HomeMy WebLinkAboutPermit Electrical 2011-1-5
225 Fifth Street+Sp.-ingfield, OR 97477+PH(541)726-3753+ FAX(541)726.3689
bEP~RTMENTl.JSEONL y
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Permit no. ~ 0 - '1 LI 0
Date: 1
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.
',': ..: 'il.lOCJl.L::'GOVERNMEI'.lT;;,t\P.p~OVAl!]?;:,j".g'i,~r;"'~l:
Zoning approval verified? 0 Yes 0 No
';:: ')h:;,~.i:,,>::::C,t\TEGOR"'ii.Of':CONSl'RlJC;nON~;"'~,"';:.."" ,",
mesidential 0 Government 0 Commercial
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Taxlot.: \
","'.' ." "'DESCRIPTION 0FWORK"""",:;\,: ;ljk;\""
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'PROPERTY 0
Name:
h}
City:
Phone:~
E-mail:
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. 60(1).
Signature: t:?/~(J~-//
:C . NTRAC1;OR' INSTALL,t\Ti0N'
Business name: 'LJ0J ~/L-
Address: 2'{'{ S r
City: Sf''i:::- ~'i:> ZIP: '7 ') Y')
Phone:
E-mail:
CCB license 1.0..
BCD license no.:
Signing supervisor's license no,:
Print name of signing supervisor:
Signature of signing supervisor:
'S>v ~
,,~~
Y\j
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 $
20 I 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 $
20 I 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 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) $ 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: (I) ( $58.00 $ ~O
~ ~'ill ~
(A) Enter subtotal of above fees rs<r~
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A]) $ U l(~
(e) Technology Fee (5% of [A]) $ ].. c,!!.
TOTAL fees and surcharges (A through C): $ 07 ~
WI"'\)I~
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CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00940
IVR Number: 811175891107
www.cLspringfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
12/20/2010
12/20/2010
12/20/2010
ISSUED:
APPLIED:
225 Fifth Sf
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@cLspringfield,or.us
EXPIRES:
VALUE:
07/03/2011
$0.00
SITE ADDRESS: 2485 F ST, Springfield, OR 97477-4462
ASSES OR'S PARCEL NO: 1703361113700
SCOPE: Plumbing Only
WORK INVOLVED: Repair
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Repair water line
Phone Number:
OWNER:
ADDRESS:
MONTALVO JUAN R
2485 F ST
SPRINGFIELD OR 97477
Contractor Type
Plumbing Contractor
Contractor Name
OWNER
CONTRACTOR INFORMATION ~
Lie Type
OWNER
BUILDING INFORMATION ~
# of Stories:
# of Units:
o
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Hazmat:
Lie No
0000000
Phone
Lie Exp
08/12/2025
Lot Size:
Sq F11st Floor:
Sq F12nd Floor:
Sq Ft Basement:
Sq FI Garage:
Sq Ft Carport:
( Sq Ft Other: 0
, vv8(;-(;8;:-003- ~ SI JatUao
UO!)eO!JIl0N Al!1!l8'(f.'iEi',~U !-~r%1 Jaqwnu
Electrical Specialty Code Edilion:lldalat alll :atON) 'Jatuao allt 6u!!leO
Springfield Fire Code Editi"'n'! SalnJ.alll 10 saldoo U!etqo Aew nOA '0600
-lnn-(;S6 !:Iva ll6noJlll 0~00-~00-"G6 u'"'O UI
Mechanical Specialty Code Edition: u_ C111 ,
lj'NJ.od aJe SalnJ asoll1 'Jatuao 1I0!)BO!/nON
Municipal! Development CO,dJ;i!)n u06aJO allt Aq patdOpe SalnJ MOIIOI
Plumbing Specialty Code EditioiiDA s8J!nbaJ Me! Uo(jaJO :NOI1N3liV
Residential Specialty Code Edition:
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: HE WORK
THIS PERMIT SHALL EXPIRE IF T T
AUTHORIZED UNDER THIS PERMIT IS NO
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Springfield Building Permit
1/5/2011 2:49:28PM
Page 1 of 3
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00940
IVR Number: 811175891107
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
12/20/2010
ISSUED:
APPLIED:
12/20/2010
12/20/2010
EXPIRES:
VALUE:
07/03/2011
$0.00
SITE ADDRESS: 2485 F ST, Springfield, OR 97477-4462
ASSESOR'S PARCEL NO: 1703361113700
SCOPE: Plumbing Only
WORK INVOLVED: Repair
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Repair water line
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
DEVELOPMENT INFORMA TION ~
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% 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
~
Descrietion
Tvoe of Construction
Unit Amount Unit Tvee
Unit Cost
Value
FEES PAID
~
DescriDtion
,?idewalk Repair
Stat!:.~f SJregon Surcharge (1,~/o o~.applicab~e fee.~_..,.
