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HomeMy WebLinkAboutPermit Electrical 2014-6-17 SPRINGFIELD -° 225 Fifth St t °tm CITY OF SPRINGFIELD Springfeld,OR 97477 o OREGON Phone: 541-726-3753 ` Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01310 www.springfeldor.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/17/2014 EXPIRES: 12/13/2014 STATUS DATE: 06/17/2014 APPLIED: 06/17/2014 SITE ADDRESS: 515 70TH ST,Springfield,OR 97478 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702352303900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install one ductless heat pump with two wall mounted air handlers OWNER: FERGUSON DOLLY J Phone Number: ADDRESS: 515 70TH ST SPRINGFIELD OR 97478 • CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED j • 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 • Notification Center. Those rules are set forth . • NOTICE' in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK 0090.in You cy obtain( Nop1es oft the rules by AUTHORIZED UNDER THIS PERMIT IS NOT number for the Oregon Utility Notification COMMENCED OR IS ABANDONED FOR • Center is 1-800-332-2344). - ANY 180 DAY PERIOD. . Springfield Building Permit 6/17/2014 11:20:03AM Page 1 of 1 • • • SPRINGFIELD CITY OF SPRINGFIELD 1 TRANSACTION RECEIPT Spnngfield,OR97477 �r 225 Fifth St OREGON 541-726-3753 811-SPR2014-01310 www.spnngfieldar.gov 515 70TH ST permitcenter @spnngfield-ocgov RECEIPT NO: 2014001322 RECORD NO: 811SPR2014-01310 DATE:06/17/2014 joWALTh18(o7t t ztr .,• ms 'A=ACCOUNT CODE/TRANS CODE "s: .-AMOUNT.DUE_-3 Balance of Minimum Electrical Permit Fees . 224-00000-426102 1004 - 20.00 Branch circuits without service or feeder-1st circuit 224-00000-426102 1004 62.00 Electrical Continuing Education fee 224-00000-425606 1032 2.50 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 ali ENTLIT E- PAYtaar R:,CcaRa irER - COMMENTS AMOUNTiFfAIp Credit Card FERGUSON DOLLY J - 98.44 057053 TOTAL PAID: 98.44 • • Electrical Permit Application DEPARTMENT USE ONLY ut 4ctlau-� cart ''fa `� '1aJ(I ��] dil�iL3� °.fry �Yl� •t . n Sly (3/v -- - r r-Jj� �.!.•_, r._ t 4,J �. L-----"; J Permit no.: 225 Fifth Street♦S rin field.OR 974770Pll(541)726-3753tFAX(541)7.6-3689 - - .f t ' I 5 � ? oaeGON Date: t/f 7// V . This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within ISO days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE . Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. eat Total CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑ Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq. 1t.or less(4) I $147.50 /5 1Q- sty. L Each additional 500 sq.ft.or portion $ 27.50 $ Job site address: r thereof City: 175 1el State: 0e. I ZIP:R 1111? Limited energy(2) $ 35.00 $ , Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) ��77 � / Services or feeders:installation,alteration.relocation .2d4-- you D/SGd3✓i✓G—C n j tin— _——__—_. 200 amps or less(2) $ 89.00 $ bit, PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $ • �L LI c-_V �'t�-COn 401 to 600 amps(2) $174.00 $ Name: L F' ! �av Address: SI —IOW) gli' 601 to 1.000 amps(2) $225.50 $ t F/-',r � � Over 1,000 amps or volts(2) $516.00 $ City: In fr( .1—x ti Slate: 0 a ZIP'• Phone: 2—6470. Fax:' - - Reconnect only(2) $ 69.00 $ • Temporary services or feeders:installation,alteration, relocation 1 E-mail: el0114/ccpo t 1 4177 1I. COIN _ This installation t' being made on r fential or farm property 200 amps or less(2)being 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)and4 .560(1). 401 to 600 amps(2) $138.50 $ Signature: � l� �i�j/( Over 6011 amps or LOOU volts,see services or feeders section above CONTRACT R INSTKeLATION Branch circuits:nett:alteration.extension per panel Business name: It inn ownit a.Fee for branch circuits with purchase of a service or feeder fee: .Address: _ Each branch circuit I $ 6.50 $ . City: Stale: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: Phone: - - I Fax: - - First branch circuit(2) / S 6 2 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, $ 80.00 Signature of signing supervisor: alteration,or extension(2) Each additional inspection:(I) $80.00 S APPLICANT USE C.r- et° (A) Enter subtotal of above fees S U (Minimum Permit Fee$80.00) . (B)Enter 12%surcharge(.12 x[A]) S l (C)Technology Fee(5%of[A]) s c f° 410-2584J(4/01;2013/COM) TOTAL fees and surcharges(A through C): $ vH% • : 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 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. bnt,L� PERRttc11 1 • Print Name of P�ermit Applica ,,// /0-/ ' 4144/4 ✓' 4747/T Signature Permit Ap scant Date • • • Permit#: _ S7! -aw OF_ O ] Tit Address: .57.1 74 )r / /1c cra 4.4 dI f Cp! 7I 717 F••' "vbr_» r: •• 8 Issued by:«� Date: a//7/74-7 69 • This Copy for Permit Offices