HomeMy WebLinkAboutPermit Electrical 2014-08-12W
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OREGON
v .springfieldocgov
CITY OF SPRINGFIELD
Building / Residential Permit
PROJECT STATUS: Issued
STATUS DATE: 08/12/2014
ISSUED: 08/12/2014
APPLIED: 05/16/2014
SITE ADDRESS: 1336 R ST, DPLX#, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703252301800
OWNER: FREEMAN ROBERT
ADDRESS: 3023 SKYVIEW LN
225 Fifth Sl
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permHcenter@spnngfield-ocgov
EXPIRES: 02/07/2015
SCOPE: Electrical Only
TYPE OF STRUCTURE: Residential
Phone Number: 541-521-8997
EUGENE OR 97405
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lic No Lie Exp Phone
General Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
By signature, I state and agree, that 1 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
HOME:
ICE:
TI IIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
CO IMENCED OR IS ABANDONED FOR
ANY 100 DAY PERIOD.
V0t
P(/ r)'
Spdngfield Building Permit
Date
ATTENTION: Oregon law re
follow rules adopted b quires you to
/
h ;
Notification Centel-. Those rules Utility
In OAR 952-001-0010 set
1•A'
forth
0090, YOU may obtain
throwes
b
copipy
o t e rues
Calling the center. (Note: the telephone
number for the Oregon Utility Notification
_ ,tiom
Center is 1.800-332-2344).
8/12/2014 1:35:45PM Page 1 of 1
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I DEPARTMENT USE ONLY
Permit no.:,. 5 / `r — /C/ V r
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
❑ Government I
❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 1331- V33
3 s �
Each additional 500 sq, ft. or portion
thereof L $ 28.00 $
Limited energy 36.00
Each manufactured home or modular
dwelling service or feeder (2) $ 71.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)
Reference: ? -753 -A5 -- 3
Taxlot.: fp d
DESCRIPTION OF WORK
W a rLci,
Co 7YLuc�d
PROPERTY OWNER r
Name: 0 £ ' 2f £)N
Address: 0 3 S I Y U l E tJ L N,
City: 5k
Stat e: CA
I ZIP: R 7 DS
Phone:5Yf Ski – V91 7
Fax: 9'1/1- l 3 - 3/ 7
E-mail: E£ nkiAy
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:Jjm 6C+,-tod{irie– LLG
Address: 449b
City: 0r (yc4 ti
State: 0(0-
ZIP: q7+ -?B
Phon . 54 6 012
Fax: -
E-mail: lm 6'/4(+__-( (O CJatC'C.+))h–,
CCB license no.:2 gp
BCD license no.:C,10
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing superviso?:. Jrr%—
440-2584-J (5/2120141C0?V0
FEE SCHEDULE
Number of inspections per item ()
Qty.
Cost
ea.
Total.
cost
Residential, per unit, service included:
1,000 sq. ft. orless (4) $151.00
Each additional 500 sq, ft. or portion
thereof L $ 28.00 $
Limited energy 36.00
Each manufactured home or modular
dwelling service or feeder (2) $ 71.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)
$ 91.00
$
201 to 400 amps (2)
$106.00
$
401 to 600 amps (2)
$178.00
$
601 to 1,000 amps (2)
$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)
$ 71.00
$
201 to 400 amps (2)
$ 98.00
$
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 1
1
$ 7.00 1
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) :TT$:
62.00
$
Each additional branch circuit 1
1
$ 7.00
$
Miscellaneous fees: service orfeeder not included
Each pump or irrigation circle (2)
$ 71.00
$
Each sign or outline lighting (2)
$ 71.00
$
Signal circuit or a limited -energy panel,
alteration, or extension (2)
$ 82.00
$
Each additional inspection: (1)
$62.00
$
APPLICANT ;USE' '
(A) Enter subtotal of above fees
(Minimum Permit Fee $82.00)
$�`T
(B) Enter 12% surcharge (.12 x [A])
$ 9 b
(C) Technology Fee (5% of [A])
$ 3
(D) Continuing Education Fee $2.50
TOTAL fees and surcharges (A through D):
$
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