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Home My WebLink AboutPermit Electrical 2010-11-1 Electrical Permit Application 225 Fifth Street+Springfield, OR 97477.PH(541)726~3753.FAX(541)726-3689 .'~ , ,-. - - DERARTMENT USE ONLY - \ .I;.... - ,. ,. Permit no.: Sf 0 - CO I Date: / I I 0 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. , ""lfOC~L;~G0VERNMENT;AF1F!R.OVAllir'1'f'~i!fr;1)'?;;. Zoning approval verified? 0 Yes 0 No ;,:~i"/i'/.;:';CAtEGOR.Yd\bF:,:CONSl'RUC'l110fo.lj;~i >';'.,' , ."., o Residential I 0 Government "N:iJ Commercial. ~l!i.{~'ii'JOBKSITE!i1NI;QRIIIIATIONIIAN[j!ilfO"CA;r,i0N~;:;~~:lt~H Job site address: /70 ~c/o"-- .~~ city6o~ ldJ.... I State: a ~ I ZIP: / 7t!~ -22"5 c/ I Taxlot.: (:) 2-;iDG .,'.' DESCRII'TION. OF 'WORK' "\,",,,",;'f 'lV"\ 6 ~ \ ::,,,,, \f\ C 1'\rA \,~Olr-.r €-' ~..D:>.,('~C'(.lS .. ~PROPERTY OWNER Name: ..c~\J ~\ v,^/v 7 c&.2.. ~ Address: "2 {):J 1-{-t'\-vJ'j1 ~~ City:S?-t-t..e---r---. I State: d'd-- T ZIP: (-7'17 () i Phone: - - I Fax: .. - ' E-mail: Reference: '0.' , 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: ;.CONTRACWR'INSTALlATI0N. Business name: r /\ ~ /'C.I J 'f" J I p &-::'\:Y)~er..r Addressc., G, 02...71 ~ M r"J ~ L _.\~ .'~ J Ci~~ d.. ~ ,,"'-. I State: N I ZIP: Phon8-J~-Z2.?;, ?'3Z? I Fax: E-mail: CCB license no.! ~ LJ I BCD license no.: r L'/ '/ Signing supervisor's license no.: ~/_ 7 ~ Print name of signing supervisor: M ~++- / _. Signature of signing superviso~~ 7-' ./ . ~\V~ 9 ~ 440-2584-1 (9108ICOM) ~~~~~~~0~~~~~0~f~E~SCHEP~~E~x~%~~~~~~~~~ Number'orinspoet!O"; peritim6~" Qly, . COst Total 'c. :".'::),~';;;:~'\ ",' --'. ~</r,'.~r,';il ",t",'l"~:'~,\: ;,_,\, _'l-.>ea/: .>.,(:.o_st '. Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 40 I to 600 amps (2) $158.00 $ 60 I to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or Jess (2) 201 to 400 amps (2) 40 I to 600 amps (2) $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,000 volts, see services 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 $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit \ \" $ 55.00 $ 5') $ 6.00 $ t/ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limitedwenergy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ ~~~~~~ir~iii~~frIi;igis{ARetrCJ{N1rt&::US'-E!;1.t~:';:.:'(iijj~;!~~~~f{:;;'~,i!;~t~::::1. (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B) Enter J 2% surcbarge (. J 2 x [A]) (C) Technology Fee (5% of [A]) TOTAL fees and surcharges (A through C): $ tv ( $ '733:- 05- $3- $,//32- SPRINGFIE~ ~Ll'_ '.' i!J; " " OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00619 IVR Number: 811181874105 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perm itcenter@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 11101/2010 ISSUED: APPLIED: 11/01/2010 11/01/2010 EXPIRES: VALUE: 04/30/2011 $0.00 SITE ADDRESS: 770 HARLOW RD, APT# 100, Springfield, OR 97477-1133 ASSES OR'S PARCEL NO: 1703223402800 SCOPE: WORK INVOLVED: TYPE OF STRUCTURE: Electrical Only Alteration Commercial PROJECT DESCRIPTION: Addl Alter 2 circuits Phone Number: OWNER: ADDRESS: SUN RETIREMENT CORPORATION 200 HAWTHORNE AVE SE A-140 SALEM OR 97301 CONTRACTOR INFORMATION ~ Contractor Type Electrical Contractor Contractor Name COMPLETE ELECTRICAL INSTALLATIONS INC lie Type CCB ~ Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: ,.....__ . Occupancy Load: I . :.!'ITION' 0'"- J . Electrical Specialty Code Edition: ." 'd 200a,n aw reqUires you to ..., r~..~s a opted by th 0 . . Springfield Fire Code Edition:./C.ltion Center Th e reg on Utility . ; , r. . - "- ,ose rules are settorth Mechanical Specialty Code Edition:2-001-001 0 through OAR 95 nnq8 y , 2-001- Municipal I DevelopmenfCode: au may obtain copies 01 the rules b call1na the cente (N y Plumbing Specialty Code,Edition; 1 th r. ate: the telephone 'u"'Ut;r or e Oregon urn . , . Residential Specialty Code EditioQienter is 1_800_33~~13~~t'I/catlon Structural Specialty Code Edition: ). I BUILDING INFORMATION # of Units: o # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Lie No 184274 Lie Exp 10/14/2012 Phone 541-225-7827 Lot Size: o Site Information ~ . Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FDR ANY 180 DAY PERIOD. .. Springfield Building Permit 11/1/2010 1:39:12PM Page 1 of3 SPRING.FIE.L~D- !\i-;1. .-... 1< av " OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00619 IVR Number:,811181874105 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilce nter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 11101/2010 ISSUED: APPLIED: 11/01/2010 11/01/2010 EXPIRES: VALUE: 04/30/2011 $0.00 SITE ADDRESS: 770 HARLOW RD, APT# 100, Springfield, OR 97477.1133 ASSESOR'S PARCEL NO: 1703223402800 SCOPE: WORK INVOLVED: TYPE OF STRUCTURE: Electrical Only Alteration Commercial PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Addl Alter 2 circuits DEVELOPMENT INFORMATION ~ Overlay Dist: # Street Trees Reqd: Paved Drive R~qd: % of Lot Coverage: Highest point on structure to north property line: REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Descriotion Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ Descriotion Branch circuits without service or feeder ~ 1st circuit Branch circuits without service or feeder ~ each additional State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Total Amount Paid Amount Paid $55.00 $6.00 $7.32 $3.05 $71.37 Date Paid 11/01/2010 11/01/2010 11/01/2010 11/01/2010 Receiot # 374759 374759 374759 374759 Springfield Building Permit 11/1/2010 1:39:12PM Page 2 of 3 SPRINGFIE~ .~l ~'i ~ . '> OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00619 IVR Number: 811181874105 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541.726.3753 Inspection Phone: 541.726.3769 Fax: 541.726.3676 permitcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 11/01/2010 ISSUED: APPLIED: 11/01/2010 11/01/2010 EXPIRES: VALUE: 04/30/2011 $0,00 SITE ADDRESS: 770 HARLOW RD, APT# 100, Springfield, OR 97477.1133 ASSESOR'S PARCEL NO: 1703223402800 SCOPE: WORK INVOLVED: TYPE OF STRUCTURE: Electrical Only Alteration Commercial PROJECT DESCRIPTION: Add/ Aller 2 circuits Plan Review ~ Deoartment Application Acceptance Received Due Date Completed Result 11/01/2010 11/01/2010 11/01/2010 Over the Counter Reviewer Chris Carpenter ,~-", Initial Review 11/01/2010 11/01/2010 Over the Counter Chris Carpenter INSPECTIONS REQUIRED , Inspections 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover 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. J 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 iront of the property, and the approve:d set of plans will remain on the site at all times during construction: ,,-J-} 0 Date Springfield Building Permit 11/1/2010 1:39:12PM Page 3 of3 S~~~. ~:~~~ ~~( ~~ ~:""""OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00619 770 HARLOW RD APT 100 CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 perm itcenter@ci.springfield.or.us RECEIPT NO: 20100007/7 RECORD NO: 81 I.SPR2010-00619 DATE: 11/01/2010 [QESCRI[:>_TI()If"~-.[;~".:::"::; '. '". '3*-" '.'-,,; .:J~::::i/~(;_G:0JJNT{CJ:~[)E'~-;'>..' : '~I\i!QPJ~T'DUE'.' . .1 Branch circuits without service or leeder. 1 st circuit 224-00000-426102 $55.00 Branch circuits without service or leeder - each additional 224-00000-426102 $6.00 State 01 Oregon Surcharge (12% 01 applicable lees) 821.00000-215004 $7.32 I~~gy fee (5% of permit total) 100-00000-425605 $3.05 TOTAL DUE: $71.37 b'I'AY~ENT TY~c.: ._PAX.OR~7;tASHIER_.CCAR~ENTER 'l'G.QMMENl'S:"'; ':...' ':.~";;':'~MQ.UI'LI""~IQ::".d:_~_._] Credjt Card 012637 COMPLETE ELECTRICAL INSTALLATIONS INC $71.37 $71.37