Loading...
HomeMy WebLinkAboutPermit Electrical 2013-12-16 SPRINGFIELD 225 Fifth St r '^ CITY OF SPRINGFIELD Springfield,OR 97477 ,;( Let Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02676 www.springfield-or.gov permitcenter @springfiel d-or.gay PROJECT STATUS: Issued ISSUED: 12/16/2013 EXPIRES: 06/14/2014 STATUS DATE: 12/16/2013 APPLIED: 12/16/2013 SITE ADDRESS: 2168 OTTO ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703244306900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Two Circuits for Kitchen OWNER: BURNS MICHAEL L Phone Number: ADDRESS: 2168 OTTO ST SPRINGFIELD OR 97477 _ CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER CCB 000000 06/01/2025 INSPECTIONS REQUIRED • Inspections 4500 Rough Electrical Rough Electric: Prior to Cover 4999 Final Electrical Final Electric: Wien 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. Owner or C ntractor Signature Date ATTENTION: Oregon law requires you to NOTICE: follow rules adopted teToe rules es are tfort THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344y Springfield Building Permit 12/16/201 10:41:56AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD hfl; .. 225 Fifth St o EGON TRA NSACTION RECEIPT Springfield.OR97477 541-726-3753 811-SPR2013-02676 • www.springfield-ar.gov 2168 OTTO ST permitcenter @springfield-or.gov RECEIPT NO: 2013002670 RECORD NO: 611-5PR2013-02676 DATE: 12/16/2013 (DESCRIPTION _ACCOUNT CODE/TRANSCODE___ __..AMOUNT DUE -..: Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00 Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50 Branch circuits without service or feeder-each additional 224-00000-426102 1004 6.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 PAYMENT TYPE L; =.PAYOR_, CASHIER:JLARSON COMMENTS .44 AMOUNT PAID_', •_ . ' '' Check BURNS MICHAEL L 93.60� 1617 TOTAL PAID: 93.60 • . Electrical Permit Application + DEPARTMENT USE ONLY y S - • = ,t t•_ 'Lr +X.712.7,43 SPRINGFIELD ;CITY ORSPRINGFIELD, OREGONh :l 11 �� permit no.:E i 1 —2m(3 — 02670 225 Fifth Shcet•S im field,,Oil 97477•1'1t(5417263753,FA\ 541726-3689 `ld p ) FAX(541)726-3689 OREGON / 2- 6 b .- Date:. This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 clays of issuance or if work is suspended for 180 days. . LOCAL GOVERNMENT APPROVAL _ FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Nmuher of inspections per item ( Qy. Cost Total ca. cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: %Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 000 sq. fl.or less(4) $147.50 $ �/ B O C� Each additional 500 sq. H.or portion $ 27.50 $ Job site address: n J thereof - City: S(r^t� 'e 0GY State: 0€ ZIP: 91,07 Limited energy(2) $ 35.00 $ Reference: Tax lot.: Each manufactured home or modular $ 69.00 DESCRIPTION OF WORK dpvcllH I.service or feeder(2) lee 7/ I f Services or feeders: installation,alteration.relocation CeG Kr CI49JIA 200 amps or less(2) 5 89.00 $ PROPERTY OWNER 20110400 amps(2) $ 104.50 $ A� Name: /rl 1c it„eel eav is 40110600 amps(2) $174.00 $ Address: ,2,./4, 5 . © 5/ 601 to 1,000 amps(2) $225.50 $ City: so4 el 1 I State: ne ZIP: Q'7`>'77 Over 1,000 amps or volts(2) 5516.00 $ Phone: Ty/ Reconnect only(2) $ 69.00 $ 1 z z o 78 Fax: - _ E-mail: Temporary services or feeders: I,slalln(iwl.alteration, relocation This installation is being made on residential or hum properly 2110 amps or less(2) S 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(I)and 479.5 0(1 401 to 600 amps(2) $138.50 $ Signature: ��/,/ �t.p Over(i011 amps or 1.000 colts,see services or feeders section above • CONTRACTOR INSTALLATION Branch circuit s:new, alteration,extension per panel Business name: Cr/Rs,' r/R F),ekn C a. Fee for branch circuits with purchase of a service or(ceder fee: Address: ( 0, eac 7 i oo 2— Each branch circuit I 1 $ 6.50 $ s b. Fee for branch circuits without purchase of a service or feeder fee: City: S >rt,� �ld State: ©/Z ZIP:If'Jy�,� Phone: ,e%7/- 229— *03 Fax: - - Fist branch circuit(2) $ 60.50 $ E-mail: Each additional branch circuit $ 6.50 $ CCB license no.: BCD license no.: Miscellaneous fees:.service ni.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 alimited-energy panel, $ 80.00 $ g- f alteration.or extension(2) Each additional inspection:(I) $80.00 $ APPLICANT USE (A) Enter subtotal of above lees $ (Minimum m Permit Fee$80.00) (B) Enter l2%surcharge(.12 x[A]) $ (CI Technology Fee(5%of[A]) $ • 440-2584-)(4/0112013/COM) TOTAL fees and surcharges(A through C): $ 7 3 (7.7 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 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 ,'cltaei RG( VIA 5 Print Name of Permit Applicant • /z//G//3 Signet e of Permit Applicant Date Permit#: o_F Address: Q: peg •• Issued by: Date: 859 • This Copy for Permit Offices