HomeMy WebLinkAboutPermit Electrical 2014-09-17ELD
225 Fifth St
FOREGON
CITY OF SPRINGFIELD
Springfield,OR97477
:Fa'`YPhone:
541-726-3753
Building / Residential Permit
Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01373
%wi .springfield-or.gov
permilcenter@springfield-orgov
PROJECT STATUS: Issued ISSUED: 09/17/2014 EXPIRES: 03/16/2015
STATUS DATE: 09/17/2014 APPLIED: 06/25/2014
SITE ADDRESS: 2056 HARBOR DR, Springfield, OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1803112203600 TYPE OF STRUCTURE:
PROJECT DESCRIPTION: E - New SFD- replace existing MF home on site
OWNER: CALOIA NEAL JOHN & HEATHER RENEE Phone Number: 541.915-9030
ADDRESS: 2066 HARBOR DR
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
Electrical Contractor DAVID LEROY SYTSMA CCB 160739 07/15/2016 541-847-8560
INSPECTIONS REQUIRED
Inspections
4225 Service or Feeder
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. 1 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
ATTENTION: Oregon larr/ rtuBs you to
follow rule6 adopted by the Olegon Uiility
Notification Center. Those lul r I > 2-001
in OAR 952-001-001 o throrujh OAii 965?_ 001-
0090. You may obtain copies of the rules by
Calling the center. (NoteCl the telephone
nurrlbe h CentisO19
1e600 332-23,14).itication
Date
PLRI,/iii SHAL l IXPIRF IF'IHE WORK
�fT+ a un�Drf3 rIN PERMI is nioI
OR fS Al3AfgDONvD FOR
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Springfield Building Permit 9/17/2014 2:00:25PM Page 1 of 1
Electrical Permit Application SPRINGFIELD
225 Fifth Street♦Springfield, OR 97477+PH(541)726-3753*FAX(541)726-3689 t �'
DEPARTMENT USE ONLY
Permit no.: 67 73
Date: / V
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
Q Residential
10 Government I
❑ Commercial
JOB SITE INFORMATION AND LOCATION '.
Job site address:20
City:
State:
ZIP:
Reference: X3/122—
Taxlot.: d
DESCRIPTION OF WORK'
Limited energy (2)
PROPERTY OWNER
Name: Ja'
Address: Fr2.(3C!'—
city:
State: OQ—
ZIP:<;;>Y7
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: ' .
Address: r
City:
tate:
I ZIPa
Phone: # — (�
Fax:
E-mail:
CCB license no.:
BCD license no.:
Signing supervisor's license no.: go 0
Print name of signing supervisor:
Signature of signing supervisor:
w� t prv�iu%
440-2584-J (5/21/2014/COh4)
FEE SCHEDULE
Number of inspections per itemO
11 Qty.
Cost -
ea.
Total
I 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)
$ 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)
$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)
$ 98.00
$
401 to 600 amps (2)
$142.00
1 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, exteruionperpanel
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
$
Each additional branch circuit
Miseelinneous 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)
$82.00
$
APPLICANT USE.
(A) Enter subtotal of above fees
(Minimum Permit Fee $82.00)
$ �7
(B) Enter 12% surcharge (.12 x [A])
$ j
(C) Technology Fee (6% of [A])
$ I 1�
(D) Continuing Education Fee $2.50
$2.60
TOTAL fees and surcharges (A through D):
$ 9 16 21