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HomeMy WebLinkAboutPermit Electrical 2013-5-6 SPRINGFIELD 225 Fifth St lit_ CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 t OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00890 wmv.springfield-ar.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/06/2013 EXPIRES: 11/02/2013 STATUS DATE: 05/06/2013 APPLIED: 05/06/2013 SITE ADDRESS: 1104 T ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703261401311 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Up to three branch circuits by owner-see S13-848 for related inspections OWNER: FERENCE BRIAN R Phone Number: ADDRESS: PO BOX 11486 EUGENE OR 97440 OWNER: PIPER NEVA A Phone Number: ADDRESS: PO BOX 11486 EUGENE OR 97440 L CONTRACTOR INFORMATION 1 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. � ilA - 516 /13 Owner or Contractor Signature Date •NOTICE: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by ANY 180 DAY PERIOD. • calling the center. (Note: the telephone number for the Oregon Utility Notification • Center is 1-800-332-2344). Springfield Building Permit 5/6/2013 11:13:29AM _ Page.1 of 1 • • SPRINGFIELD - CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 541-726-3753 811-SPR2013-00890 www.springfield-or.gov 1104 T ST permitcenter@spdngfield-or.gov RECEIPT NO: 2013000875 RECORD NO: 811 SPR2013-00890 DATE:05/06/2013 2 a 4Afik=`"-ACCOUNTaCODEITRANS CODE 4-2.1.4;--'717? Ri 0 ,: DUEL! Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00 Branch circuits without service or feeder- 1st circuit • 224-00000-426102 1004 60.50 Branch circuits without service or feeder-each additional 224-00000-426102 1004 6.50 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 P.AYMENTATYP.E-. P,AVOR. CnsweR:JIARSON '-.."5,.7COMMENTS. _ AMOUNT¢FAIp„> WPr.- 4. Check FERENCE BRIAN R 93.60 • 5600 TOTAL PAID: 93.60 • 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 R- 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. • 13 R r ,'J regeucE • Print�Name of Permit Applicant • / Signature of Permit Applicant Date • Permit#: CI 3 - OF -�O Address: pt m � 6,7 / 7 F F 0 c U 1 ac !/ Yc-. '( 7( r aiam >,_ Issued by: Date: .574 7/ 7 g 59� • • This Copy for Permit Offices a Electrical Permit Application DEPARTMENT USE ONLY ar °" SPRINGFIELD ' CLTYOFSP pFIELD,'0REG1 ' ( 225 Fifth Street•Springfield.OR 97477•P14041)726-3753•F AX(541)726-3689 1 OREGON ,//�//� Date: �/s/ ( 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. 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: Q-Residential ❑Government ❑Commercial 1 1,000 sq.Ii.or less(4) $147.50 $. JOB SITE INFORMATION C 'AND f LOCATION a �/Q 1 T Cf PPf Each additional 500 sq. H.or portion $ 27.50 $ # Job Site address: r thereof # City: SPr,,sQ eCt.I State: OR ZIP:ey Y73- Limited energy(2) $ 35.00 I $ f Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or fender(2) t C /� Services or feeders:installation,alteration,relocation bu0 Pfo ten. -&,icw , 200 amps or am less 7 P (2) I $ 89.00 $ PROPERTY OWNER 201 to 400 amps(2) I S 104.50 S 1 Name: 401 to 600 amps(2) $174.00 S QR,Rco FE i Address: 2111 II 8 Sta.- 601 to 1.000 amps(2) $225.50 $ 1 City: S d State: 012.., ZIP:4 l9i} Over 1,000 amps or volts(2) - $516.00 $ Phone:91(-Fqf- e5%—. Fax: - - Reconnect only(2) $ 69.00 S Temporary services or feeders:installation, alteration, relocation E-mail: h4n1 tl+e0 e C!1 tY\ . 200 amps or less(2) This installation is being rune on residential or farm property $ 69.00 $ E 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 E 479.540(1)Nd 479.560____ 401 to 600 amps(2) $138.50 $ 1 Signature: 21,(.021■ .t.Q1124u_Q_— Over 600 amps or 1,000 volts.see services or feeders section above [ CONTRACTOR INSTALLATION Branch circuits: new,alteration,extension per panel t Business name: Jl,"..)/176?Z a. Fee for branch circuits with purchase of a service or feeder fee: I t Address: Each branch circuit $ 6.50 $ I I City: State: ZIP: b.Fee for branch circuits without purchase ofa service or feeder fee: t Phone: - - Fax: - - First branch circuit(2) J $ 60.50 $ Each additional branch circuit 1! $ 6.50 $ r J I E-mail: l CCB license no.: BCD license no.: Miscellaneous fees:service oirfeeder 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 circuit or a limited-energy panel, f Signature of signing supervisor: alteration,or extension(2) $ 80.00 S 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[A]) $ � (C)Technology Fee(5%of[Al) . $ t/���'- AA 440-2584-J(4/01/2011 ICON // ) TOTAL fees and surcharges(A through C): $ �/i it i