HomeMy WebLinkAboutPermit Electrical 2014-6-17 •
SPRINGFIELD 225 Fifth St
Firt' -a- CITY OF SPRINGFIELD Springfield,OR 97477
(`l� Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01262
www.springfield-or.gov permitce nter @s pri n gfield-or.goy
PROJECT STATUS: Issued r ISSUED: 06/17/2014 EXPIRES: 12/13/2014
STATUS DATE: 06/17/2014 APPLIED: 06/10/2014
SITE ADDRESS: 4501 FRANKLIN BLVD,SPC#15, Eugene,OR 97403 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703344400200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New service for pump- see s14-11891 s14-1130-FLOOD HAZARD AREA ZONE A: grade at
this location is—1ft below BFE,and placing the service on the existion pole at—4ft above
• grade will satisfy flood protection requirements, per Jim Donovan-see attached
documents.
OWNER: COUNTS LIVING TRUST Phone Number:
ADDRESS: 2140 ROCKY LN
EUGENE OR 97401
L CONTRACTOR INFORMATION
I
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor DAVID LEROY SYTSMA CCB 160739 07/15/2016 541-847-8560
INSPECTIONS REQUIRED ` -
Inspections
4140 Underground Electric Underground Electric: Prior to cover
•
4225 Service or Feeder
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
E;
In OAR 952-001-0010 through OAR 952-001- ; PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone ORIZED UNDER THIS PERMIT IS NOT
number for the Oregon Utility Notification tiAENCED OR IS ABANDONED FOR ••••
Center is 1-800-332-2344). 180 DAY PERIOD.
Springfield Building Permit 6/17/2014 1:54:24PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR97477
3 OREGON 541-726-3753
^
811-S P R2014-01262
www.springfield-or.gov 4501 FRANKLIN BLVD. SPC 15 permitcenter @springfield-or.gov
RECEIPT NO: 2014001326 RECORD NO:811-SPR2014-01262 DATE:06/17/2014
[DESCRIPTION: = 4: ACCOUNT CODE/TRANS.,CODE ` F .AMOUNT DUE
:.:';
Branch circuits with service or feeder each circuit 224-00000-426102 1004 7.00
Electrical Continuing Education fee 224-00000-425606 1032 2.50
Services 200 amps or less 224-00000-426102 1004 91.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 11.76
Technology fee(5%of permit total) 100-00000-425605 2099 4.90
TOTAL DUE: 117.16
PAYMENTTYPE_ __ _.PAYORCASHIER:CCARPENTER COMMENTS =- _. - AMOUNT PAID ', v _:_j
Credit Card DAVID LEROY SYTSMA 117.16
517145
TOTAL PAID: 117.16
Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
CTIT OFSPRINGFIELD OREGON `, , '� - permit no.: 0/ L —
G' s^`:m s -ca.:-. `,1 bon.,WeiSdx : 1 ti .e gwj, l.3;;.id.F tr a ,C-/ 7 — / -(
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 -
Date: OfriLl
. 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. `
LOCAL?GOVERNMENT. APPROVAL „ , `.!, r-FEE SCHEDULE -
Zoning approval verified? ❑ Yes ❑No 'Number of inspections per Item () Qty. Cost Total,,
. °., , ��ea..,. ,.cost ;
r
`CATEGORY OF 'CONSTRUCTION
Residential,per unit,service included:
[Residential ❑Government ❑ Commercial
JOB:'SITE. INFORMATION:i AND;LOCATION' ', 1,000 sq. ft. or less(4) $151.00 $
Each additional 500 sq.ft.or portion
Job site address: Lf co I frtAAy j/it) 5(L)Q9 thereof $ 28.00 $
City: Stater ZIP: 774 63 Limited energy(2) $ 36.00 $
Referenc(,g7 c f Cf L( I Taxlot /I Q 0 Each manufactured home or modular
,-;,; , ',;.DESCRIPTION.;,OF WORK; t t , -! dwelling service or feeder(2) $ 71.00 $
{ DO.�J^ fl 1) it V n/ Services or feeders: installation, alteration, re location
200 amps or less(2) $ 91.00 $
,.;j, ,i:]1 :'.RROPERTY'_OWNER ?t:$'r -? ?'`^-` 201 to 400 amps(2) , $106.00 $
Name: 05-t24,77 401 to 600 amps(2) $178.00 $
Address: 27 L/d /G : "' ! 6.4‘./ 601 to 1,000 amps(2) $230.00 _$ —
City: ,f l �7"
�/ , State: j— ZIP:9 9€17 Over 1,000 amps or volts(2) - $527.00 $
Phone:" - ,- Fax: - - Reconnect only(2) $ 71.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less(2) ( $ 71.00 $
owned by me or a member of my immediate family. This 201 to 400 amps(2) 5 98.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1)and 479.560(1). 401 to 600 amps(2) $142.00 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
ti_a .:- CONTRACTO(R� INSTALLATION"r ,z' y 4K Branch circuits:new alteration, extension per panel
Business name: n At �,s i11 51,1d-5-7m a.- a.Fee for branch circuits with purchase of a service or feeder fee:
Addresss:-t 2,?) I //2 Dj 9 7770,0A p J Each branch circuit ( $ 7.00 $
City: Tam (�e__ State: Do, ZIP:,1 b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:,5 l yq_. Fax: - - First branch circuit(2) $ 62.00 $
E-mail:) L Each additional branch circuit $ 7.00 $
Miscellaneous fees:service or feeder not included
CCB license no.:/(0 7.3¢ BCD license no.:� .,�j(y � I
Signing supervisor's license no.: •y o3 a7 Each pump or irrigation circle(2) $ 71.00 $
9l J
Print name of signing supervisor: p i q 0;c9 rS ig Each sign or outline lighting(2) $ 71.00 $
/� / / Signal circuit or a limited-energy panel, $ 82.00 $
Signature of signing supervisor: aivk lb ...,,.-.1. alteration,or extension(2)
Each additional inspection:(1) $82.00 $
x ,, ,.,, APPLICANT`USES, - �'' t .tir"r `, ;,:
(A) Enter subtotal of above fees
(Minimum Permit Fee$82.00) $waP
(B)Enter 12%surcharge(.12 x[A]) $ /�/"(7(0
(C)Technology Fee(5%of[A]) $ [lam
(D)Continuing Education Fee$2.50 $2.50
TOTAL fees and surcharges(A through D): $/()J
440-2584-1(5/212014/C0M)