HomeMy WebLinkAboutPermit Electrical 2005-5-5
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX:, (541)726-3689
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ELECTRICAL PERMIT APPLICATION0~llrlco/lofyl.
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City Job Number <.......- ) - OO'f2.J..f Date /r<11 1)0'('/-.01'0/',.
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3. COMl?LE1;E 13 S>(!JIJEDLtf.EJ!~O~
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,....< '$ ........CY
('0 A u;o "<1
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A. New Residential-/~le Mu '~mH{PtfO'~~ing unit.
Service Included ~i!f...""'''5 __ '-'S& 7".9
1000 sq. ft. or less ~,~ 6.00 2/2..-,0:)
Each additional 500 sq. ft. or ~ "'" '7/ Co
portion thereof t ~ $ 19.00 ~/cg.
....
1.
LOCATIONOFINSTALIATION
4/Jh Vlrsl/\/<:{ k ,+/;8
LEGAL DESCRIPTION
17to'2- 31.:~> OJ 102-
JOB DESCRIPTION
~jJ~rl"a I
bJJ~Y
. ,
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor6Jeni'i'htt fl--RJ <;e{l)lCR. m~
1-)' I
Address'1/r,SfY2 h)tJ-} ()iVl'SiOfJ /jJe
City tU~jl\X 77~O~ Phone bO 1- t 9 6g
<.J 6()~ 5
IO~'/01
I J
Constr. Contr. Number /5' /'51/
<6liJ/~D S-
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Signature of Supervising Electrician
~~d#6UK
I
Owne"N/f,e ~~ J'Y', b~
Address Of) \ ~ \'Lrui~
Ci~~_O~ Phoneld).\ CG1A
Supervisor License Number
Expiration Date
Expiration Date
OWNER INSTALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Sf~~a{iv;.C;~fFl'i5DLO
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
or ReJocation:
200 Amps or less $ 63.00
201 ~Tq:fWI~NPVregon law rplj.Uires$yQ\ffl)
401 ArnpsGQjqQQQ;\1.~opted by the Orego$)lMimy
601 ~psi(@tOO() i_r. Those rules aresse~flou1h
overirooo\~AQij\!-001 0 through OAR ~-.6@1-
RecorUOODo)f~u may obtain copies of theST\'j(oooby
~~I.li~g,mi.~i.~~~r. Note: the telephop,~
c..'t~hib(Jfll~~~~~ ."" i> .,.atian
. Centeris - 00-332- .
Installation, Alteration or Relocation
200 Amps or less
20 1 Ame.~ to 400 Amps
401 Amps to 600 Amps
J
SO,DO
$ 50.00
$ 69.00
$100.00
D.
New Alteration or Extension Per Panel
One CirwiL $ 43.00
Eac~ A~~t~~M~f~irA~~itcorJ ~ith \'~ I r' ~ n': l \., I
Service 1011 !JEeeaet\P.en:mtd i'\ l \ 1\ t ", '. 1, $,.;3 .00
~,~UIIJQRj4kP4:! L~LiLil,lJtlL ,iI, ~',~,,' i !. L~::
E.l\1is~,1:L~l,WS~~~~t(yi~~l>[~t'de~p():tIW'~4~~dt~ Each Installation
PlfJ"{ 1 dO U /,\'l' F L H. \- (.'::
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTALOFABOVE
33<b~ -::.3~~~
i ~.Iolo
SjP'b ~.8r.A
~~/~~I~
Shared Drive(T: )/Building Fonns/Electrical Pelmit Application 1-03,doc
7% State Surcharge
10% Administrative Fee
:J.-~' , ~~
TOTAL
~
li
11
II
\. CITY OF SPRINGFIELD
Building/Combination Permit,
PERMIT NO: COM2005-00424
ISSUED: 05/05/2005
APPLIED: 04/14/2005
EXPIRES: 11/05/2005
VALUE: $ 247,872.00
~ Status
"
Issued
, 225 Fifth Street, Springfield, OR
o 541-726-3753 Phone
1 541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4136 Virginia Ave 4138
ASSESSOR'S PARCEL NO.: 1702323303702
Springfield TYPE OF WORK: Duplex
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Residential Duplex
Owner: SHALLUM BIVENS
Address: 871 S 72ND
SPRINGFIELD OR 97478
Phone Number: 541-521-9324
~
I CONTRACTOR INFORMATION.
