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Home My WebLink AboutPermit Electrical 2013-11-1 r SPRINGFIELD .. 225 Fifth St ` °- CITY OF SPRINGFIELD Springfeld,OR 97477 -; � Phone:541-726-3753 �' OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02430 www.springfield-or.gov permitcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 11/01/2013 EXPIRES: 04/30/2014 STATUS DATE: 11/01/2013 APPLIED: 11/01/2013 SITE ADDRESS: 910 NANCY AVE,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703272103200 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Adding circuits,changing out sub panel-rewiring existing circuits changing out devices OWNER: RAUBE CHET P 8 SUE Phone Number: ADDRESS: 910 NANCY AVE 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 4210 Service Change 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. ti 11 \ 3 Owner or Contractor Signature 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 calling the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon Utility Notification • Center is 1-800-332-2344). Springfield Building Permit 11/1/2013 1:33:48PM Page 1 of 1 • • • SPRINGFIELD -- CITY OF SPRINGFIELD 225 Fifth St 4Ayy.. TRANSACTION RECEIPT 569996914,0R 97477 `OREGON 541-726-3753 811-SPR2013-02430 www.springfield-or.gov 910 NANCY AVE permitcenter@springtield-cr.gov RECEIPT NO: 2013002408 RECORD NO:811-SPR2013-02430 DATE: 11/01/2013 tDESCRIPTION _ —ACCOUNT,CODE/TRANS CODE -. AMOUNT,DUE. -d Branch circuits with service or feeder each circuit 224-00000-426102 1004 32.50 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 14.58 Technology fee(5%of permit total) 100-00000-425605 2099 6.08 TOTAL DUE: 142.16 LPAYMENTTYPE `PAYOR cnw ea:aLARS OR- - °_ - - AMOUNT PAID.,. :..„.`_W<•, _ 'I Credit Card RAUBE CHET P&SUE 142.16 204113 TOTAL PAID: 142.16 • • Electrical Permit Application DEPARTMENT USEONLY $PNINGFIEIG ;1�+ } war{ `.,,,,," '�"!"*"x;„' .,( „... e 'M.r. ,z �.n 4T-ViOF SPRINGFlELD4OREG-43N bs. = S/3 2- �L :e r.14.,-.:s- A .. ..,.s�+w„ ;s; ;r ' :.��at:- - -- r7. g Permit no.: 225 Fifth Street♦Springfield,OR 97477♦Pft(541)726-3753♦FAX(541)726-3689 / Date: /1// // 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. :11L:QCi4L„GOVERNMENTi4PPROVAL s x`'` t. s(l4 ' ' a: �. �a . ..a,��'.�.EEE�SCHEDULE.)t ,'r�"�P ?Set:"= Zoning approval verified? Yes No svi64°+a 'zi 4, ,b- e f -£.Cost' i v.d-'Fotal. pp ❑ ❑ Number of Ihspecnuns pe ahem O - Qty:' ;,ea 41e y cost;.! w r '1QATEGORY,OE:"_CONSTRUCTION NA- F+ Residential,per unit,service included: Residential ❑Government ❑Commercial s'"rT4 JOE�SITE,:INF,ORMATION„AND fLOCATION' vr 1,000 sq. fr. or less(4) $147.50 $ Ave— Each additional 500 sq.ft.or portion Job site address: 7/O /i�J 4'yc A thereof - $ 27.50 $ City: 4, 1C/,( State: a< ZIP: ?1 7 y Limited energy(2) $ 35.00 $ Reference: Taxlot Each manufactured home or modular ,.. „,�� rv,€ i, v.� NI-0 .. , ��4' ;� dwelling service or feeder(2) . $ 69.00 $ 13gitESCRIPTIO WORK �,;,,: rts,a Services or feeders: installation, alteration, relocation i 6 4 L C i/, /0s' . S-/ .r - ._. / 200 amps or less(2) j $ 89.00 $ %I ; !/ ✓ / (4'LA i of ' c"rx thass`:W-'"4.3' .1:PR e.' RTY4OWNER'. ,;fi , . `i `x:pv`t',��,: i0l to 400 amps(2) $ 104.50 $ Name: (?_P ¢- So.e /-(Q/!,✓vJ 401 to 600 amps(2) $174.00 $ Address: 9'i o A/a / Cy ll/1(JQ- 601 to 1,000 amps(2) $225.50 $ City: S I.244_,h 9 V/f/c e,/ State: , ZIP:lf 7!( 77 Over 1,000 amps or volts(2) $516.00 $ Phone / / - ` - Fax: - - Reconnect only(2) $ 69.00 $ E-mail: Temporary services or feeders: installation, alteration, relocation ra L/�e -a net hi etx-0 ' to-2-r) 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)and 47•. (0(1 . 401 to 600 amps(2) $138.50 $ Signature: t 1 ! / Over 600 amps or 1,000 volts,see services or feeders section above s ist3.�°3. 'iniceONTRACTOR,INSTALLATIO- N i- ( �,�yr, �,. ¢°y ma, Branch circuits:new alteration, extension per panel Business name: C5/JeVe-r---- a. Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit 5 0 $ 6.50 $ 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 $ Si atureof signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $ g g P alteration,or extension(2) Each additional inspection:(I) $80.00 $ ;n1:1 ` „APPLICANTaUSETfn,.—'„ a'ttla+z i (A) Enter subtotal of above fees $ f i (Minimum Permit Fee$80.00) ,` (B)Enter 12%surcharge(.12 x [A]) $ (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): $ /e.lt I& 440-2584-7(4/01/2013/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. 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 F( , 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. • Print Name of Permit Applicant • /1 / ( / 13 Signature of Permit Applicant Date Permit#: S1ZY�D /oF- o; Address: 9/O /� �✓�r �:r still-91 Issued by: Date: ///1 // 3 859 • This Copy for Permit Offices •