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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 ."..... 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 / ~l~~:OElISll'E~INf;ORMJl."fIONlr,t\NPlli[OCA;r,ION@'\~~:i~1:i~ ~ r ~ ~~97 Taxlot.: \ ","'.' ." "'DESCRIPTION 0FWORK"""",:;\,: ;ljk;\"" ',e- '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) ~;j1'i~\~ft-H{it~~~~1~i4~lrtt;_'?F:EE~stAE[jO~E~?i}t~~\;j'riJ!;;.~~~~1t;i(~~ o ,',,- '0 Ld':'''-' _"''" --,.,'!/';. ;::" '," '"~""" ,_ ,.,<",;:;"iiJ,'l'/ii';-,.,;,'l<t,.}}.:: , """_,,,",.-:' l.tiulI!he~"ofj~.~P,~~~~'~;~ip,~:r~i~I~::C)':;~;: 'Bj;<1 :~;i~i~~::: ::,': :~~t~~ 0, , !""o",~"",-P',_--'-" ""~"~'d..-~'i:,,,,' ','f ..lv;, '\."i.,~, ...-,',' ,;-.1'~,_, ,'_~"- "_,,,' ",' 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~ /=0"'- lJi'11t]t LINe. f2.t=.-r'- 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. ~ -~ -, ~ . .,'{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