HomeMy WebLinkAboutPermit Electrical 2014-5-16 SPRINGFIELD 225 Fifth St
' r CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01092
www.springfield-or.goy permitce nter @springtield-or.gov
PROJECT STATUS: Issued ISSUED: 05/16/2014 EXPIRES: 11/11/2014
STATUS DATE: 05/16/2014 APPLIED: 05/16/2014
SITE ADDRESS: 4878 E ST,Springfield,OR 97478 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1702332301405 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: E-Bathroom addition-132 SF
OWNER: HENRY JOHNNY D Phone Number:
ADDRESS: 4878 E ST
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor DAVID LEROY SYTSMA CCB 160739 07/15/2014 541-847-8560
General Contractor KELLY M KING CCB 65401 04/27/2015 541-520-1922
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
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
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
number for the Oregon Utility Notification
ANY 180 DAY PERIOD. Center is 1-800-332.2344).
Springfield Building Permit 5/16/2014 2:09:15PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
�,, TRANSACTION RECEIPT SpnngfieldOR97477
.OREGON 541-726-3753
811-S PR2014-01092
www.springfield-or.gov 4878 E ST permilcenter @springtield-orgov
RECEIPT NO: 2014001084 RECORD NO:811-SPR2014-01092 DATE:05/16/2014
DESCRIPTION :.__ ;•-. _ _ _ ; . L., ACCOUNT-CODE/TRANS,CODE_.m .;...„:_AMOUNT DUE. -7
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
LPAYMENT_T_YPE • PAYOR CASHIER:CCARPENTSR: COMMENTS - . -`AMOUNT PAID • . I
Credit Card DAVID LEROY SYTSMA 93.60
616180
TOTAL PAID: 93.60
Electrical Permit Application • sPw Nor Ego DEPARTMENT USE ONLY
"p-scr,,:tiiY e+v 'd Ii? L'l'HSrj �.�a ---i 't it -.rs'
1 enitY OFI�SPRINGE,lELD OREGO� . .. S/L(— /07 2
,,,A-Ate xt''"i-.'..;.r�'' . .;.,,-::vF2;�. .4,'..��.,,,,hi.':�kgi,h,p ,z,-. - j -u "9, ! / 'v,^': Permit •n0.:
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 -
_Date: S7/4. l A`-/
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.
-.L'`OCAL GOVERNMENTrAPPROVAL - `- /:::',:):: :',:;i:::,./;,- 5 : FEES CHEDULE 6 `:-
Zoning approval verified? Yes No ::i,..,„ ost :,Total.!'.
g pp ❑ ❑ Number of∎nspecttons per ttem O Qty ea , :cost -'
'CATEGORY.-OF. CONSTRUCTION
Residential,per unit,service included:
❑Residential ❑Government ❑Commercial
JOB SITE INFORMATIONWAND LOCATION ` 1,000 sq.ft.or less(4) $147.50 $
� Each additional 500 sq. ft.or portion
Job site address: H, 91 6 ' S� thereof $ 27.50 $
City: Sp' j10 l State:b/� ZIP:nj �7Y Limited energy(2) $ 35.00 $
Referen e: / "\ Taxlot.: Each manufactured home or modular $ 69.00 $
;'.. ;SDESC RI/P�TlON ,OF-WORK•_? dwelling service or feeder(2)
e?_ �'7�-��>"—� +'\V bN Services or feeders: installation, alteration, relocation
O I'll 200 amps or less(2) $ 89.00 .$
11,4 PROPERTY'OWNER ;1, 201 to 400 amps(2) $ 104.50 , $
Name: /fn( /2 y 401 to 600 amps(2) $174.00 $
Address: 1/7W a _ ( 601 to 1,000 amps(2) $225.50 $
City:67-0-5 F.c_1 State: ar I ZIP:.j 7 7/ Over 1,000 amps or volts(2) $516.00 $
Phone: - - I Fax: - - _ Reconnect only(2) 1 $ 69.00 $
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) $ 96.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.5400)and 479.5600). 401 to 600 amps(2) $136.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
am' x'N''F,'GON,T,RACTOVNSTALL'ATION. - Branch circuits:new, alteration, extension per panel
Business name: j)h( 1; S y �S 07-04-- a.Fee for branch circuits with purchase of a/service or feeder fee:
Address: �`D t /bcC 1/2 -- Each branch circuit i/ $ 6.50 $
City: fi b A,'
k.2i _ ! _ I State: OA_ I ZIP: 7 7L.5t b.Fee for branch circuits without purchase of a service or feeder fee:
Phoney-4/ 1 744q Fax: --- First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.:/4O 77 3T I BCD license no.: C. a-a Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 27 D3 ck Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: S l'a i p Each sign or outline lighting(2) $ 69.00 $
iR
C Signal circuit or a limited-energy panel,
Signature of signing supervisor: alteration,or extension(2) $ 80.00 $
e
Each additional inspection:(1) $80.00 $
' leelz - _ .APPLICANT USE
(A) Enter subtotal of above fees Sid ma
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $ g °
(C)Technology Fee(5%of[AD $ Y/
TOTAL fees and surcharges (A through C): $ 93fU
440-2584-I(4/012013/COM)