HomeMy WebLinkAboutPermit Electrical 2010-11-19
225 Fifth Streett Springfield, OR 97477tPH(541)726.3753t FAX(541)726~3689
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Penn it no.:
Date: II
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.
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Zoning approval verified? 0 Yes 0 No
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[(Residential D Government D Commercial
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Job site address: 3"1 2- S. L. fl-D
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Reference: -:?fL TaxloO
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Name: ~ "- N ;~
Address: SCJ2
City: S<i7 " ....'
ZIP: C'i]c.;lG
This installation is being made on residential or fann 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: ";'\ , ......
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Business name: ..,.. . :::1L--'
Address:
City:
Phone:
E-mail:
CCB license no.: ty.COOO
ZIP:
BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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440.2584.) (9/08/COM)
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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 $(j7
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 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 less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $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 ofa service or feeder fee:
Each branch circuit f I $ 6.00 I $ VJ
b. Fee.for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
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 limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees $r!
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (. 12 x [All $ /tJ If'-(
(C) Technology Fee (5% of[All $ir~
TOTAL rees and surcharges (A through C): $ II)) '7"/
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~+r 'OREGON
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00756
IVR Number: 811108907335
www.cj.springfield.or.us
225 Fifth SI
, Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
Issued
permilcenter@ci,springfield.or.us
PROJECT STATUS:
STATUS DATE:
ISSUED:
APPLIED:
11/19/2010
11/19/2010
11/19/2010
SITE ADDRESS: 392 S 43RD ST, Springfield, OR 97478-5918
ASSESOR'S PARCEL NO: 1702323403100
EXPIRES:
VALUE:
05/18/2011
$0.00
SCOPE: Electrical Only
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
New breaker panel and 1 circuit
Phone Number:
OWNER:
ADDRESS:
DICt<ENSON RONALD 0 & REBECCA l
392 S 43RD ST
SPRINGFIELD OR 97478
I
~
Contractor Type
Contractor Name
OVVNER
CONTRACTOR INFORMATION
Lic Type
OWNER
BUILDING INFORMATION ~
# of Stories:
# of Units:
o
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Hazmat:
lie No
0000000
Lie Exp
08/12/2025
Phone
Lot Size:
Sq Ft 1 st Floor:
Sq Ft2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other: 0
ATTENTION: Ore9cclipancy:~".~,dJS you to
Electrical Specialty Code ~di~\;jh~ rltles adopted by the Oregon Utility
, ,. . ~OliTICatlOn Center. Those rules are set forth
SpringfIeld Fire Code Ed'\'8'OAR 952-001-0010 through OAR 952-001-
Mechanical Specialty Code~~djtion~u may obtain copies of the rules by
Municipal f Development cOde,ling the center. (Note: the telephone
Plumbing Specialty Code Editi1l~:er for the Oregon Utility Notification
.,. Center is 1-800-332-2344)
Residential Specialty Code Ed,ilian: .
