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HomeMy WebLinkAboutPermit Electrical 2014-4-25 SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfeld,OR 97477 ht 5c `rY Phone: 541-726-3753 °aE�°" Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00917 wv w.springfield-ar.gov permitcenter @springfield-or.goy PROJECT STATUS: Issued • ISSUED: 04/25/2014 EXPIRES: 10/22/2014 STATUS DATE: 04/25/2014 APPLIED: 04/25/2014 SITE ADDRESS: 1236 JANUS ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703342200208 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Kitchen rewiring OWNER: KIMBALL THERESA M 8 GEORGE C Phone Number: . ADDRESS: 1236 JANUS ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION b Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electncal Contractor OWNER CCB 000000 08/01/2025 _ INSPECTIONS REQUIRED 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 pe it •.rd is located at the front of the property, and the approved set of plans will remain on the site at all times during ..nstru tion. / ■ tilt.�I J .�gY / O P r er • Contracto, ignatu - Date • ATTENTION: Oregon law requires you Uti to lity follow rules adopted by the Oregon Notification Center. Those rules are 52-oOth ,Lit ICE: in OAR 952-001-0010 through OAR 952001- HIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED 0090. You may obtain copies of the rules by calling the center. (o�tU il'dy Notification COMMENCED OR ISRABANDON D FOR NOT number for the Oreg ANY 180 DAY PERIOD. Center is 1-800-3 tilitY 4). Springfield Building Permit 4/25/2014 2:30:40PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St OV- TRANSACTION RECEIPT Spnngfield,OR 97477 541-726-3753 OREGON 811-SPR2014-00917 www.spnngfield-or.gov 1236 JANUS ST permitcenter©spnngfield-or.gov RECEIPT NO: 2014000927 RECORD NO:811-SPR2014-00917 DATE:04/25/2014 o • a , ,.,,: _-,,;k3_` t r k � lntEACCOUNT.CODE/TRANS'CODES'. c`ra': :aAMOUNrDUE, 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 P,AYMENT4TYPE P,,AYOR casiimiMEaisori'... COMMENTS' .:.M `, iAM9UNT_PAIU,^ Credit Card OWNER 93.60 306949 TOTAL PAID: 93.60 • . 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: 4K 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 1 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. adi, 4e-.-- 4 . / Print Na of Pe' it Applicant '/ / ' •nat; of-e t App off, - Da - • Permit .> ( #: 7 "S / 7 of /207 3 4(As a�;--% .1 Address: F/_ a�?��s?1c 0 ci ,13 0—A._ 7cz 77 rn , ': • Issued by: C-41 —Date: /2 6 1//-/ r- 59 This Copy for Permit Offices Electrical Permit Application DEPARTMENT USE ONLY :msµ ifv; ww7, -r�¢�gp :Q7 y-- . "_ ,;(;"1:...:: SPRINGFIELD C Y O SPRINGFIEED', OREGO f . = , :,. S/�/— 9,i 'L' Permit no.: ,r «% a 225 Fifth Snret•Spy inghcld.OR 97477•P110-11)726-3753•F AX(541)726-3689 �`• OREGON Date: 10 17 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. 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: frintesidential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION 000 sq. 11. or Icss(4) $147.50 t, 3 U S Mach additional 500 sq. ft.or portion $ 27.50 $ Job site address: �— Urcreof City:���if((Z./' "State: ZIP:q���/// Limited energy(2) $ 35.00 Reference: fa.dot.: / Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK hdwelling service or feeder(2) Services or feeder's: installation, a0crulion, reloculiun —. _-. — 200 snaps or Icss(2) $ 89.00 a PROPERTY 0 , R 201 to 400 amps(2) S 104.50 $ Name: , c___ Grp/� 401 to 60(1 amps(2) $174.00 .$ e — 601 to 1,000 amps(2) $225.50 $ Address: / i� — �•a� Over 1,000 amps or volts(2) $516.00 S City: .lnil A '• ale:cpp ZIP:C1 77 Phone�-'�y Q s �y� /,� - _ Reconnect only(2) $ 69.00 l) 97- / s 774x.: E-mail: Temporary services or feeders: ie.rtalloliou. alteration, relDealinn This installation is being made on residential or farm property 200 amps or lax.(2) $ 69.00 ' $ owned by nr .r a member of my i mediate family. This 201 to 400 amps(2) $ 96.00 $ property is no intended for sale,e 'change, lease. rent. OAR 479.540(I)m'. ,79.560(I). / '_ / 401 to 600 amps(2) $138.50 $ gnatufe: / •A (n Over 600 amps or 1.000 volts,see services or feeders section above " TRACT R IN'TALLATI I N Branch circuits: epic alteration, extension per panel • Business name: (/ / L"-21_, a. Fee for branch circuits with purchase ofa service or feeder lee: Address: Each branch circuit S 6.50 $ City: State: ZIP: h. Fee for branch circuits-without purchase ofa service or feeder fee: Phone: - - Fax: - - First branch circuit 12) I $ 60.50 S E-mail: Each additional hranch circuit S 6.50 5 CCB license no.: BCD license no.: Miscellaneous lees:.service or_feeder not included Signing supervisor's license no.: Each pump or irrigation circle(2) _ S 69.00 $ Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $ Signal circuit or a limited-energy panel. 5 80.00 $ Signature of signing supervisor: alteration. or extension(2) Each additional inspection: (I) $80.00 . $...................-...- APPLICANT USE (A) Enter subtotal of above fees - (Minimum Permit Fee$80.00) (B) Enter 12%surcharge(.12 x All (C)Technology Tee(5%ofie\i) $ cI • TOTAL fees and surcharges(A through C): $al --- 440-2584-114(01/2013/COM) S ( e