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HomeMy WebLinkAboutPermit Electrical 2014-5-15 . SPRINGFIELD 225 Fifth St k i CITY OF SPRINGFIELD Springfield,OR 97477 t Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 • Fax: 541-726-3676 PERMIT NO: 811-SPR2 01 4-01 072 www.springfield-or.gov pe rmitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/15/2014 . EXPIRES: 11/10/2014 STATUS DATE: 05/15/2014 APPLIED: 05/15/2014 SITE ADDRESS: 1138 CUSTOM WAY,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703263408000 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New detached shop OWNER: LACEY GERALD R&LISA M Phone Number: ADDRESS: 1138 CUSTOM WAY SPRINGFIELD OR 97477 CONTRACTOR INFORMATION II Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER CCB 000000 08/01/2025 General Contractor OWNER CCB 000000 08/01/2025 L INSPECTIONS REQUIRED Inspections 4140 Underground Electric Underground Electric: Prior to cover 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. ft / nature 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- PERMIT SHALL EXPIRE IF THE WORK '0090. You may obtain copies of the rules by calling the center. (Note: the telephone i ORIZED UNDER .1-HIS PERMIT IS NOT number for the Oregon Utility Notification I'riMENCED OR IS ABANDONED FOR Center is 1-800-332-2344). ,' Y 180 DAY PERIOD. : • Springfield Building Permit 5/15/2014 11:46:56AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD „� O 2z5 Fifth St TRANSACTION RECEIPT SpringfieiQOR97477 �� 541-726-3753 OREGON 811-SPR2014-01072 www.springfield-or.gov 1138 CUSTOM WAY pennitcenter©springtield-or.gov RECEIPT NO: 2014001069 RECORD NO: 811-SPR2014-01072 DATE:05/15/2014 :DESCRIPTION 12 . ACCOUNT CODE/TRANS CODE _ ._._: AMOUNT DUE. 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 _PAYMENT TYPE. .PAYOR CASHIER:CCARPENTER'° ,COMMENTS' AMOUNT PAIDr ' Check LACEY GERALD R&LISA M 93.60 2193 TOTAL PAID: 93.60 • . . . . . Electrical Permit Application sPRiNGFID DEPARTMENT USE ONLY -::' .5%-%:,.$2r.,-459-r--....7ta.1•3-.V:.1-4:--rci-tr,---;:n2.5 - sert.,linn..:5•. r.arnt-:.:4-,0 E fr.,i; , ilarnit0FASPRINGEIELD,q0RECONFot Li,,trz,::-4,;:gatzAi Pennit n°'.. SA/ 2- —i ,a 7 225 Fifth Street•Springfield,OR 97477•Pk1(541)726-3753•FAX(541)726-3689 ' Date: ._, 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. -.:':::?; : ,!;;;ALOCAISGOVERNMENT:I.AFfPROVALN&,;"--;-: . :'. ,1:.:1::-7_VL:.6•=:"I ;‘::-;;;=.FEEISCHEDULE1 -_=:14je4.,1';-,:,::::,;:-C:t:iji Zoning approval verified? El Yes 111 No 'Nt!raer of irq0Cction psr:!Wi;(0;7: qt). '•"-;-ea-:- :: :;',cost CATEGORY!)0E,i.CONSTRUCTION[14:-.7.7=::eti;:-,,, .."-. '''''''t ''. '''': • • . " ' ' ' - u '. c.: Residential,per unit,service included: 0 Residential 0 Government n Commercial 1,000 sq. ft.or less(4) $147.50 $ ::::::::: ::JOBIL SITE:I NI FO.RMATION'IAND:1 LOCATION'i-IE` ::'.'':11:' Each additional 500 sq.ft or portion . Job site address: /73 6-- CJ 60-1 3.//7 - thereof - $ 27.50 $ City: 51/1/".5C Le 44 State: Ott ZIP: 9'7 y 77 Limited energy(2) $ 35.00 $ Reference: " Taxlot.: Each manufactured home or modular $ 69.00 $ dwelling service or feeder(2) : ':'tfs''tl-..??..:;!.'iDESCRIRTIONICIDF-1)NORK,-,•:":::'::"If-i.. * t:',1,;. Services or feeders: 7 ,-' --v-ui hr--2W Z.-1 7S installation, alteration, relocation .-)‘__- & ci 200 amps or less(2) I $ 89.00 $ .,,ii;t:ii'i'j'?,;tk±,i--:)T4,--:::PROF!ERTY;OWNER::`?,;; :,.,,•:,,::".,:1'2:0): '..,:a • 201 to 400 amps(2) 1 $ 104.50 $ Name: 6.c.,thtla. 12 1..1 e cre- . 401 to 600 amps(2) $174.00 $ Address: //3 b- c,,.s 4,--c-i—,-,,, 601 to 1,000 amps(2) $225.50 $ City: 40t/7 c.', 41 State: °A- ZIP: 9, 7777 Over 1,000 amps or volts(2) $516.00 $ Phone:01-5/V- 33811 Fax: - - Reconnect only(2) $ 69.00 $ Temporary services or feeders:installation, alteration, relocation E-mail: j4 cery 5-76 c. .pi c 4 i 1-. A L.'''. 200 amps or less(2) This instaliatio is being made on residential or farm property $ 69.00 $ owned by me or a member of my immediate family. This 201 to 400 amps(2) 5 96.00 $ property is not intended for sale, exchange, lease, or rent.OAR ,........._......A79.540(1)and. ,56Q1 :Jo,' 401 to 600 amps(2) $138.50 $ i .e Over 600 amps or 1,000 volts,see services or feeders section above Signature: t., ', r J,ZONI,•-..“'" NSTALLATION,-;-:'.: ;::"-,'':-::Fif;,:,--'1f:'.24:' Branch circuits:new alteration, extension per panel Busin nom41fri; dr b7L_ 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) i $ 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 $ Signal circuit or a limited-energy panel, Signature of signing supervisor: $ 80.00 $ alteration,or extension(2) . Each additional inspection:(1) $80.00 $ =.44.1gtkli.4t4MAilS.:01:Jeki,iitilSE `.;:tiiittA:kii:ti-3-4;.:::::',.: (A) Enter subtotal of above fees $ C-- (Minimum Permit Fee$80.00) (B)Enter 12%surcharge(.12 x[A]) • $ (C)Technology Fee(5%of[A]) $ cy tk.) TOTAL fees and surcharges(A through C): • $ 4:2596° 440-25844(4/01/2013/C0M) . 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`�Y 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. (4.7f4/c R L,iCC y Print Name of PermitApplicaP(t • gna •�/�• i Applicant Oat • Permit#: . Sit(, /v7 Z oF_ o Address: // 7 c.cs 723“ -- L.,/y ¢:`gulfs;: ' Issued by: Ca "-- Date: 77/ S// tP 859 This Copy for Permit Offices