HomeMy WebLinkAboutPermit Electrical 2008-10-28
,., J CITY OF SPRrnGEIELD, OREGON
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SPRA:G::~.'.. ~~ .
~ .6!.. !)ATE-1O~_f!,~
~ \OV' . ~OURCE M.. ~r>:-
Date. 10 - Z 7-08
225 FJFI'H STREET. SPRINGFIELD, OR 97477.. PH:(541)72&-,753 . F,4X, (541)72&-3689
ELECTRICAL PERMIT APPliCATION
City Job NUmber (Ooll>A.z-ooP-O/S7S
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LEGAL DESCRIPTION:
\703252.2> 60700
JOB DESCRIPTION:
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days. .
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact' d Home or
Modular Dwelling Service or
Feeder
$121.00
$.22.00
$57.00
1'""i1'S,wt!>"Hi%"'0iW\jMj"ll;A"t'1~:(!MYil~~'~;;N'~"4~"'~~'11~i:,i;,;;t;WW",';A1loi41omi>w:: ,
"OONJR'AeceR'lNSTvfL!:!tflilON:ONhyj;,"
2. "ti"""*~'r.S~OIiPj((i<j:.1,i';"'(@i!iliffi~tB1il",1r+,tI;7;;;;;'i '" _."~"!',"":;s.!;\,-",."E0>-,18,,;;;,,.m;
200 Amps or less I $ 73.00
201 Amps to 400 Amps $ 86.00
401 Amps to 600 Amps $143.00
requires 96U}ljmps to 1000 Amps $186.00
.~'nr)N: Oregon ~aV-:"'e orego~\~RO Amps/Volts $426.00
ro\lO~ rules adopt"Thds~ rules are"R~~8B~~ Only $ 57.00
'1lcalion Cenler. hrough OAR 9_52 ,
Notl 52 001 ~001 0 t . I the ~ , 4";i5;Jr0.n;"'lli!lJill'l"~'*"I"""M;)"'\*s'\I'l sil&m m~jyittb~~~w~'lI'rft1m~
Supervisor License Numb"lh O~~R 9 - ".x;_~hIHin(~of~~~h~ t~{e" r!.,r;y!$''t~~~loX,!t;<;ep~~~lr0~[l1w.!~.jii~~9ir''''B,j&~,~Jli~'li11
009. he cenler. 0"'1 Nolilication
Expiration Date ca \ _ 'M Ihe oregon Ullh.2Y3441!'staIIation, Alteration or Relocation I
nl fi" ~. .. . 1 buu-332 ,.
"'~. center IS - . 200 Amps or less $ 57.00
Constr. Contr. Number 0 . 201 Amps to 400 Amps ' $ 79.00
401 Amps to 600 Amps $114.00.
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. :!-Qe:r:vI~~QI0,1-'"'eeu-er:s::-' DSLa a.. oU'q;, , ,:era. ons::o.rJ;e.oeation:i'A
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Electrical Contractor
Address
City
Expiration bate
Signature of Supervising Electrician
Over 600 Amps or 1000 Volts see "B" above.
D. ,*~llfj~J11(8~~~lmrm,"1
OwnersName loon (,J (l..,"NCI,r--
, _ E. c" IfmFJnitiilit:l:a~Jf~E1f~h4:I_ii~~ti~lI
Address 1'I3? U 4,'Nl FJ <'Jl '4" r.-~ ~tt.', \. "l"tI "~,~....!ii!'... ....'",..,..~.......',._..J..h."...._..= ...~
City -Sfr,{J Phone51{1-":a.W~;;4~RWI'iIS-\~I~J6~~~otoR $57.00
'~1\"\OR\7.EO ~gnt'I1Ig $ 57.00
OWNER INSTALLATION t.: WlWIE~CEI) ~ergylResidential $ 29.00
!be ~ation is being made on property I own ~~~'\ 80 I)f\.'{ t'imited Energy/Co=ercial $ 52.00
IS not IDtended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
1!'i4\l-~"""",."w...!""r'"''".__"''''''''''''.''''' "I'. ""....-.. .......'lil!"~.II' 73
4 ..f.v!l>mT~!I:')Hi:Ml(ljlm,f\1I~ ...il~ft~';'~~i1!' .