Contractor License.
NORDIC HOMES & CQNSTRUCTION LLC 156131
EVERYDA YELECTRICAL SERVICE 136371
Expiration Date
07/09/2007
08/12/2005
Phone
541-521-9324
541-607-6908
\ Contractor Type
~ General '
"
l
Electrical
# of Units:
Primary Occupancy Group:,
Secondary Occupancy Group:
~. Primary Construction Type
Secondary Construction Type:
~ # of Bedrooms:
I BUILDING INFORMATION J t
on laW requIre you, ,0 ,
2 'J~J1EN1W)ttl'sQWg: b the Oregon Utl\l2V Lot Size: '
R-3 folloW ruHei~R.~~Yu\es are ~.tI6rth. Sq Ft Ist Floor:
Notificatioll)<i3e6l't1ieJf:thrOU9h O~9!:ifegp1 Sq Ft 2nd Floor:
VN, 'OAR 95W.(l@A~\P. p'Ies 01 ttftJl1~8 by Sq Ft Basement:
to 'lnh1a\n CO e
0090. '(oB~"".rf'C. Note: the te\ijpl1~ Sq Ft Garage/Carport
6 a\\ind\t\,!~1Jl\ab: ~ ~ti\it'l NotJr~, n Sq Ft Other:
C b~lt~agMj\ ~"_2344).n/a Occupant Load: '
nUm , _ ,.." ~n .:u;.
I DEVELb~'ME~j INFORMATION '.'
4,626
1,056
1,376
576
t\f ~ .
.'!; ~ Frontyard Setback:
; Side 1 Setback:
" Side 2 Setback: '
;~ Rearyard Setback:
Solar Setbacks:
, 18.00
6.00
6.00
21.00
35.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
2
Yes
33.20
, REQUIRED PARKING
Total: 4
Handicapped:
Compact:
. 'r.
.,,.>,
,
I PUBLI~.fRP.VEMENTS ~ XPIRE W 1HE \NO~\'\
Street Improvements: -r\-lIS PERM\ \ ~tll"\\... E um<te~i~H,J~ NO\'
Fully Improved I ORIIED LINDER "\ n ulnnNEO ~G~
Storm Sewer Available: Yes ALI"\\-I NeED ORIS ABrlJOWrtspouts/Drains:
Special Instruction: ~~~~io DA'< PERIOD, ,
Notes: Storm drainage piped to curb face 4/15/2005 CAS
Curbside 5'
Curb and Gutter
',j
I;'
,~;
Pa2;e 1 of 4
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2005-00424
ISSUED: 05/05/2005
APPLIED: 04/14/2005
EXPIRES: 11/05/2005
VALUE: $ 247,872.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
J
: Description '
Dwellinl!s
Garal!e
Tvpe of Construction
V Wood Frame
Garal!e
$ Per Sq Ft
or multiplier
$96.00
$25.00
Square Footage
or Bid Amount
2,432.00
576.00
Value
Date Calculated
Total Value of Project
$233,472.00
$14,400.00
$247,872.00
05/05/2005
05/05/2005
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $426.82 4/12/05 1200500000000000438
-Mechanical Issuance Fee:'" $10.00 5/5/05 1200500000000000578
+ 10% Administrative Fee $209.07 5/5/05 1200500000000000578
+ 7% State Surcharge $146.35 5/5/05 1200500000000000578
2 Baths One or Two Family $508.00 5/5/05 1200500000000000578
Addressing Assignment $62.00 5/5/05 1200500000000000578
Addressing Assignment $62.00 5/5/05 1200500000000000578
~ . - :~ Building P.ermit $1,046.65 5/5/05 1200500000000000578
" .
