HomeMy WebLinkAboutPermit Electrical 2014-3-28 SPRINGFIELD • 225 Fifth St •
CITY OF SPRINGFIELD Springfield,OR 97477
� OREGON Phone: 541-726-3753 •
Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
• PERMIT NO: 811-SPR2014-00670
www.springfeld-or.gov permitcenter @sprtngfield-ar.gov
PROJECT STATUS: Issued ISSUED: 03/28/2014 EXPIRES: 09/24/2014
STATUS DATE: 03/28/2014 APPLIED: 03/28/2014
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SITE ADDRESS: 1823 S 61ST ST,Springfield,OR 97478 SCOPE: Electrical Only •
ASSESOR'S PARCEL NO: 1802033400120 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: E-Cricuit alteration by owner
OWNER: FULLER COURTNEY M Phone Number:
ADDRESS: 1823 S 61ST ST
SPRINGFIELD OR 97478
OWNER: WOOD DANIEL N JR • Phone Number:
ADDRESS: 1823 S 61ST ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic-No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
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INSPECTIONS REQUIRED
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Inspections
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.
� )-07 3 — 14
Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
NOTICE: •
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 95n Center. Those ghes are t
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 1-800-332-2344). •
Springfield Building Permit 3/28/2014 1:06:56PM Page 1 of 1
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SPRINGFIELD —` CITY OF SPRINGFIELD
iCk .^ 225 Fifth'St
OREGON TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
811-SPR2014-00670
www.spdngield-or.gov 1823 S 61ST ST permitcenter @spnngield-or.gov
RECEIPT NO: 2014000680 RECORD NO: 811-SPR2014-00670 DATE:03/28/2014
DESCRIPTION ,,a_ lia 'V + - ' !1 iza =_ACCOUNT-'CODE,TRANSTCODE -;_ a .N ANIOUNTsDUE tti
Electrical Inspection For Which No Fee is Specifically Indicated 224-00000-426102 , 1075 80.00
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
.,........._._,m,_,_ . ,.._... , .,iiil,m,r,..,...W.T g- p_pi.. ^ - AMOUNT'PAIU_ rSr�maae=smaiun
PAYMENTd+Rf PE'��PAY,ORTcasRIER:,ccaaaeNrER"a� e,�I�COMMENTS : .,;:� ,. .. .�� a-_ .,. �.,1� r?an�rt���ram ;
Credit Card FULLER COURTNEY M 93.60
211394
TOTAL PAID: 93.60
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.Electrical Permit Application DEPARTMENT'USE ONLY
_'M1 3
CITYE OF,SPRINGFIELD, OREGON
as r 4, �3. r , r. .,.. ,- . 9: * .4 PermitnoPW -67a
225 Fifth Street•Springfield,OR 974779H-1(541)726-3753o FAX(541)726-3689 SAY
Date: 3/21//t
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.
:: isLOCAL;GOVERNMENT;iAPPROVAL,-f f0„ ;t,„ t; y F,EELSCHEDULE,Vik'i,ii`*y„"ytA` f.5At:
Zoning approval verified? El Yes ❑No Numb r o"f(nspectigpss•pe'tteO i- Qty: " east , ' •oostl '
'ti`e ` + CATEGORY$'OF?,CONSTRUCTION L „ 1 s.
Y"- Residential,per unit,service included: •
'Residential I ❑Government I ❑Commercial 1,000 sq.ft.or less(4) $147.50 $
r JOBtlaSITE:.INFORMATION" AND L'OCATION'.'._
Each additional 500 sq. ft.or onion
Job site address: \C6�p 3 l g\- thereof q p - $ 27.50 $
City:3Q f 1(∎ f-\e 1a State: ziP:a")u Limited energy(2) $ 35.00 $
Reference: / Z. (-9-734,/ Taxlot :ect/2O Each manufactured home or modular $ 69.00 $
hk',3>rs1DESCRIPTION OF.):-WORK'; s iS;kf ,y, dwelling service or feeder(2)
n,�'� /t c/ //� Services or feeders: installation, alteration,relocation
/7Z dive 200 amps or less(2) $ 89.00 $
F:i :i 4?;2r E,RPROPERTYm WNERF!1h ' xte1±,Nat . 201 to 400 amps(2) $ 104.50 $
Name: CAU 1 rU\ jY i, Iafl �,ODOd 401 to 600 amps(2) $174.00 $
Address: 124-2) \S C�1 601 to 1,000 amps(2) $225.50 $
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City: nt(k ad State: I ZIP:G)�c/ Over 1,000 amps or volts(2) $516.00 $
.�` r a Vey- . --)414 I Reconnect only(2) $ 69.00 $
Phone: 111 �_ll O b Fax:
E-mail: (ward- code m5O . Cj(Y1 Temporary services or feeders: installation, alteration, relocation
This installation is being made 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
479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $
Signature: d el Over 600 amps or 1,000 volts,see services or feeders section above
x'i a'ii't;" iii i;i1. CO: I RRACTOR INSTALLATION ;t4 ?`. err ` Branch circuits:new alteration, extension per panel
Business name. SLID/”1 a.Fee for branch circuits with purchase of a service or feeder fee:
Address: (/'" Each branch circuit if $ 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 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) . $80.00 $
t w < r'1 i `AREICANT USE''.F',yf' ' M-;a
(A) Enter subtotal of above fees i
(Minimum Permit Fee$80.00) $
(B)Enter 12%surcharge(.12 x[A]) $ 5
(C)Technology Fee(5%of[A]) $ Li eQ
TOTAL fees and surcharges(A through C): $ /34.9
440-2584-1(4/012013/COM)
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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:
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Name CCB# Expiration Date
will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or •
K� 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.
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Print Name of Permit Applicant
3 -D<6 -1c/
Signature of Permit Applicant Date
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Permit#: . 5/Y — 71;1
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Address: — :rit _-,c;;:.
674/7 a -4�'�
Issued by: effrz-- Date: T/2 / c/ aa
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• This Copy for Permit Offices