. ?~"A'tjit!fi~-.cl41,-";~",,,o;'''''(%i'''__~:~$~"ik'~~lm, ~j;~~j;'11~~im~~ .~ .
12%.State Surcharge . 87'=-
10% Administrative Fee 7:S
5% Technology Fee ~ b.l-
'12 7/
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 50.00
$ 5.00
Owners Signature:
_.-::;:::7
_.d-.J
. Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application 7~8.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54]-726-3769 Inspection Line
CITY OF SPRINGFIELD'
BuildIng/Combination Permit
PERMIT NO: COM2008-01578
ISSUED: 10/27/2008
APPLIED: 10/27/2608
EXPIRES: 04/27/2009
VALUE:
SITE ADDRESS: 1433 HAYDEN BRIDGE RD
ASSESSOR'S PARCEL NO.: 1703252200700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition.
Residential
PROJECT DESCRIPTION: 200amp service for shop use
Owner:
Address:
TODD RINGLER
1433 HAYDEN BRIDGE RD
SPR]NGFIELD OR 97477
Contractor Type
Electrical
, Contractor .
OWNER
# of Units:
Primary Occupancy Group: R-3
Secondary Occupancy Group:
Primary Construction Type VB
Secondary Construction Type:
# of Bedrooms:
Frontyard Se'tback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
Phone Number:
541-521-5600
I CONTRACTOR INFORMATION I
License
,_ "ou\O
I BUlLDING'tNFOiiiVI~llr6N;~'~n
, 'ii '" 1>
- C"'!" 'J' -- A O~ ,,,- sa'" -'-, 00\-
:'.'; ,,\n0\9U.._ e \Ule r> 9,,2"
. , ',." :',. c# ol,StQr.eS'i qll 011-" uleS '0'1
.'; . GH1igli\:9f:>S&~~~tJ\. \lIe \ \,\01'8
, . . ,!CHp.e~ofiH{.ft\l\e'. \\,\e \el~\l\'\ca\\On
" .... .<, uu' ''''0' t-IO\\
. ':",eI l\Wate."T.ype: . \\\1\\'1 .,
~. , .. .- , r.e\" - ....n\' U 234'1'1.
',' '" '":,;~\\~!;e:.'l'ype:().332-
" -',-e\ 1'En!'.rgL lla'fR:
,I. ,:,., CS~'ri~kled Building: nla
Expiration Date Phone
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
. Sq Ft Other:
Occupant Loa~:
I DEVELOPMENT INFORMATION'
. REQUIRED PARKING
Total: ,:
HandiCapped:
Compact:
'I
I
. Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
.",0'J..
'\'i: ~,J.
I PUBL,IC IMPROVEMENTS ~iY-'t. \r i~, is ~O'
~01\Ct.. ~\, S\\"''-'- t.{\\iS ?ii~~pe:
,\\is ?'t.?;il't:.b \)~\)'t.~ ",'O",~mllwnspoutslDrains:
. \:i\\O?; " oY- ~" ,
, ,j\'u \-J\'t:.~Ct\J 't:.V-iO\)'
, CO\-J\.. 'Oil Gf>.'{ \'
j\~'{ \ ,
I, V itluation DescriDtio'n I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
" Date Calculated
Paee 1 of 2
~~c.
.CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-01578
ISSUED: 10/27/2008
APPLIED: 10/2712008
EXPIR~S: 04/2712009
VALUE:
Status
Iss u ed
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676,Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description'
+ 10% Administrative Fee
+ ]2% Stale Surcharge
+ 5% Techn~logy Fee
Perm Serv/Fdr 200 amps or less
-Amount Paid
Date Paid
Receipt Number
$7.30
$8.76
$3.65
$73.00
10/27/08
10127/08
]0/27/08
] 0127/08
]200800000000001088
1200800000000001088
120080000000000]088
1200800000000001088
Total Amount Paid
$92.71
I Plan Reviews ~
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Reouired Insnectio!,. I
Electric Service: Approval required prior to. utility company energizing service.
