HomeMy WebLinkAboutPermit Electrical 2013-6-24 SPRINGFIELD 225 Fifth St
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CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
hit--\OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01363
www.springfield-or.gov permitcenter @springfield-ar.gov
PROJECT STATUS: Issued ISSUED: 06/24/2013 EXPIRES: 12/20/2013
STATUS DATE: 06/24/2013 APPLIED: 06/24/2013
SITE ADDRESS: 589 HARLOW RD A,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703271200900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Sub Panel w/4 circuites
OWNER: STOLSIG CHARLES A JR 8 MICHELLE C Phone Number:
ADDRESS: 589 HARLOW RD#A
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.
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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 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.
(Thlriail_k_i &7d (49/a4/1 (2)
Owners or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
NOTICE:
Notification Center. Those r h OAR 952 001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtainhroug `l1THORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain cod/ies of'hie toes by
calling the center. (`''1'' . "riMENCED OR IS ABANDONED FOR
�r
number for the „
,'.,r DFRIOO.
Genie iS I-::ul, ,
Springfield Building Permit 6/24/2013 10:05:19AM Page 1 of 1
SPRINGFIELD - cunt OF SPRINGFIELD
225 Fifth St
C,`N6�o`H TRANSACTION RECEIPT Springfield,OR97477
541-726-3753
811-S PR2013-01363
www.springfield-or.gov 589 HARLOW RD A permitcenter @springfield-ar.gov
RECEIPT NO: 2013001322 RECORD NO:811-SPR2013-01363 DATE:06/24/2013
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DESCRIPTION • ACCOUNT CODE/TRANS CODE AMOUNT-DUE
Branch circuits with service or feeder each circuit 224-00000-426102 1004 26.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 13.80
Technology fee(5%of permit total) 100-00000-425605 2099 5.75
TOTAL DUE: 134.55
}_
..PAYMENT TYPE E _;� � AMOUNT PAID
_ PAYOR�CASHIER::ILARSON � � COMMENTSa,-.._.�.,.,...,.,.> �.-__.__.....,.... .«._....._..- ...,.—....._.,._ _.__....._._
Check STOLSIG CHARLES A JR&MICHELL 134.55
579
TOTAL PAID: 134.55
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Electrical Permit Application ) DEPARTMENT U -=-',
SE ONLY
SPptNGFlELO ry - x - -�- SL r
• P LIGITY-toFiSPNGEIELDIOREGONgat5 Permit no {1 I 3243 01 3 Cr;
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: /2 y 1-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.
LOCH fkaOVERNMENT'APPROVAL __' r :X,a.`._ _ ..:'-,FEE''SCHEDULE' °,?:;;;:gr:;:5:Z.Nita
Zoning a P P roval verified? Yes ❑No far ` C,.e6 s ,r'
w nspctpit t
,, _ ,.CATEGORY-'OF,CONSTRUCTION , (,g.,T.coostt a l t-
Residential,per unit,service included:
Residential ❑Government ❑Commercial 1,000 sq.ft.or less(4) $734.00 $
•° , „,JOB%SITE?INFORMATION,:ANDY L'OCy}ATTInION ai +' Each addi onal 500 sq.ft.or portion
Job site address:'_S (9� A .nay lO,.) KrY•. thereof $ 25.00 $
City S P f.•�c t J d State: Of ZIP: 97 g 7 7 Limited energy(2) $ 32.00 $
Reference: Taxlot.: Each manufactured home or modular 63.00 $
dwelling service or feeder(2)
Re M D dl f pQ Services or feeders: installation,alteration,relocation
200 amps or less(2) 1 $ 81.00 $
11:1:1K 11PROPERTW OWN ERw;S?T,1.° ._.` ;� 201 to 400 amps(2) I $ 95.00 $401 to Name: ehet;its v n ,L�e 1�Q n SN)S 9.'3r 601 to 600 a amps(2)
)2) 5158.00 $$
Address:,..1g�/ A/'1 hate Ltd) R�
City:�1D,t,ud q�,e1cy State: ( ZIP: 9)7 t/)2 Over 1,000 amps or volts(2) $469.00 $
Phone>9/-/'1$= g 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
479.540(1)and 479.560(1). 401 to 600 amps(2) $126.00 $
Signature 1, �, i Over 600 amps or 1,000 volts,see services or feeders section above iar
3i.-r `;; ,a,?CONTRACTOR<INST =L<TION ' „'' ` Branch circuits:new alteration, extension per panel
Business name:/5(4/ n-- a.Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit L1 $ 6.00 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: BCD license no:: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 63.00 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 63.00 $
Bn g g P alteration,or extension(2)
Each additional inspection:(1) $58.00 $
°- _ll Z APPLICANT_USE F"; ,, _`;;'L'
(A) Enter subtotal of above fees $
(Minimum Permit Fee$58.00)
(B)Enter 12%surcharge(.12 x[A]) .$
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): $1;5 —
440-25847(9/08/COM)
. Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
• issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
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Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
M 01)9. LU c$ ,fot Cy
Print Name of Permit Applicant
Signature of Permit Applicant Date
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Permit#: Ce2i( ZOt 1 0 l3 6 3 (—of_
Address: S5:99 ! irg-v'(0
FQ Fe:M���t:10
Issued by: 4,4 Date: 6/Z `//r ) 59
This Copy for Permit Offices