HomeMy WebLinkAboutPermit Electrical 2014-5-20 •
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SPRINGFIELD • 225 Fifth St
-L-- CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01103
www.spnngfield-or.gov permitcenter @spungfield-or.gov
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PROJECT STATUS: Issued ISSUED: 05/20/2014 EXPIRES: 11/15/2014
STATUS DATE: 05/20/2014 APPLIED: 05/20/2014
SITE ADDRESS: 2600 WAYSIDE LN,Springfield,OR 97477 SCOPE: Bathroom
ASSESOR'S PARCEL NO: 1703224402600 TYPE OF STRUCTURE: Residential .J
PROJECT DESCRIPTION: E-Bathroom remodel
OWNER: ADRIANCE WALTER M Phone Number:
ADDRESS: 2600 WAYSIDE LN
SPRINGFIELD OR 97477
OWNER: WALL RUNGRAWE Phone Number:
ADDRESS:. 2600 WAYSIDE LN
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor OWNER COB 000000 08/01/2025'
Electrical Contractor OWNER COB 000000 08/01/2025
Plumbing Contractor OWNER COB 000000 08/01/2025
Mechanical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
4500 Rough Electrical Rough Electric: Prior to Cover
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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.
// 1 - 577,0/22/Y. •
Owner or/ontractor Signature • Date
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• ATTENTION: Oregon law requires you to
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follow rules adopted by the Oregon Utility
NOTICE: Notification Center. Those rules are set forth •
THIS PERMIT SHALL EXPIRE IF THE WORK 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 5/20/2014 10:01:24AM Page 1 of 1
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SPRINGFIELD'–_. CITY OF SPRINGFIELD
225 Fifth St
tt £GON TRANSACTION RECEIPT Spdngfleld.OR 97477
541-726-3753
811-SPR2014-01103
www.springfleld-or.gov 2600 WAYSIDE LN permitcenter @springfield-or.gov
RECEIPT NO: 2014001097 RECORD NO:811 SPR2014-01103 DATE:05/20/2014
DESCRIPTION f fl& -'.^t":1 at ,,. a
�,: .i »�CODE/TRANS CODE -',�_.� .�'..�AMOUNTfMt.
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
. _ . COMMENTS g ..r- AMOUNT4PAID -3, G.." ti
_,P -"'-casxiea(.ccaRRExrER �.;,<._^,:COMMENTS "=:. E_`.,e,�_—
Credit Card ADRIANCE WALTER M _ 93.60
• 224266
TOTAL PAID: 93.60
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Electrical Permit Application DEPARTMENT USE ONLY
SPNINGFIELD [/ qn
wi,"..v v{- .�Y...,c€ .---z£`�i acc-- 's 3 . a .2ty 11w 4- - E E �/ f //QJ`
ICITVOESPRINGS1ELD;`ORE(iOW ;ate"" � Permit no.:
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: 5720// it
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.
. i'LOCAL,GOVERNMENT APPROVAL ",; - :+/ .`'.FEE- SCHEDULE N;; ;1:,;1:.'-`';',
Zoning approval verified? ❑ Yes ❑No Number of inspections per item() .:Qty = Cost .;Total'
CATEGORY: OF, CONSTRUCTION .. . Sea. cost ,.
Residential,per unit,service included:
Residential ❑ Government ❑Commercial
JOB SITE.INFORMATION'-°AND.iLOCATION7 1,000 sq fr. or less(4) $747.50 $
Each additional 500 sq.ft or portion
Job site address: 2CQa (,JAs-(S;‘d Q L P thereof $ 27.50 $
City: 5er,4.r)p_Gp I State: Q&- ZIP: 97777 Limited energy(2) $ 35.00 $
Reference:/ /Ol '2.2L(Zi Taxlot Q 7.,6 Co Each manufactured home or modular
dwelling service or feeder(2) $ 69.00 $
tDESGRIPTION OF WORK ='
k 0 7 Cfrc[ e, der{yin_ I C/(•,,' • f- Services or feeders: installation,alteration,relocation
7 200 amps or less(2) $ 89.00 $
,, i, PROPERTY'OWNER . 201 to 400 amps(2) $ 104.50 $
Name: -,I fl-1 f;At)(� I 401 to 600 amps(2) $174.00 $ .
Address: Lt1n —/"t`IL 1r p 601 to 1,000 amps(2) $225.50 $
City: gpj)0q,1 -(Q \A t State: Q 2 ZIP:CI7t./77 Over 1,000 amps or volts(2) $516.00 $
S�{/ (2) 7' d I ' I Reconnect only(2) $ 69.00 $
Phone: / 0 Fax: - -
E-mail:
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) 5 96.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.5400)and 479/.`.0(1). 401 to 600 amps(2) $138.50 $
/ `//!
Signature I Over 600 amps or 1,000 volts,see services or feeders section above
.i 'r's41<-,° CONT/pCTORc INSTALLATION , _ Branch circuits:new alteration, extension per panel
Business name: /7�„//A� J� a.Fee for branch circuits with purchase of a service or feeder fee:
Address: v Each branch circuit .9 $ 6.50 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) l $ 60.50 $
i. 91
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 $
gn gn g P alteration,or extension(2)
Each additional inspection:(1) $80.00 $
;45" ,rMM't-;AP_FLICANT'AOSE ;``f ;4A
(A) Enter subtotal of above fees $ ^A��
(Minimum Permit Fee$80.00) sU
(B)Enter 12%surcharge(.12 x[A]) • $ 906,0
(C)Technology Fee(5%of[A]) - $ Yes)
TOTAL fees and surcharges(A through C): $ 9 Y6
440-2584-1(4/012013/COM)