Curbcut Permit $80.00 5/5/05 1200500000000000578
Dryer Vent $12.00 5/5/05 1200500000000000578
~'1 E.xhaust Hoods $18.00 5/5/05 1200500000000000578
r;
Miscellaneous Mechanical $144.00 5/5/05 1200500000000000578
Plan Review Major - Planning $103.00 ' 5/5/05 1200500000000000578
Plan Review Residential $253.50 5/5/05 1200500000000000578
Residence Wiring 1000 Sq Ft $212.00 5/5/05 1200500000000000578
Residence Wiring Ea Addtl 500 $76.00 5/5/05 1200500000000000578
Sanitary Sewer - Improvement $621.52 5/5/05 , 1200500000000000578
Sanitary Sewer - Reimbursement $817.36 5/5/05 1200500000000000578
SDC MWMC Administration '$10.00 5/5/05 ' 1200500000000000578
SDC MWMC Improvement $1,730.62 5/5/05 1200500000000000578
SDC MWMC Reimbursement $164.06 5/5/05 1200500000000000578
SDC Sanitary/Storm Admin $162.38 5/5/05 1200500000000000578
SDC Transpo Admin $138.62 5/5/05 1200500000000000578
SDC Transpo Improvement $1,544.98 5/5/05 1200500000000000578
SDC Transpo Reimbursement $350.26 5/5/05 1200500000000000578
Storm Drainage Impervious Area $781.20 5/5/05 1200500000000000578
Temp Power 200 amps or less $50.00 5/5/05 1200500000000000578
Vent Fan $24.00 5/5/05 1200500000000000578
~ Willamalane Attached (duplex) $1,848.00 5/5/05 1200500000000000578
Total Amount Paid' $11,612.39
Pal!e 2 of 4
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2005-00424
ISSUED: 05/05/2005
APPLIED: 04/14/2005. ,
EXPIRES: 11/05/2005
VALUE: $ 247,872.00
c ;.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
'i
,
I' Plan Reviews I
Initial Review 04/14/2005 04/14/2005 APP SKG
Planninl! Review 04/14/2005 04/28/2005 APP TAJ Partition Plat (SUB2005-00005)
recorded by County on 3/23/05
Public Works Review 04/14/2005 04/15/2005 APP CAS Storm drainage piped to curb face
4/15/2005 CAS
Structural Review 04/14/2005 05/05/2005 APP JB Approved as noted.
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same wor,ung day, inspections requested after 7:00 a.m. will be made the following work
day.
i
,.
J
Curbcut.; Standard: After forms are erected but prior to placement of concrete.
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection. .
Footing: After trenches are excavated.
Foundation:, After forms are erected but prior to concrete placement.
Post a~d Beam: Prior to floor i!lsulation or decking.
Floor Insulation:, Prior to decking. '
,'1
,
Shear Wall Nailing: Before covering sheathing with finish materials:
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Final Building: After all required inspections have been reques.ted and approve.d and the building is complete.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to nlling trench and including required testing.
Sanitary Sewer Line: Prior.to filling trench and including required testing.
Underfloor Plumbing: Prior to insulation Or decking.
Storm Sewer Line:- Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover ,
Pal!e 3 of 4
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CITY OF SPRINGFIELD'
Status
Issued
Building/Combination Permit
PERMIT NO: COM2005-00424
ISSUED: 05/05/2005
APPLIED: 04/14/2005
EXPIRES: 11/05/2005
VALUE: $ 247,872.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line,
Final Mechanical: When all mechanical work is complete.
