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Home My WebLink AboutPermit Electrical 2013-8-5 • SPRINGFIELD 225 Fifth St ht. 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-SPR201 3-01 753 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 08/05/2013 EXPIRES: 01/31/2014 STATUS DATE: 08/05/2013 APPLIED: 08/05/2013 SITE ADDRESS: 7955 S A ST,Springfield,OR 97478 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702363002500 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace 200A service OWNER: EASTMAN LESA G Phone Number: ADDRESS: 5125 DAISY ST • SPRINGFIELD OR 97478 • OWNER: EVANS GORDON B Phone Number: ADDRESS: 5125 DAISY ST . SPRINGFIELD OR 97478 L CONTRACTOR INFORMATION Y Contractor Type - Contractor Name Lic Type Lic No Lie Exp Phone Electrical Contractor OWNER CCB 000000 08/01/2025 L 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. / i ( 72 Own- or Contractor Signature Date • 1 Oregon law requires you to ATTENTION: Oreg the Oregon Utility follow rules adopted by FIRE 1F THE WORK Notification Center. Those rules are set forth NOTICE: SHA1 E� in OAR 952-001-0010 obtain copses of the yule Oby AUTHORIZED UND S ABANDONED FORNOT 0090. You may Note: the teleph = COMMENCED OR calling the center. ( gp DAY PERIOD. number for the Oregon Utility Notification AoY Center Is 1-800-332-2344)• Springfield Building Permit 8/5/2013 2:29:34PM Page 1 of 1 • SPRINGFIELD - CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT 61799901eld,OR 97477 �' aI 541-726-3753 OREGON 811-SPR2013-01753 www.springfield-or.gov 7955 S A ST permitcenter @springfield-or.gov RECEIPT NO: 2013001704 RECORD NO:811-SPR2013-01753 DATE:08/05/2013 'DESCRIPTION _: : . . ACCOUNT CODE/TRANS CODE _- AMOUNT DUE_] 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 PAYMENT TYPE w , PAYOR CASHIER:CCARPENTERw 'COMMENTS _, • 4 'AMOUNT PAID Check EVANS GORDON B 104.13 148 TOTAL PAID: 104.13 • • Electrical Permit Application DEPARTMENT USE ONLY t -. ,, •*?° 'L SPRINGFIELD G rJ /ITY iOF SPRINGFIELD, OREGON Permit no.:�> — ( 7 C---7 225 Fifth$treet•Springtield,OR97477 1PH(54l) 26-3753•FAX(54l)726-3689 - 1OKEGON (��. I Date: fJX / 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 t ea. To cost al CATEGORY OF CONSTRUCTION Residential,per unit,service included: Residential ❑Government ❑Commercial 1 JOB SITE INFORMATION AND LOCATION 1,000 sq, ft.or less(4) $147.50 $ i 7 S Each additional 500 sq. ft.or portion $ 27.50 $ Job site address: ,� eC-L- thereof Ci / State:OR ZIP:O 1 ty;�j7 Zl�G�7'>° O U I 744 78 Limited energy(2) $ 35.00 $ ( Reference: // Taxlot.: Each manufactured home or modular DESCRIPTION OF WORK dwelling service or feeder(2) $ 69.00 $ Services or feeders:installation,alteration,relocation 200 amps or less(2) ( $ 89.00 °/) ( "-- I 201.to 400 amps(2) $ 104.50 S I PROPERTY OWNER 1 • //I 401 to 600 amps(2) $174.00 $ I Namz:( 'TO roR �NCi/1 ��' 7 ' L" . Address: 5- ,7 i a/f O .1 e e / 601 to 1.000 amps(2) $225.50 S I City:_,/ State:O� Zig`/Ry70 Over 1,000 amps or volts(2) $516.00 $ Phone: %6/5-353f Fax - - Reconnect only(2) $ 69.00 S 1. '/ 9 —7 Temporary services or feeders:installation, alteration,relocation t F.,-mail: 7 ! / 5�.�.S��Cto�,CO�Yl This installation is being made on residentia or farm property 200 amps or less(2) $ 69.00 $ I 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 479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $ I Signature: Over 600 amps or 1,000 volts,see services or�eeders section above CONTRACTOR INSTALLATION� // Branch circuits: new.alteration,extension per panel Business namea�/'i 5 7�C/GLT (/�Nn�i/f a. Fee for branch circuits with purchase of a service or feeder fee: ' Address: Each branch circuit $ 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) $ 60.50 $ E-mail: Each additional branch circuit $ 6.50 $ 6 CCB license no.: BCD license no.: Miscellaneous lees:service orrfeeder not included i 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, I Signature of signing supervisor: alteration,or extension(2) $ 80.00 $ 1 I Each additional inspection:(I) $80.00 $ APPLICANT USE 1 (A) Enter subtotal of above fees $ 7? i I (Minimum Permit Fee 580.00) (B)Enter 12%surcharge(.12 x[A]) $/Q(rsi- 1 (C)Technology Fee(5%of[Al) $ g±J 440-2584-1(4/01/2013/C0M) TOTAL fees and surcharges(A through C): $, _/1 i . 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 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. Fitt ET-IC—Pi—CI Print Name of Permit Applicant • J Si. ature of Permit Applicant Date • Permit#: S( ) /753 o F • Address: /7 cJ aina ahs t, 0 R0 072- 9� 7� ` ::�y�,i:.: / m YL • Issued by: Date: V5 7 3 V . 8 s 9 • This Copy for Permit Offices