By signature, I state and agree, that I have carefully examined thecompleted applicalion and do hereby cehify 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 of Oregon pertaining to the work desedbed herein, and
that NO OCCUPAN9Y will be made of any structure without permission of the Community Services Divi~ion, 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 fnrther 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 remairi on the site at all
times during construction.
--------
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Owner or Contractors Signature
Date
Paee 2 00
.f/
, -
, \~
'Permit #: Co vv(z,ocl -.0 I S' 7~f?
. -.- , . -", ,.
Addiess:-. 1433,"+-f"'thttJ :l:rL '. "
.. .,,,,-"
issued by: ., ":h.'C Date: i () -:-1..7 :"'0,%
..
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.... .....
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Construction Contractors Board,
700 Summer 8t NE Suite 300 '" .
PO Box 14140 . . ,:" .
Salem OR 97309-5fj52' ", ".' ".
Phoue: 503-378-4621 : .'
Web Address:, www..ccb..state.or.us
.' . ..~ -.:
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i: .
.41
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.. .' .
~. ~. _ Ii
St~tement: I~forrriatiori Notice to' Property Own,ers
::': " AboutCons~ructionResponsibilities., 'i' ,
'".r
,
. , ' "_, . -,-, ., '. - 'I
Note: Oregon Law; ORS 701:055(4) 'requiresresidential construction permit applicants who.are not
'_ ' 'I ,-
,," li~(msedwith theConstruciion Contractors Board to'sigiz.thefollowing statement before a building
, permit can be issued. This statement is requiredJor residential 'building, ,eleCtrical, mechanical and
'plumbing permits,Licensed ~rchitect'qnd engin~er appiicants, exemptfrom licensing under ,
o.RS 701.010(7), need not submit t~is' statement, .rhisstate,m~nt:will befile,d'with th~ permit. :
. . ,; :, '_ 1.-c ' " ...'1. . _ . ~~' t. : . .." .,~ ~: .
Fill in the:appwp,;ate blanks,and initialb~xes I and 2, arid elth~r,box 3..\ '~r 3B: '"
~. :'town, reside in: or willreside in the completed struc~e. . c~ . ;
\', . , '-. . . . . ~' .' I. '. . ; -,' ", - . .
,~2. I.understandthat I mtisLbecom~licensed as a constn!ctioncontractor'iHhe strucfure is said or
.' . I f
offered for.sa\e'before or oJI completio,n. I '. ,:
'.
o 3A. My generalcontractor is
(Name)
(CCB #)
J will instruct my gener~1 conir~ctor that all subcontractors who w~rk on the strubture must be
jicens~d with ihe Construction Contractors Board.' . " . . ' ;, . .
. ..' ,
OR
r~B. I will be my own g~neral contractor.
. '. 'IfI hire subco~~act~rs, I willltire 'onlysubcontrac~orslicensed ~iih the Construdtion Contractors
;Board. IfI change my mind,and hire a general contractor, I will contract with a c,ontractor who is
'licensed with the C,CB,and will immediately notify the,6ffice issuing this building permit of the
,name of the contractor. " : " '
. ~ . l' .
. : ~ -
I hereby certify that tbe'above information,is correct and tbat I bave read and do understimdtbe Information
" ,- ". - - 'I
Notice toProperlJi Ownersabo.ut Construction Responsibilities on:tbe rev~rse.sideoftbis form,
'~.-
,.
L
--'./ '"
----. ~ if" / t9 - ::??..;. 0 Jl.
(Signature ofpermi(applic,ant), (Date) .
(White' copy to issuing. agency pef71]it file, pink copy to applicant.). ii
"",
- .
Property_owner.doc 06:01-04
225 Fifth Street,
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield: Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-0 1578,
COM2008-0 1'578
COM2008-0 1578
COM2008-0 1578 '
Payments:
Type of Payment
CreditCard
cReceintl
......
RECEIPT #:
Date: 10/27/2008'
1200800000000001088
Description
Penn ServlFdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
TODD RINGLER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received.1
djb
101916 In Person
Payment Total:
Page I of I
9:11:23AM
Amount Due
73,00
3,65
8,76
7,30
$92.7]
Amount Paid
$92,71
$92.71
10/27/2008