Temporary Electric: ' Approval required prior to Utility Company energizing pole;
"Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
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 of 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 ti~e, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set o( plans will remain on the site at all,
times during construction; , ,
,~
~
" s-;f-~.r
Owner or Contractors Signature
f
Date
Pa2e 4 of 4
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
I. STORM DRAlNAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. x I COST PER S.F. CHARGE
2520.00 ' I $0.3 10 = I $781.20
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. x I COST PER S.F. x I DISCOUNT RATE I
0.00 I $0.310 I 50% = I
ITEM 1 TOTAL - STORM DRAINAGE SDC '$781.20
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's x
I 34
B. IMPROVEMENT COST:
I NUMBER OF DFU's x
I 34
CITY OF'S1l~GFIELD SYSTEMS DEVELOPME~~ORKSHEET
COM2005-00424
ShaJlum Bivens
4136 & 4138 Virginia St
1702323303702
SINGLE FAMILY RESIDENCE
2 BUILDING SIZE (SF: 2000
LOT SIZE (SF):
4626
r.rJ
iJ..1
Cl
o
u
~
iJ..1
E--<
- en
>-<
o
~
DISCOUNT
$0.00
$781.20 1070
COST PER DFU
$24.04
$817.36
1091
$18.28
$621.52
1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $1,438.88
;3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE x I NUMBER OF UNITS x COST PER TRIP x I NEW TRIP FACTORI
I 9.57 'I 2 $18.30 I 1.00 I $350.26 1093
B. IMPROVEMENT COST:
I ADT TRIP RATE x I NUMBER OF UNITS I x I COST PER TRIP x I NEW TRIP FACTOR
I 9.57 I 2 I $80.72 I 1.00 $1,544.98 1094
ITEM 3 TOTAL - TRANSPORT A nON SDC =1 $1,895.24
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x COST PER FEU
I 2 $82.03 = $164.06 1054
B. IMPROVEMENT COST:
INUMBER OF FEU's x COST PER FEU
I 2 $865.31 = 1 $1,730.62 11055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) , $0.00 1054
MWMC ADMINISTRATIVE FEE , $10.00 1056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =1 $1,904.68
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $6,020.00
5. ADMINISTRATIVE FEE:
SUBTOTAL x ADM. FEE RATE
$6,020.00 5%
'TOTAL SANITARY ADMINISTRATr'ON FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Cheryl Slaymaker
PREPARED BY
CHARGE
$301.00
162.38
$138.62
11079
.1078
4/15/2005
=, $6,321.00
TOTAL SDC CHARGES
DATE
,
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNlT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUrv ALENT UNITS
I BATHTUB -. -~~- ~~
2 0 3 = 6
IDRINKlNG FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
ILAUNDRY TUB 0 0 2 = 0
ICLOTHESWASHER/MOP SINK 2 0 3 = 6
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0
IRECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
ISHOWER, SINGLE STALL 0 0 2 = 0
I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 2 0 3 = 6
I SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0
SINK: SINGLE LAVATORY/RESIDENTIAL BAR 4 0 1 = 4
URINAL, STALL / WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 4 0 3 = 12
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 34
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at ] 67 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE ] 979
]979
]980
]98]
]982
]983
]984
]985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$l,OOO
ASSESSED VALUE
$5.29
$5.29
$5.19
$5.12
$4.98
$4.80
$4.63
$4.40
$4.07
$3.67
$3.22
$2.73
$2.25
$1.80
$1.59
$1.45
$1.25
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
2
2
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
= I
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
o
=
$0.00
TOTAL MWMC CREDIT
225 Fifth Street
Spr,ingfield, Oregon 97477
541-7,26-3759 Phone
r'ity of Springfield Official Receipt
.welopment Services Department
Public Works Department
Job/Journal Number
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
, COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
, COM2005-00424
': GOM2005-00424
COM2005-00424
COM2005-00424
CbM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
COM2005-00424
CbM2005-00424
Payments:
Type of Payment
Check
~t'
.,
;(
. ~ .]
'{
,I
5/512005
RECEIPT #:
1200500000000000578
Date: 05/05/2005
Description
Addressing Assignment
Willamalane Attached (duplex)
Temp Power 200 amps or less
Curb cut Permit
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
Plan Review Major - Planning
Plan Review Residential
Building Permit
Addressing Assignment
2 Baths One or Two Family
Vent Fan
Exhaust Hoods
Dryer Vent
Miscellaneous Mechanical
-Mechanical Issuance Fee-
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
NORDIC HOMES CONSTR
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
1332
In Person
Payment Total:
Page 1 of 1
2:44:23PM
Amount Due
62.00
1,848.00
50.00
80.00
781.20
817.36
621.52
350.26
1,544.98
164.06
1,730.62
10.00
162.38
138.62
103.00
253.50
1,046.65
62.00
508.00
24.00
18.00
12.00
144.00
10.00
212.00
76.00
146.35
209.07
$11,185.57
Amount Paid
$11,185.57
$11,185.57