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Home My WebLink AboutPermit Electrical 2014-5-16 SPRINGFIELD ---- 225 Fifth St CITY OF SPRINGFIELD Springheld,OR 97477 " t._ Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01093 www.springfield-or.gov parmitcenter @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: 1175 CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703264412000 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Add 200 Amp panel OWNER: RAY JOSHUA D Phone Number: ADDRESS: 1175 CENTENNIAL BLVD SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION • Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER GCB 000000 08/01/2025 INSPECTIONS REQUIRED I Inspections 4225 Service or Feeder 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 \NOR( follow rules adopted by the Oregon Utility NOTICE: SNA«EXPIRE IF THE Notification Center. Those rules are set forth THIS PERMIT is NOT in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER 0090. You may obtain copies of the rules by IS ABANDONED FOR calling the center. (Note: the telephone COMMENC AY PERIOD. number for the Oregon Utility Notification ANY 180 D Center is 1-800-332-2344). Springfield Building Permit 5/16/2014 2:28:16PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD • kON TRANSACTION RECEIPT 541-726-3753 811-SP R2014-01093 www.springfield-or.gov 1175 CENTENNIAL BLVD permitcenter @springfield-or.gov RECEIPT NO: 2014001085 RECORD NO:811-SPR2014-01093 DATE:05/16/2014 (DESCRIPTION - - • - ' �.j ACCOUNT_CODE/TRANS CODE_.'_ t___,,__.AMOUNTDUE. : Branch circuits with service or feeder each circuit 224-00000-426102 1004 78.00 Services 200 amps or less 224-00000-426102 1004 89.00 • State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20,04 Technology fee(5%of permit total) 100-00000-425605 2099 8.35 ------� --- ------� TOTAL DUE: 195.39 • ..PAYMENT-„TYPE--,_ -.PAYOR CASHIER:CCARPENTER_ - COMMENTS,_ ,, , ____. ___ _,_AMOUNT PAID Credit Card RAY JOSHUA D 195.39 025794 TOTAL PAID: 195.39 • • Electrical Permit Application , DEPARTMENT USE ONLY SPRi1NGF1ELO i.,-. .r- = � , w wl --,rr x r E'nxr. .,5. +1. ,� ,.',-.. -} :t 6 -R CITQYI OF�SPRINGEWED'rOREG-OW _: " 1 C 1&& S/y - / 0V E Permit no.: F w..; c.2r R?- fa'�_ . .,.-,,.. .:.�:w+,.�,"�„Cfdmr.v :,".�;•E —,. :.gy . * —7�y� �j y+', 225 Fifth Street•Springtield,OR 974774PH(541)726-3753•FAX(541)726-3689 /l ' Date: 37/ o / / q 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. KLOCALU,GOVERNMENT APPROVAL `.!:; , FEE; SCHEDULE -;\"- Zoning approval verified? ❑Yes ❑No "Number of ins ecttons er item Cost Total- _ P per O % Qh' ea .. . cost,,-. CATEGORY; OF, CONSTRUCTION 1 ��JJ Residential,per unit,service included: Residential ❑Government ❑Commercial / \ .. 1,000 sq. fr. or less(4) $147.50 $ JOB;,SITE.INFORMATION ;AND:LOCATION.,' _ Each additional 500sq.fr.orportion Job site address: 17ccex1�P�lni4k (151d, thereof $ 27.50 $ City: S \S :,: State:67._ ZIP: Cf 7 971 Limited energy(2) $ 35.00 $ Referencd: I Taxlot.: Each manufactured home or modular $ 69.00 $ `DESCR[P.TION.�OF ;WORK dwelling service or feeder(2) `:T" Services or feeders: installation, alteration,relocation 200 amps or less(2) / $ 89.00 $3--, ss i r.: ', '- PROPERTY'OWNER ,_ (t, _ 201 to 400 amps(2) $ 104.50 $ 401 to 600 amps(2) $174.00 $ Name: b� AS\ � .. �l` ! ..�1 A I _(I 601 to 1,000 amps(2) $225.50 $ Address: \ `e City: S , O K. State: ZIP: (^ l✓ r Over 1,000 amps or volts(2) $516.00 $ a Reconnect only(2) $ 69.00 $ Phone:�� Fax: - - _l_ q Temporary services or feeders: installation, alteration, relocation E-mail: CGl '`0�1(\L1C 1�Q CrG1�.lt�{Y� This installation ss--bbeing made on residential p�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: dt4 £ A I . tk,,,A Over 600 amps or 1,000 volts,see services or feeders section above ,,t ,i;2ONv,•CTO'=1NSTA ',j'TION. ^ ) Branch circuits:new, alteration, extension per panel �- Business name: S a.Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit j t-f $ 6:50 $ 2/ 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 $ Si afore 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 $ Sgit r°=;-s' iAPPLICANT§USE iii ::s3-i (A) Enter subtotal of above fees (Minimum Permit Fee$80.00) $/G 7 E'Ll—. (B)Enter 12%surcharge(.12 x[A]) $ 20 (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges (A through C): $ ( ' j 440-2584-I(4/012013/COM) , Y 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, mebhanical, 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 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. \ ) bSilnota‘ U iLid/ _ Print Name of Permit Applicant ___ , •si, ture of Permit Applicant 3 . Date Permit#: I -1 — /0? 5 o f 0 �_ Address: //75 7v I"^v'n_ �.wa; Issued by: —Date: ,S//(v//V • /859 • This Copy for Permit Offices •