HomeMy WebLinkAboutPermit Electrical 2013-8-21 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-SPR2013-01874
www.springfeld-or.gov permitcenter(t+jspringfield-cr.gav
PROJECT STATUS: Issued ISSUED: 08/21/2013 EXPIRES: 02/16/2014
STATUS DATE: 08/21/2013 APPLIED: 08/21/2013
SITE ADDRESS: 2620 31ST ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702193200602 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Service and 7 Circuits for Barn
OWNER: BRANCH JAMES A&VIRGINIA L Phone Number:
ADDRESS: 2620 N 31ST ST •
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION I •
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. ? /
Z ( / 3
ner or Contractor Signature - :!:1-7 Date
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 ANY 180 DAY PERIOD.
calling the center. (Note: the telepn..,rc:
•
number for the Oren^.r, D'otificanon
Cent ;; .I :s? ';.•41.
Springfield Building Permit 8/21/2013 1:39:52PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spr;ngfteld.oR97477
O REGON
541-726-3753
811-SPR2013-01874
www.springfieldocgov 2620 31ST ST permitcenter @springfield-ar.gov
RECEIPT NO: 2013001827 RECORD NO:811SPR2013-01874 • DATE:08/21/2013
del*1oTfl �re1 x1� _-?k} ..�,f l ir �.
' � ' .�._. -';t' r°.'ACCOUNT CODElTRANS'CODE =?� .� ':C=• �e e y'a,
Branch circuits with service or feeder each circuit 224-00000-426102 1004 45.50
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 16.14
Technology fee(5%of permit total) 100-00000-425605 2099 6.73
TOTAL DUE: 157.37
BAYMENTrTYP.E". PAYOR: casNIER:JLARSON COMMENTS AMOUNTyPAID
Check BRANCH JAMES A&VIRGINIA L 157.37
4431
TOTAL PAID: 157.37
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Electrical Permit Application spq,�,�FIE�o DEPARTMENT!USE ONLY
a;:-7:-.75 4-z* ; ',Y y�krk.-- ,�,ia .a r8"n, ,1tr—.crr.,l;rZ � 'D ^ ..
SC I;TrNQF1SPRI�IGFIELD, t7RREGH_N =- Permit no.: � k an l Ol67<
225 Fifth Street♦Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 //
Date: 8 /z/ / 13
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.
` EOCAL.GOYERNMENTOPPROYAG ` :;„s,. j'ifr-iiiilligialtairg EEISCHEPULE ; ."jt` , : 1,
Zoning approval verified? Yes No 'r'i x1 ' ' t le 'J'7 i Cost ri 3;Total
Zoning PP ❑ ❑ Number olinspections per dem O,' x Qty [sea i,?';y,,._costa.:,-
, ?+,,'CATEGORY$OF&CONSTRUCTION 'v,„=;ri,',' `
Residential,per unit,service included:
Residential ❑Government ❑Commercial
1,000 sq.ft or less(4) $147.50 $
10B ISITE;11NFORMATION AND LOCATION;; t,.4 ;> Each additional 500 sq.ft.or portion
Job site address: z � Z 0 3 1 # S thereof - $ 27.50 $
City: c- c (d State: 0 l� ZIP: 9 7`-/77 Limited energy(2) $ 35.00 $
Reference: 17 a Z. I 3 2 Taxlot.: 5 0 0 Each manufactured home or modular
`;Feiq t„r"'St DESCR PTION`&OFjWORK” 9",: !.-a,,? y:; dwelling service or feeder(2) $ 69.00 $
/ / l Services or feeders: installation, alteration, relocation
1- e y it 7 S 4 itol P/CI S �a r 04,/'*n 200 amps or less(2) $ 89.00 $
I 55,9
W i;°REOtEri' ;BRO,RERTY;OWNEF ;° , ;:kliNXClan 201 to 400 amps(2) $ 104.50 $
Name: r' c to Y✓t c S 13 rem Cr 401 to 600 amps(2) $174.00 $
Address: Z 6-2,0 -, / s4 s 601 to 1,000 amps(2) $225.50 $
City: ]? c(o( State: 0 it ZIP: +97Le 7
7 Over 1,000 amps or volts(2) $516.00 $
Phone:55'/-79y- S�6 ` Fax: - - Reconnect only(2) $ 69.00 $
E-mail: / Temporary services or feeders: installation, alteration, relocation
� Vbr-GVtc 1/4-@.> 200 amps or less(2)
This installation is being made on residential or farm property $ 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)an 479.5600). 401 to 600 amps(2) $138.50 $
Signature: G.^ A 6,,✓(--- Over 600 amps or 1,000 volts,see services or feeders section above
". MEi*,. ONTRQCTOR,INSTAL`LATION ? } __t,''„M Branch circuits:new, alteration, extension per panel
Busines me: a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit '1 $ 6.50 $95.
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 $
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 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
(A) Enter subtotal of above fees
(Minimum Permit Fee S80.00) $ / 3,7)-0
(B)Enter 12%surcharge(.12 x[A]) $
(C)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through C): 5) S 7 3'-
440-2584-1(4/012013/C0M)
. 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
XI 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.
Jctw is At 4;)ra(r,c
Print Name of Permit Applicant
gnature of Permit Applicant Date
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Permit#: p F_
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u^\f
Address: i:-` 7/�•.
in
Issued by: Date: 859
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This Copy for Permit Offices
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