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HomeMy WebLinkAboutPermit Electrical 2013-6-3 SPRINGFIELD 225 Fifth St • t CITY OF SPRINGFIELD Spring6eld,OR 97477 OREGON Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01137 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/03/2013 EXPIRES: 11/29/2013 STATUS DATE: 06/03/2013 APPLIED: 06/03/2013 SITE ADDRESS: 5470 FRANKLIN BLVD,Eugene,OR 97403 SCOPE: Electrical Only • ASSESOR'S PARCEL NO: 1803034000800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Repair service and 6 circuits OWNER: THOMSEN MARC A Phone Number: ADDRESS: 2150 LAURA ST SPACE 63 SPRINGFIELD OR 97477 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 . 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. Ida:._ 4/3/3 Owner or Contractor Signature Date ;..G°. • ATTENTION: Oregon law requires you to NOTICE: ' 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 �,. calling the center. (Note: the teleph::r=3 ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 6/3/2013 10:15:53AM Page 1 of 1 SPRINGFIELD --° CITY OF SPRINGFIELD hrTRANSACTION RECEIPT SprielR 97477 �� 541-726-3753 OREGON 811-SPR2013-01137 . www.springfield-or.gov 5470 FRANKLIN BLVD permitcenter @springfield-or.gov RECEIPT NO: 2013001086 RECORD NO:811-SPR2013-01137 DATE:06/03/2013 LDESCRIPtION ACCOUNL.CODE/TRANSCODE AMOUNT;DUE Branch circuits with service or feeder each circuit 224-00000-426102 1004 39.00 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 15.36 Technology fee(5%of permit total) 100-00000-425605 2099 6.40 TOTAL DUE: 149.76 r.,LLPAYMENT TYPE PAYOR CASHIER ccARPENTER - COMMENTS - ',AMOUNT PAID = " j Cash THOMSEN MARL A 149.76 TOTAL PAID: 149.76 • • . 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 Mai* 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 IVI 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. /t4 G_ ' ej . 1 4_4 Print Name of Permit Applicant 4/37- Signature of Permit Applicant • Date • Permit#: S ( 3 - 037 F_ v : Address: 5-1170 (77-0171/44-1 • p c 4�� &IC 97Ya3 F':,.�;.�,�mt ; Issued by: te: /3'//3 8 59 • • This Copy for Permit Offices Electrical Permit Application . PEPARTIVIENTIJSE ONLY ci ttSPRINGFIELD ' % UP R G41NLD '0 �- N t �« z sn, si. au4.r fi .3 'io.:Q53Fasi, x x2 ,I4.‘,. i- Pemitno.: S I 'II / s 225 Fifth Streets Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 ?? Date: W3A3 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. ;thoCAL: GOVERNMENT APPROVAL, , ;?•„ ,,,, , FEE.?SCWEDULE , .,:,' = Zoning approval verified? ❑Yes ❑No Number of tnspecnons per iteri O Qty Cost Total :.._ ,.. .,.. e CATEGORY OF:CONSTRUCTION :' =S / Residential,per unit,service included: Residential ❑Government ❑Commercial UOB�SIT.EINFORMATION,=ANDL'OCATION ;',` 1,000 sq. ft.or less(4) $147.50 $ Job site address: �j y 7 D /2,q,1 i/ f/ IT(4./ hereof additional 500 sq.ft.or portion $ 27.50 $ City:5t),.ryfie State: 02 ZIP: 771o3 Limited energy(2) $ 35.00 $ Reference: - Taxlot.: Each manufactured home or modular $ 69.00 $ - a _~s dwelling service or feeder(2) s ,,. `DESCRIPTION f_OF_WORK,<; n � p `t, ©F 3 �i Services or feeders: installation, alteration,relocation /�-" 4•�{L, 200 amps or less(2) ' $ 89.00 $ gy®� . -2 e-i PROPERTY tOWNER , , _ r y 201 to 400 amps(2) $ 104.50 $ Narnejli A-Lt- 7"HQM,F_I 401 to 600 amps(2) $174.00 $ h,70 1 �„ J n � 601 to 1,000 amps(2) $225.50- $ Address:J"/ / /,,L'1."',"✓t .[1 - City: FA)6� C State: ©2 ZIP: 9y03 Over 1,000 amps or volts(2) $516.00 $ J, /v��?27 Fax: Reconnect only(2) $ 69.00 $ Phone: 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, e .I j -ase, or rent. OAR - -- - - 479.540(1) and 479.560(1). / 401 to 600 amps(2) $138.50 $ Signature: {v/,,�_� - Over 600 amps or 1,000 volts,see services or feeders section above ,t• „C CONTTRAC�TOORR'INSTALLATION.: ,,,, Branch circuits:new alteration, extension per panel Business name: 17/t t—VZ-- a.Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit - § $ 6.50., s3141° City: - State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: Phone: - - Fax: - - First branch circuit(2) . E-mail: Each additional branch circuit C.-n s0 $ - CCB license no.: BCD license no.: Miscellaneous fees:service 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 $ Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $ im g P alteration,or extension(2) Each additional inspection:(1) $80.00 $ C '=' ;". ';�rz `[ 'r" 'AOPLIC'ANTi USE .) +- H ti? (A) Enter subtotal of above fees /2 . (Minimum Permit Fee$80.00) $ (B)Enter 12%surcharge(.12 x[A]) • _ $ /�34 (C)Technology Fee(5%of[A]) , $ 4/110 TOTAL fees and surcharges (A through C): $ !117,, ,16 440-2584-5(4/012013/COM)