 S 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 479.540(1)and 479.560(1). �__. 401 to 600 amps(2) $138.50 $ t Signature: � Over 600 amps or 1,000 volts,see services or feeders section above C NTR fOR"INSTA LATION Branch circuits: new,alteration,extension per panel Business name:( it/e_1-- a.Fcc for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit 5 6.50 $ t City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: Phone: - - Fax: - - First branch circuit(2) 5 60.50 $ i E-mail: Each additional branch circuit $ 6.50 $ CCB license no.: BCD license no,: Miscellaneous lees:service or feeder not included r 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 alimited-energy panel, $ 80.00 S p alteration,or extension(2) Each additional inspection:(I) $80.00 $ ; APPLICANT USE ■ (A) Enter subtotal of above lees $z-- I (Minimum Permit Fee$80.00) ( I (B)Enter 12%surcharge(.12 x[Al) $ LOP? I (C)Technology Fee(5%of[A]) $ 0.14(5- 1 TOTAL fees and surcharges(A through C): $ /0 Y L. 440-2534-J(4/01!2013/CObt) . g (" e 1 SPRINGFIELD — CITY OF SPRINGFIELD --- 225 Fifth Sl tEGON TRANSACTION RECEIPT Spdngfield,OR97477 541-726-3753 811-SPR2013-00810 www.springfieldor.gov 386 55TH ST permitcenter @springfield-or,goy RECEIPT NO: 2013000801 RECORD NO:811-SPR2013-00810 DATE:04/22/2013 (e]�Yy:71 Mtl[o]tl`" , ap „ „_,,.. d i r 1, ,E _ !N ''AC60UNTiGODErtRANSCODE 4 •r'�'"l ''ANIOUNTIDUE 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 PAYMENTIITYPE_ : P,AY.OR, cASRIER:,ccARPENTER '';-,COMMENTS a_ ' `E.- 1:` t. .AMOUNT,iPAID Check HUNT TERRY L&SANDRA L 104.13 6807 TOTAL PAID: 104.13 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: • Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or • z I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 2i2C/ 111/ Print Name bf Permit Applicant • Jn a — 20 /3 Signature Permit pplicant Date • Permit#: Sr 3 — F S/ Address: e •_tt PFbo � 26(7F- •. ; 4Y Issued by: Z.—Date: y/ 2 //3 Vas9 This Copy for Permit Offices