Structural Specialty Code Edition:
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Energy Path:
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 FOR
ANY 180 DAY PERIOD,
Springfield Building Permit
11/19/201 1:31:13PM
Page 1 of 3
www.ci.springfie\d.or.us
. CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00756
IVR Number: 811108907335
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
ISSUED:
APPLIED:
11/19/2010
11/19/2010
EXPIRES:
VALUE:
05/18/2011
$0.00
11/19/2010
SITE ADDRESS: 392 S 43RD ST, Springfield, OR 97478-5918
ASSESOR'S PARCEL NO: 1702323403100
SCOPE: Electrical Only
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Residential
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
New breaker panel and 1 circuit
DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure
to north property line:
REQUIRED PARKING
PROJECT DESCRIPTION:
Total:
Handicapped:
Compact:
PUBLIC IMPROVEMENTS
I
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
DownspoutfDrains:
. Valuation Description
I
Descriotion
Tvoe of Construction
Unit Amount Unit Tvoe
Unit Cost
Value
FEES PAID
I
Descriotion
Services 200 amps or less
Branch circuits with service or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Total Amount Paid
Amount Paid
$81.00
$6.00
$10.44
$4.35
$101.79
Date Paid
11/19/2010
11/19/2010
11/19/2010
11/19/2010
Receiot #
374941
374941
374941
374941
Springfield Building Permit
11/19/201 1:31:13PM
Page 2 of 3
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00756
IVR Number: 811108907335
www.ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
ISSUED:
APPLIED:
11/19/2010
11/19/2010
Issued
11/19/2010
225 Fifth St
Springfield, OR 97477 '
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or.us
EXPIRES:
VALUE:
05/18/2011
$0.00
SITE ADDRESS: 392 S 43RD ST, Springfield, OR 97478-5918
ASSESOR'S PARCEL NO: 1702323403100
SCOPE: Electrical Only
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:,
New breaker panel and 1 circuit
Plan Review
~
DeDartment
Application Acceptance
Received
11/19/2010
Due Date
11/19/2010
Completed
11/19/2010
Result
Over the Counter
Reviewer
Chrjs Carpenter
11/19/2010 11/19/2010
Issued
Structural Review 11/19/2010 11/19/2010 11/19/2010
Comments: Over the counter permit
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Not Required
".'
Not Required,.~._ ,~'
-, _,I' ",..i,"f"'-
'._"'01"<.'
INSPECTIONS REQUIRED
~
Inspections
4225 Service or Feeder
Chris Carpenter
Chris Carpenter
ChfjsCarperrter~,: ,". _ -
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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. 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 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.
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Owner or Contractor Signature
i l- j'1 - /6
Date
Springfield Building Permit
11f19/201 1:31:13PM
Page 3 of 3
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. .
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be tiled with the permit.
Please check the appropriate box:
o I own, reside in, or will reside in the completed structure and my general contractor is:
Name
CCB#
Expiration Date
o I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
/' .
[2j I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand.the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate,
QDtJ \:>; (..kp IV '::::.OrJ
Print Name of Permit Applicant
'.Kl\\"- Q~ :~<V'<:> ~
Signature of Permit Applicant
II-Iq...../()
Date
Permit #:
S(/7 -
592.
7S-&
<; 'i]rcJ..
Address:
'SfF'-\) OIL Dj',)'17f
Issued by: CJSL.-. Date: iI,/;~/; 0
This Copy for Permit Offices
. . . .
Sfi:.:. ,.G.;:EL~
~{~
:t?",~' OREGON
www.ci.springfield.or.us
.
TRANSACTION RECEIPT
811-SPR2010-00756
392 S 43RD ST
CITY OF SPRINGFIELD
,225 Fifth 51
5pringfiefd~OR 97477
541-726-3753
permilcenter@cLspringfield.or.us
RECEIPT NO: 2010000879
RECORD NO: 811-SPR2010-00756
DATE: 11/19/2010
;;' :, ~~;S~",;'(.:; !~;':i'~;e':4c.C:QONf26:QbJ:c-;,.. '::.~l\MO.uN:r;QUj: ,,;....:;:HI
224-00000-426102 $81,00
224-00000-426102 $6.00
821-00000-215004 $10.44
100-00000-425605 $4.35
TOTAL DUE: $101.79
F~~YM!;.t:l.:tJYRE' 'L~AY~Bf;;:_,C6$HI~R:CCARiiENTER " : C_QMMENJ~S' ~"".f;,!: ':~f.:.. . ..:7A1'!!9QI'IJ.J'~lb' -'-r .2J
lDESCRi~TJON'.' ,;',';;i---,'';.~':' -
_Services 200 amps or less
Branch circuits with service or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
Technolo~y fee (5% of permit total)
Cash
DICKENSON RONALD 0 &
REBECCA L
$101.79
$101.79