HomeMy WebLinkAboutPermit Electrical 2014-09-09SPRINGFIELD
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OREGON
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Building / Residential Permit
PERMIT NO: 811-SPR2014-01947
225 Fifth Sl
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@spdngfield-on9ov
PROJECT STATUS: Issued ISSUED: 09/09/2014 EXPIRES: 03/07/2015
STATUS DATE: 09/09/2014 APPLIED: 09/09/2014
SITE ADDRESS: 175 DEADMOND FERRY RD, Springfield, OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703140001300 TYPE OF STRUCTURE: Residential
----PROJECT- DESCRIPTION:--Nowcadet-heater-and-
OWNER: BENJAMIN W JORDAN FAMILY TRUST
ADDRESS: 522 BROOKDALE AVE
Phone Number:
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
Electrical Contractor PACIFIC ELECTRIC LLC CCB 199661 04/22/2015 641-206.7700
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 Slate 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
constructs 1.
Owner or Contractor Signature Date
ATTEN(ION: 01monn I :v i_,MI61es you to
follow rules adol t ud'oy dte Orogen Utility
Notification Center. Those I ides 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 Notification
Center is 1-800-332-2344).
<<:
!S PERA4IT SI SALE EXPIRE IE THE WORK
IORILED UNDER THIS PERMIT IS NOT
{_NCID OR IS ATIANDONED FOR
`'n DAY PERIOD.
Springfield Building Permit 9/9/2014 2:00:22PM Page 1 of 1
CITY OF SPRINGFIELD
LRIGFIELD----
TRANSACTION RECEIPT
225 FiSt
Spnngfeld,OR 97477
OREGON
811-SPR2014-01947
541-726-3753'
w w.spdngfield-0r.gov 175 DEADMOND FERRY RD
permitcenter@spnngfield-or.gov
RECEIPT NO: 2014001978 RECORD NO: 811-SPR2014-01947
DATE: 09/09/2014
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Balance of Minimum Electrical Permit Fees 224-00000-426102
1004 13.00
Branch circuits without service or feeder - 1st circuit 224-00000-426102
1004 62.00
Branch circuits without service or feeder- each additional 224-00000-426102
1004 7.00
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
,MEWt,
Credit Card Allan D. Sustello / Pacific Electric LLC
98.44
087887
TOTAL PAID: 98.44
�' • I 1 1
7ITYQF SPRINGFIELD OREGON
DEPARTMENT USE ONLY
Date: '" t
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
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Jobsiteaddress: 1oco_N�)4 Fetr
"
city-. -rf- —
_Stale: - _
ZIP: -- -
Reference: '
_
Taxlot.:
SC IPTION :OF WORK
a1 W Iffier- — IleaJ aJL v)&Q
__$-36.00--$-------
PROPERTY :OWNER
Name: �
Address:v
w
City: `
State; ZIP:
Phone:
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: 6- e t � % C. e 1'ecyfi
Address: q9`3" _ �_"_ Lk
t
City:
State: Cg.
ZIP: %-7t(U
Phone: '94 Z06 -;7'7G0 1
Fax:
E-mail:
CCB license no._license no.: - �f
Signing supervisor's license no.: �(ab 5
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (5/21/2014/COM)
FEE SCHEDULE
Number of inspections per item O -Qty.
east
cost
Residential, per unit, service included:
1,000 sq. ft. or less (4)
$161.00
$
Each additional 500 sq. ft. or portion
thereof
$ 28.00
$
--Limited -energy (2)-_-- _-...___._
__$-36.00--$-------
Each manufactured home or modular
dwelling service or feeder (2)
$ 71.00
$
Services or feeders: installation, alteration, relocation
200 amps or less (2)
$ 01.00
$
201 to 400 amps (2)
$106.00
$
401 to 600 amps (2)
$178.00
$
I to 1,000 amps (2)
$230.00
$
Over 1,000 amps or volts (2)
$627.00
$
Reconnect only (2)
$ 71.00
$
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) -
$ 71.00
$
201 to 400 amps (2)
$ 96,00
$
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 perpanel
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)
'
$ 62.00 1
$
Each additional branch circuit
'
$ 7.00 1
$
Miscellaneous fees: service or feeder 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)
$82.00
$
APPLICANT': USE;
(A) Enter subtotal of above fees
(Minimum Permit Fee $82.00)
$ r
(B) Enter 12% surcharge (.12 x [A])
$
(C) Technology Fee (6% of [A])
$ t�
(D) Continuing Education Fee $2.50
$2.60
TOTAL fees and surcharges (A through D):
$ s
I