HomeMy WebLinkAboutPermit Electrical 2016-12-01 (2)iP|'\ic:r€LDfftMffi CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2016-02983
r th shall remain at the ite until final
225 Fifth St
Springfield,OR 97477
Phone: 54'l-726-3753
IVR Phone: I -888-299-2821
Message Phone: 541 -7 26-3769
permitcenter@springf ield-or. govM.springfleld-or. gov
PROJECT STATUS
STATUS DATE:
lssued
12t01t2016
ISSUED:
APPLIED:
12t01t2016
12101t20'.16
EXPIRES:
IVR REF #:
05130t2017
81 1 021 02091 1
This
SITE ADDRESS: 2138 37th PL, Springfield, OR 97477
ASSESOR'SPARCELNO: 1702301202700
PROJECT DESCRIPTION: Low voltage for floor heat by Owner/GC
SCOPE:
ryPE OF STRUCTURE:
OWNER:
ADDRESS
BREEDEN BROS INC
366 E 4OTH AVE STE 250
EUGENE OR 97405
Phone Number:
CONTRACTOR IN FORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
ccB 27 1214412016 541-686-9431
INSPECTIONS REQUIRED
IVR Code / lnspection Type
4550 Limited Energy
or Signature
NOTICE:
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By signature' I state and agree, that I have carefully examined the completed application and do hereby certify that allinformation hereon is true and correct, and I furthei certify that any and all work performed shall be done in accordance with theordinances of the city of springfield and the Laws of the state or oregon pertaining to the work described herein, and that NooccuPANCY will be made of any structure without permission of tne-curient Development Department, Building safety. Ifurther certify that only contractors and employees who are in compliance with oRS chapter 701 will be used on this project. Ifurther agree to ensure that all required inspeitions are requested at the proper time, that each address is readable from the
:ffi:l [*ff"?:rmit card is located at the front of the propertv, ano the "pJou"a set of prans wiir remain on the site at ail times
For Commercial Plumbing permits, please call springfield utility Board water Division. Newbackflow prevention requirements may apply. (54i!li26_23g6.
This Permit, or copy thereof, sharl remain at the jobsite untirfinar inspection.
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Date
Springfield Buiiding permit
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CITY OF SPRINGFIELD
TRANSACTION RECEIPT
81 1-SPR2016-02983
2138 37th PL
225 Fifth St
Springfield,OR 97477
541-726-3753
M.springfield-or.gov permitcenter@springfi eld-or. gov
RECEIPT NO: 2016003215 RECORD NO: 81 1 -SPR2016-02983 DATE:12/0112016
Electrical Continuing Education fee
Other Limited Energy
State of Oregon Surcharge (12% ol applicable fees)
Technology fee (5% of permit total)
224-00000425606
224-00000-426102
821 -00000-21 5004
1 00-00000-425605
1032
1 004
1 099
2099
2.50
89.00
10.68
4.45
TOTAL DUE:106.63
Credit Card
083348
BREEDEN BROS INC 106.63
TOTAL PAID:106.63
DESCRIPTION AGCOUNT CODE/TRANS' CODE AMOUNT DUE
PAYOR
Electrical Permit A Iication SPFIIilGF:ELD
225 Fift h Street r Springfl eld. OR 91 41 1 . P H(547) ?26-3753 r F-d\ (541)1 26-3 689
&,:Permit no
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-
GOVERNMENT
Residential, per unit, service inciuded:
Job site address: Zljb j1a! Pq
Name ffoxE9
Address:3b E * 5-Ttr 25o
Miscellaneous fees: service orfeeder not inchded
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4 40-2 5 84 -J (4 / | /20 L6/ COM)
s
S
Date:
Zoning approval verified? ! Ves [] No
E Government f CommerciaiResidential
.JOB SITE INFORMATION D LOCATION
1{City: 3 trIEL,State: OR.Zrc
Ta,xlot.Reference:
ctE,c Tf
city: IZUqENE 9616'CR zw: n17O5
Fax:Phone:%l -6sb- 9451
E-mail:
Tnis mstallation is beng made on residential or farrn property
owned by me or a member of my rmmediate family. Thrs
is not intended for sa1e, exchange, iease, or rent. OAR
1) and 479.560(1).
properfy
479.s40(
Signature:
CONTRACTOR INSTALLATION
Busiaess name: 4gg A> ,*U'l€
Address
ZTPCity:Stare
Phone Fax:
E-mai1:
CCB license no.: Z7 BCD license no.
Signing supervisor's license no.
Prjat name of sign:ag supervisor: Jop, 'i-r,lor"tps*J
Signature of signrag s.rp"*iso., f
s163.001,000 sq. 11. or less (4)
Each addirionai 500 sq. ft. or porfion
thereof $ 31.00
s 39.00 SLimited energy (2)
Sdq)77 00Each manul-actured home or mociular
dwelling sewice or t-eeder (2)
Services or feeders: installatian, alteration, relocation
s 98.00 $200 amps or less (2)
201 to 400 amps (2)$114.00 $
$1s3.oo | $401 to 600 amps (2)
$249.00 s601 to 1,000 amps (2)
$Over 1,000 amps or voits (2)SsTo.oo
s 77.00 $Reconnect only (2)
Temporary services or feeders: installatio n, alteratio n, relocatio n
$200 amps or less (2)$ 77.00
$ 106.00 $20i to 400 amps (2)
s401 ro 600 amps (2)s1 54.00
Over 600 amps or 1,000 volts, see serwices 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 $ 7.oo
b. Fee for branch circuits without purchase of a service or tbeder fee:
First branch circuit (2)$ 77.00 $
Each additional branch circuit
Each pump or irrigation circle (2)
s
s$ 77.00
$ 7.oo
s 83.00 $Each sign or outline lighting (2)
",g,lu@frg)x{atioo, orexiension (2) \I )rnoo $
Each additional inspection; (1)s83.00 s
USE
(A) Enter subtotal of above fees
(Minimum Permit Fee $89.00)'5?
(B) Enter 12% surcharge (.12 x [A])$
(C) Technology Fee (s% of [A])$
(D) Continuing Education Fee $2.50 S2.50
TOTAL fees and surcharges (A through D)s roa9
OF
DESCRIPTION OF WORK
PROPERTY OWNER
FEE:
Total
costNumber oiinspections per item { }
S