The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2014-2-19 1. SPRINGFIELD"—."' 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 T - t Phone: 541-726-3753 i. • OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00365 www.springfield-or.gov permitcenter @springfield-or.gov • •PROJECT STATUS: Issued ISSUED: 02/19/2014 - EXPIRES: 08/18/2014 STATUS DATE: 02/19/2014 APPLIED: 02/19/2014 SITE ADDRESS: 642 28TH ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703361111601 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Service mast repair • OWNER: HENNING ERICH R Phone Number: ADDRESS: 642 N 28TH ST SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER - CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 4200 Reconnect Service • 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 Contractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- NOTICE: THIS PERMIT mint EXPIRE IF THE WORK 0090. You may obtain copies of the rules by calling the center. (Note: the telephone AUTHORIZED UNDER THIS NDONED FOR O-., number for the Oregon Utility Notification COMMENCED OR IS ARAN Center is 1-800-332-2344). ANY 180 DAY PERIOD. Springfield Building Permit 2/19/2014 10:48:05AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD k22s PiRn St lcOR TRANSACTION RECEIPT 225Fifthd.oR97477 '` OREGON 541-726-3753 811-S P R2014-00365 • www.springfield-or.gov 642 28TH ST permiteenter @springfield-or.gov RECEIPT NO: 2014000351 RECORD NO:811-SPR2014.00365 DATE:02/19/2014 LDESCRIPTION_- - ` = ,. ' ACCOUNT CODE/TRANS CODE _:...,; ' -.T.,AMOUNT,DUE,J Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00 Service reconnect only 224-00000-426102 1004 69.00 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 L„PAYME — :- _ 'AMOUNT PAID 47 NT�TYPE,_TPAYORcasweR:ccnRPeRrErs 'w_COMMENTS_�_�r -_. _`'`' Cash HENNING ERICH R 93.60 TOTAL PAID: 93.60 • • • • • Electrical Permit Application SPRINGFIELD DEPARTMENT USE ONLY CITY OF SPRINGFIELD, OREGON 0 Permit no.: //y_"?%f 225 Fifth Street♦Springfield,OR 97477♦P11(541)726-3753♦FAX(541)726-3689 Date: 2-//5 //C/ 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 Total ea. cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: '.Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq. ft.or less(4) $134.00 $ Each additional 500 sq.ft.or portion Job site address: 691_ y_g TM. thereof $ 25.00 $ City jP3) CCf)re... State0Q ZIP:7777. Limited energy(2) $ 32.00 $ Reference: /7o'356// Taxlot: //a9/ Each manufactured home or modular $ 63.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) R,Bevil �g' ,y � IN-AY/ZC( /lag Services or feeders:installation,alteration,relocation �q f' �l �l 200 amps or less(2) $ 81.00 $ PROPERTY OWNER 201 to 400 amps(2) $ 95.00 $ Name:fir/c1../ /44 /Y/ y 401 to 600 amps(2) $158.00 $ C 4J2 Z Address: a 601 to 1,000 amps(2) $205.00 $ Chy 40/A fl % 7/ Fax:hO, State:00f zip:97y77 Over 1,000 amps or volts(2) $469.00 $ 7 -9/ ��! Phon�l S - - Reconnect only(2) $ 63.00 $ E-mail:/t' .Y)9cj 6�i A'o'f, )V1L_ co/! Temporary services or feeders:installation,alteration,relocation This installation is being made on residential or farm property 200 amps or less(2) $ 63.00 $ owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 87.00 $ property is not intended for sale,exchange,lease,or rent. OAR 479.540(1)and 479.5 00 l 401 to 600 amps(2) $126.00 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above CO I ff,,RACTOR INSTALLATION Branch circuits:new,alteration,extension per panel Business name:(/61--/N' a.Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit $ 6.00 $ • City: State: . ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: Phone: - - Fax: - - First branch circuit(2) $ 55.00 $ E-mail: Each additional branch circuit $ 6.00 $ CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included Signing supervisor's license no.: Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: Each sign or outline lighting(2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ Signature of signing supervisor: alteration,or extension(2) Each additional inspection:(I) $58.00 $ ^/ APPLICANT USE �/ /� (A) Enter subtotal of above fees $ DrJ ./�� /„` 3 / //^ (Minimum Permit Fee$58.00) / U/ (B)Enter 12%surcharge(.12 x[A]) $ q41 (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): $ 4 361° 440-2584-i(9/08/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#F 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. Print Name of Permit Applicant • Signature of 'ennit Applicant Date • / r Permit#: i -°° 3 6 J )Address: 4jjçj .,o I^ • vtom#:: Issued by: CC. Date: / is's 9 This Copy for Permit Offices