HomeMy WebLinkAboutPermit Electrical 2014-6-2 SPRINGFIELD 225 Fifth St
k,: AL CITY OF SPRINGFIELD Springfield,OR97477
v Phone: 541-726-3753
- OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01189
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/02/2014 EXPIRES: 11/28/2014
STATUS DATE: 06/02/2014 APPLIED: 06/02/2014
SITE ADDRESS: 4501 FRANKLIN BLVD,SPC#14, Eugene,OR 97403 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703344400200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Electrical repairs-see 811-SPR2014-01130
OWNER: COUNTS LIVING TRUST Phone Number:
ADDRESS: 2140 ROCKY LN
EUGENE OR 97401
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
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 • THIS P E:
Notification Center. Those rules are set forth , THIS PERMIT SHALL EXPIRE W 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 6)2/2014 11:20:39AM Page 1 of 1
SPRINGFIELD.--.0' CITY OF SPRINGFIELD
225 Fifth St ,
a. ya
TRANSACTION RECEIPT 5pringf6-375897977
OREGON
541-726-3753
11- 811-SPR2014-01189
www.springfield-or.gov 4501 FRANKLIN BLVD. SPC 14 permitcenter @springfield-or.gov
RECEIPT NO: 2014001195 RECORD NO:811-SPR2014-01189 DATE:06/02/2014
LDESCRIPTION - ACCOUNT CODE/TRANS_CODE ,_ -AMOUNT DUE_
Electrical Continuing Education fee 224-00000-425606 1032 2.50
Electrical Inspection For Which No Fee is Specifically Indicated 224-00000-426102 1075 82.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
L
PAYMENTTYPE__PAYOR CASHIER:ccARPENTER _.` COMMENTS __� • AMOUNT PAID
___
Credit Card DAVID LEROY SYTSMA 98.44
312002
TOTAL PAID: 98.44
Electrical Permit Application :DEPARTMENT USE ONLY
• SPfi1NGPI8LG i
''CITY OPSPRINGFIELEr OREGON Permit no.: 5/`{7127
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: 6(2/I 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.
%s LOCALy'GOV,ERNMENT-iAPP.ROVAL ` -1" . x.; z , „ „ ,' r:ft%FEE:?SCHEDULE cti w- T
Zoning approval verified? ❑ Yes t "Cost
❑No ,;Numbervofinspecttons er item Total
'`.f ,,,)''CATEGORY,OF CONSTRUCTION ,$ ? ) ty , ,: :-`P ��n Qty. lea
"` Residential,per unit,service included:
❑ Residential ❑Government ❑Commercial 1,000 sq. ft. or less(4) $151.00 $
,.,u€€. .JO&SITE',INFORMATION:AND;LOCATION f:,r,,, ;
Each additional 500 sq. ft.or portion
Job site address: 1 j D) R�v„ 6A g AA t hereof $ 28.00 $
City: y'St'I L-/'0-110$ tate: e=fi -ZIP: Limited energy(2) $ 36.00 $
References ` f is Taxlot Each manufactured home or modular
a4`^1r ` �1C NISCRIP Is ', OF�WORKfrr,,. z i ,.;, dwelling service or feeder(2) $ 71.00 $
/ V' ( 9,--..ti
Services or feeders: installation, alteration, relocation
( 200 amps or less(2) $ 91.00 $
•,`a,' ,: 7r,o 4 -,PROP.ERT.Y':OWNER ` =•y'",''r r�, 7$;`i,,,,u$. `r 201 to 400 amps(2) $106.00 $
Name: �,(i, „gig,`l. f , C-L,,, 1 f t, 401 to 600 amps(2) $178.00 $
Address:j go ih l� h^St r.79.4�/ - 601 to 1,000 amps(2) $230.00 $
City: 5 ,r/),,,„ 7` �S/tape: I ZIP: f Over 1,000 amps or volts(2) $527.00 $
O r� Reconnect only(2) $ 71.00 $
Phone: - - 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) $ 71.00 $
owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 98.00 $
property is not intended for sale,exchange, lease,or rent. OAR
479.540(1)and 479.5600). 401 to 600 amps(2) $142.00 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
.=1 „x CONTRACTOR INSTALLATION ,,'",lez-'nt7; Branch circuits:new, alteration, extension per panel
' Business name: 0,9 n-U t co_ 51-F (' c_.:s 9_ a. Fee for branch circuits with purchase of a service or feeder fee:
Address: pot l t p 7 ,4 kg r „"G /T Each branch circuit $ 7.00 $
City:)\ nits/me__Y f /1 /State:DA ZIP: 72''15- b.Fee for branch circuits without purchase of a service or feeder fee:
Phoney .9/.. 7.,8j 2f D Fax: - - First branch circuit(2) ( $ 62.00 $
E-mail: Each additional branch circuit $ 7.00 $
CCB license no.://t i'3 f I. BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: .2 Q 3 D Each pump or irrigation circle(2) $ 71.00 $
Print name of signing supervisor: p ,L,Pf Q s fr Each sign or outline lighting(2) $ 71.00 $
// /J Signal circuit or a limited-energy panel,
Signature of signing supervisor: cpee��/ Jn /i, alteration,or extension(2) $ 82.00 $
'��%�/ `e If", Each additional inspection:(1) $82.00 $
117254-. , r i' r'APP,LICANtiftE).1 ..e-}';,, t1
(A) Enter subtotal of above fees $ ��t
(Minimum Permit Fee$82.00)
(B)Enter 12%surcharge(.12 x[A]) $ 9
. (C)Technology Fee(5%of[A]) $ {i
(D)Continuing Education Fee$2.50 $2.50
TOTAL fees and surcharges(A through D): - $ 9O
440-2584-1(5/21/2014/COM)