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HomeMy WebLinkAboutPermit Electrical 2014-1-8 • SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 l Phone: 541-726-3753 OREGON Building I Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00037 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 01/08/2014 EXPIRES: 07/07/2014 STATUS DATE: 01/08/2014 APPLIED: 01/08/2014 SITE ADDRESS: 2612 F ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703361112900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace 200A service OWNER: DOWNEY PATRICK STUART&GLORIA M Phone Number: ADDRESS: 1286 BOND LN EUGENE OR 97401 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 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. 9747A erg iai/ne 4//y 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 Notifica?ion Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT ooCkA.Ry u2may obt an copies ofthe uses 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 1/8/2014 9:48:38AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St OREGON TRANSACTION RECEIPT Spdngfield,OR 97477 541-726-3753 811-SPR2014-00037 www 99999field-ar.gov 2612 F ST permitcenter @springfield-or.goy RECEIPT NO: 2014000032 RECORD NO:811-SPR2014-00037 - DATE:01/08/2014 ]o1 .'ftitiojto] h-kLv..i`:.r=-� t,yr,", ,,,t"-- .r ttet-'."*_'-i . .t' . , ACCOUNT_COD tRANS CODE' .'-rr.'- F. `C.AMOUNT DUEL I 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 I AYMENT4YPE P. YOR graiiiranenn rigs COMMENTS _ AMOU rnOlD Credit Card DOWNEY PATRICK STUART&GLOP 104.13 094063 TOTAL PAID: 104.13 . 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. Print Name of Permit Applicant ) , //�/� Signature of Permit Applicant Date • • Permit#: 51q—60077 °F • Address: '267/2- /' f/ a.ielpt � r_ -= v..a: Issued by:azt, . Date: // ,fey �ra9g • This Copy for Permit Offices Electrical Permit Application DEPARTMENT USE ONLY ; SPNINGFIELD£'E_'®�Ij -' .•_.. _ t lSPA-':�:f"st. '+.i Ti " wit5,:t vf".1 . v Y3 IT�Y ORSPRINGN1'>�LIKOREGON / Le ' 0 o17 ar,,,t s+%''a, »sT „' e. `.. , .:A,:r? e, , e nit st, - Permit no.: ( U 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 a�'""` Date: //eF / 1/V 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. „S,, ;a,LOCAL, GOVERNMENVAFPROVAL w NV.,%1VFEE'l.....SCH E DU LiErr.PalgtV:1-ctiVT9 g approval ❑ Yes p p it() � Qty`�i Cost ''Total.. Zonm a royal veri5ed? ❑No ,number afsms rec[ions- T!...1 ": s yn ...CATEGORY.,.OF ,CONSTRUCTION „ '''' -- ..:'';: o.z nea v:. .,:'cost.,i. Residential,per unit,service included: ©ikt idential ❑Government ❑Commercial .,h„z. J OBIS IT Eli N FO RMATION AN D;;LOCATIO N.:r , ,.; 1,000 sq. h. or less(4) $147.50 $ Each additional 500 sq.ft.or portion Job site address: 20/2. 5/ thereof $ 27.50 $ City:5, ,-,, C, 0 1, State: 0 Q' ZIP: } Ny 7 7 Limited energy(2) $ 35.00 $ Reference: t Taxlot.: Each manufactured home or modular u i ,1a1;.,-x.c =^ dwelling service or feeder(2) $ 69.00 $ �t,..' � ...:. ;SD ESCRIPTION OF.,WORK' ,. ,, .,, sR s', eC 061 AL 1n p cst/J! (;i, Services or feeders: installation, alteration, relocation 200 amps or less(2) / $ 89.00 $ F - h� zzm:PROPERTY OWNER, a , 4 -`au 201 to 400 amps(2) $ 104.50 $ Name: PPk t (7l or,t'-_ A t-c)n"t1 401 to 600 amps(2) $174.00 $ Address: ,p) ,2 F .�--)-' 1 7 1 601 to 1,000 amps(2) $225.50 $ . City:, nn it '� State: C C ZIP: /2{ 17 Over 1,000 amps or volts(2) $516.00 $ ' Phone:S1)E 2222( - 3 300 Fax: - - Reconnect only(2) $ 69.00 $ E-mail:n Temporary services or feeders: installation, alteration, relocation Y' ��cOlAino'� @ms n..Co>� This instal alien is being t1lade on residential or farm property 200 amps or less(2) $ 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 479.5400)an 479.560(1). 401 to 600 amps(2) $138.50 $ Signature:�(�-t L ,v�hd`"� Over 600 amps or 1,000 volts,see services or feeders section above ��';- t--1xCON71 RACTOR;INS TALLAlf,ION' :""_f-i Branch circuits:new alteration, extension per panel Business name: i J/6/ -7"■., JJJ a.Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit $ 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 licenseno.: 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, Signature of signing supervisor: alteration,or extension(2) $ 80.00 $ Each additional inspection:(1) $80.00 $ :I iw-c^.s i')»`7# -`,APPLICANT USE +", f` § ; k w g (A) Enter subtotal of above fees $ ��/ (Minimum Permit Fee$80.00) (B)Enter 12%surcharge(.12 x[A]) S /Q L>1 (C)Technology Fee(5%of[A]) $ re-5- TOTAL fees and surcharges(A through C): S/ 4/L1- • 440-2584-1(4/01/2013/C0M)