:!"echnology f:.:~~f permit totaIL___~_.__..._",,"__.
Water Line
Hourly Electrical I~SpeC~~(n~v~red t:Y sched)
State of Oregon Surcharge (12% of applicable fees),
Technology fee (5% of permit total)
Total Amount Paid
Amount Paid Date Paid
$15.50 12/20/2010
$9.12 12/20/2010
.-~.--'-~------~.._,--~,-"..-_._-._..-...~..,.-.""'.
$4.58 12/20/2010
$76.00 12/20/2010
$58.00 01/05/2011
$6.96 01/05/2011
$2.90 01/05/2011
$173.06
ReciDt #
2010001102
2010001102
2010001102
2010001102
2011000041
--------*"'----
2011000041
----.--
2011000041
Springfield Building Permit
1/5/2011 2:49:28PM
Page20f3
. 5.p~n-lG.FIE. ~
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. .,'{OREGON
WWW.ci.5pringfleld.or.us
CITY OF SPRINGFIELD
. Building I Residential Permit
PERMIT NO: 811-SPR2010-00940
IVR Number: 811175891107
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or.U5
PROJECT STATUS:
STATUS DATE:
Issued
12/20/2010
ISSUED:
APPLIED:
12/20/2010
12/20/2010
EXPIRES:
VALUE:
07/03/2011
$0.00
SITE ADDRESS: 2485 F ST, Springfield, OR 97477-4462
ASSES OR'S PARCEL NO: 1703361113700
SCOPE: Plumbing Only
WORK INVOLVED: Repair
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Repair water line
Plan Review
I
Deoartment
Application Acceptance
Received Due Date Comoleted Result
1212012010 1212012010 1212012010 Overthe Counter
Reviewer
David Bowlsby
Planning Review 12/20/2010 12/20/2010 12/20/2010
Comments: Over the counter permit
Not Required
David Bowlsby
Comments: Over the counter permit
Inspection 1212012010 1212012010 1212712010
Comments: Inspection in process
In Process
Steve Graham
INSPECTIONS REQUIRED I
Inspections
3315 Water Line
9506 Sidewalk - Setback
4120 UFER Ground
Sidewalk - Setback: After forms are erected but prior to placement of concrete.
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.
-;;If? ~ 10/-6J5~//
~~r Contractor Signature Date
Springfield Building Permit
1/5/2011 2:49:28PM
Page 3 of 3
I.'.
,
"
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 penn its.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
D 1 own, reside in, or will reside in the completed structure and my general contractor is:
Name
CCB#
Expiration Date
D I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
.<11 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 Infonnation Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
--z:: ~/?~/JO
Ffint Name of Penn~ Applicant
~~
dJ/-&5"-//
Date
Permit #: Sf) (L2-::J 1 a - 00<; '1 0
Issued by: ~ate: ~( i; (I'
Address:
Z 1../1, <;:. F (7.
.
S. f'p.....i> _ i> (2... ~'l '-I '7 '?
This Copy for Permit Offices
SP.R~.NG.._..FIF..l~
~..
&'!EGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2010-00940
2485 F ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000041 RECORD NO: 811-SPR2010-00940 DATE: 01/05/2011
!DESCRfP.cTION;.,~,:.,"'::5.:;:/;::;:~\~;l;::';;.:i5f:;~-:;:f~',:<;,-:"!;' ,t ii' ,', r; 'AC.C0.l.iN~tC0DE~ f',' ,":7;:~AMOUNT_DUE~_~~,.::J
Hourly Electrical Inspections Fee (not covered by sch.d) 224-00000-426102 58.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 6.96
Technology fee (5% of permit total) 100-00000-425605 2.90
TOTAL DUE: 67.86
- .-'."....;'"1' ,'AMOuNT pAID' ,'C.' ;>~>' ">1
$67.86
tJ>AYMENTTYPE":,;tpAVOR-'-' ~CAStjl~R:CCARPENTER--_' .COMMi'liI.fS''':; "
Credit Card Juan Montalvo
087132
TOTAL PAID:
$67.86