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Home My WebLink AboutPermit Electrical 2014-07-28SPRINGFIELD 11: , %7lam+ OaEGOtJ www.springfield-or.gov PROJECT STATUS: Issued CITY OF SPRINGFIELD Building / Residential Permit PERMIT NO: 811-SPR2014-01612 STATUS DATE: 07/28/2014 SITE ADDRESS: 1123 N ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703264401300 OWNER: WELLS TIM R & RHONDA L ADDRESS: 1123 N ST 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@sprin gfield-or. gov ISSUED: 07/28/2014 EXPIRES: 01/23/2015 APPLIED: 07/28/2014 SCOPE: Electrical Only TYPE OF STRUCTURE: Residential Phone Number: SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone Electrical Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 4225 Service or Feeder 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 Safely. 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 NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001.0010 through OAR 952.001. 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notiffcatioq Center is 1.800.332.2344). Springfield Building Permit 7/28/2014 11:20:55AM Page 1 of 1 RECEIPT NO: 2014001608 RECORD NO: 811-SPR2014-01612 DATE: 07/28/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Electrical Continuing Education fee 224-00000-425606 1032 2.50 Services 200 amps or less 224-00000-426102 1004 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 91.00 10.92 Technology fee (5% of permit total) 100-00000-425605 2099 4.55 TOTAL DUE: 108.97 PAYMENT TYPE PAYOR CASHIER: CCARPENTER COMMENTS "AMOUNT PAID WELLS TIM R & RHONDA L 064350 TOTAL PAID: 108.97 CITY OP SPRINOFIELD LISNGFIELD `„ TRANSACTION RECEIPT 225 Fffth St Spnngfield,OR 97477 OREGON 811-SPR2014-01612 541-726-3753 vnvv.spnngfield-or gov 1123 N ST permilcenler@springfield-or.gov RECEIPT NO: 2014001608 RECORD NO: 811-SPR2014-01612 DATE: 07/28/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Electrical Continuing Education fee 224-00000-425606 1032 2.50 Services 200 amps or less 224-00000-426102 1004 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 91.00 10.92 Technology fee (5% of permit total) 100-00000-425605 2099 4.55 TOTAL DUE: 108.97 PAYMENT TYPE PAYOR CASHIER: CCARPENTER COMMENTS "AMOUNT PAID WELLS TIM R & RHONDA L 064350 TOTAL PAID: 108.97 Electrical Permit Application sPq,a�F;E o 225 Fifth Street Springfield, OR 97477oPH(541)726-3753oFAX(541)726-3689 "- - DEPARTMENT USE ONLY Permit no.: ��-/y �7' Date: Z 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 Zoning approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential I ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION Job site address: , V thereof Stateol2 -.._ZIP: 9;> Reference: Taxlot.: DESCRIPTION OF WORK $ 36.00 $ PROPERTY OWNER Name!17 C / Address: r �j City: State: CJ ZIP: -7 %, Phone: -027 Fax: - E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560 1 . Signature: CONTRACTOR .INSTALLATION. Business name: �' �✓��Z — Address: City: State: ZIP: Phone: Fax: E-mail: CCB license no.: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: 440-2584-J (5/212014/CO4 FEE SCHEDULE Number of inspections per item O Qty. Cost - Total ea, cost Residential, per unit, service included: 1,000 sq. ft. or less (4) Each pump or irrigation circle (2) $151.00 $ Each additional 500 sq. ft. or portion Each sign or outline lighting (2) $ 28,00 $ thereof Signal circuit or a limited -energy panel, alteration, or extension (2) $178.00 $ Limited energy (2) Each additional inspection: (1) $ 36.00 $ Each manufactured home or modular $ 71.00 $ dwelling service or feeder (2) $ 71.00 $ Services or feeders: installation, alteration, relocation 200 amps or less (2) Each pump or irrigation circle (2) $ 91.00 $ 201 to 400 amps (2) Each sign or outline lighting (2) $106.00 $ 401 to 600 amps (2) Signal circuit or a limited -energy panel, alteration, or extension (2) $178.00 $ 601 to 1,000 amps (2) Each additional inspection: (1) $230.00 $ Over 1,000 amps or volts (2) $527.00 $ Reconnect only (2) $ 71.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) e I $ 71.00 I $ 201 to 400 amps (2) $ 08.00 $ 401 to 600 amps (2) $142.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit I I $ 7.00 I $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 62.00 Each additional branch circuit ++i_671-+000011$$1 $7. Miscellaneous fees: service orfeeder not included Each pump or irrigation circle (2) (B) Enter 12% surcharge (.12 x [A]) $ 71.00 $ Each sign or outline lighting (2) (D) Continuing Education Fee $2.50 $ 71.00 $ Signal circuit or a limited -energy panel, alteration, or extension (2) $ 82.00 $ Each additional inspection: (1) $82.00 $ (A) Enter subtotal of above fees (Minimum Permit Fee $82.00) $ J (B) Enter 12% surcharge (.12 x [A]) $ Q (C) Technology Fee (5% of [A]) $y (D) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through D): ------------- $/00 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 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. Print Name of Permit Applicant Signait Applicant Date Permit #: S/ V— L6 / Z Address: � � � Al —� 7 /&—f=T p��i✓�h�z�� ort -y S7y� Issued by: Date: 2 / This Copy for Permit Offices