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Home My WebLink AboutPermit Electrical 2011-1-6 Elect~ical Permit Application . I 22S Fifth Streit. Springfield, OR 97477tPH(S41)726-37SH FAX(S41)726-3689 , " ,-(.',,' .. " .. :DE~~j:nMENT USE ONLY Penn it no,: 6//~ 5;p;2 ~I ~ - Date: Q/r O~ -- / ! 30 . 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. ' 'j '0. ""l!OCAL::GOVERNMENTAJ:'PROVABX.:c,{<'~1~'it\t\~:. Zoning approval verified? 0 Yes 0 No ;; ,~!;:L~:.,.:,;/;,ICATEGORYiJ'OF,',:CONSl'RUCTION:::~ Job site address: City: 5: Reference: , r-';', Name: Address: Phone: E-mail: This installation is being made on residential or farm property owned by me or a member ormy immediate family. This I property is not intended for sale, exchange, lease, or rent. OAR: 479.540(1) and 479.560(i). Signature: -'CONTRACTOR INSTALLATION Business name: BJ;vfV't;"n- Address: ZIP: City: Phone: E-mail: CCB license no.: Signing supervisor's license no.; Print name of signing supervisor: Signature of signing supervisor: 1<0/'" _ IF For L.-- %~~ ~~ J :,s.' 440-2584-1 (9/08/COM) , '" ~;~t1,~h.\~Jfi~~~~~t1%~ro~1L1r~~~rfE-EE~_S~CA ED.U~E~~~~?t~,~\w.:~~~t~4~~~\~ '_1'lU m ber"of.jri~p~~tio'ti~p~r., it~~.l) :T ~~-:Qty-.' , Cost ;;, Total 'r " ';Yf" ," . "";', _~: .' Yi:;:~ <)h -i~' C,.l ,',.,'" ,- I,;_'~"'; "." .".' J;:'~:ea}! , cost, , Residential, per unit, service included: , 1,000 sq. fl. or less (4) $134.00 $ Each additional 500 sq. ft, ,or portion $ 2S.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 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $20S.00 $ Over 1,000 amps or volts (2) $469.00 $ RecQf!~'~c.!:RP!~I(~', $ 63.00 $ T ..!.nll........ -.'.. v~~nlJn '';J'~ II I I e^rp_p.l?~ary's~~vJc~~l!f,..,~e~...Jers: lnstQ ~,aJtp!J~a,!f;~c;tion, re oeation 2~6 ampi'Or' 'less;(2)lter -Th vy tfle 0. egol - 'v . IlJJ..aJ nr:-,.., _ _ . /1,<:.'0..",_ I$ti63,00 $ 25PfoJ409~a1Pp~s~m ~~~1 0 throuqhO tHe ~ ett",,;, $ jPn, ~$ 87,1)0 4q.,f~/I"-' u J ~.....tQIlI COPI he II ~ -uu J ~ 4 to 9001anipsl('~hter I^'~,- e,s ot 1,$He,.OO $ "~I-:pl lor tn -- ,-....... lilt:' Tel' ~-!. Over 600-~.p~P!.FPOOtV8!!~i S3rj~,rf1~cr<::,,?:~feed.e!s section above . "<:> I ~~yn 0..,,.., J.' "i;0'J'L-'ac'BrJ Branch circuits: new, al e alifmjLexl.(!1y4 per p { 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 c,ircuit (2) I $ 55.00 $:;):) ~ 'OE~~hfadditional branch circuit Ie T ~^ n;$,K6.00 $It- , .." ...,n""llr:: tOll' U' ~I\II" :::-.Hf-\LL 1_'" II ''-'' . M ~s~el~~~~'!.s f~~~ ;",sp;yise..2r((e~4-ep'{l,P.nnf&44t{) T Il' j t":'llt"llL CU U 11lL.J 1.-' , . .,.- $ . Each pump or(irrigation circle\(-2)ONE[1 FO $ 63.00 (. ""'" "~__.... ~ I. " ". ~ ,.... ...' '..... ,.,) \ '1\'I','II_'''vl.-..... ...... .- J . ~~~ch~ ~~n lqrIP.utlll].e~Fg~f!~g (2) $ 63.00 $ Signal circuit or a Iimited.energy panel, $ 63.00 $ alteration, or extension (2) Each additionaJ inspection: (I) $S8.00 $ ~m~~~t~~~;lf~~~11[~%~'ReiJf(;A~~1t{51JS~E1!i~:;;:~~'~~[:jig~~:~:b;(;~~c':;:,~ (A) Enter subtotal of above fees $&-1 , f-v (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [AD $ ((_C (C) Technology Fee (S% of [AD $ J.Sr> TOTAL fees and surcharges (A through C): $"/K-- ~ 1 :t- c; i ..... SP~I\NF:,I~E:~D" ' ?","kd',_ "",'C[' '~.1 0;, J~<<X; OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us I Building I Res,idential Permit PERMIT NO: 811-SPR2011-00030 I IVR Number: ,811162324337 permitcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 01/06/2011 'I " ISSUED: I APPL!ED: 01/06/2011 01/06/2011 EXPIRES: VALUE: 07/05/2011 $0,00 SITE ADDRESS: 1394 T ST. Springfield. OR 97477-2432 ASSES OR'S PARCEL NO: 1703252300605 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT'DESCRIPTION: Reconnect AH~ HP ~ Add to circuits OWNER: ADDRESS: FOSBACK HAROLD L 1394T $T SPRINGFIELD OR 97477 Phone Number: Contractor Type Contractor Name CONTRACirOR INFORMATION ~ Lie Type Lic No Lic Exp Phone BUILDING INFORMATION ~ # of Units: o # of Stories: ,I Height of Stnj.cture: Type of Heat:;, Water Type:: Range Type: ' Hazmat: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: I Springfield Fire Code Edition: 1 . Mechanical Specialty Code Edition: Municipal I D~velopment Code: " Plumbing Specialty Code Edition: , Residential Specialty Code Edition: Structural Specialty Code Edition: Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: 1I!OTICE' , THIS PERMIT SHALL EXPIRE IF THE WORI( AUTHORIZED UNDER THIS PERMIT IS NOT '. COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, ATTENTION' Ore follow rules ~do pan law requires you to Notification Centtre1, by the Oregon Utility In OAR 952-001-00'1 0 t~ose rules are setforth 0090, You ma 0 ' rough OAR 952-001_ calling the c~nt~;al(~of'es of the rules by number for the 0" 0 e" the telephone legon Utility N t'f' , Center is 1 800 3 0 Ilcatlon - - 32-2344). Springfield Building Permit 1/6120~ 1 10:40:26AM Page 1 of 3 ; ., www.ci.springfield.or.us CITY OF SRRINGFIELD Building I Residential Permit PERMIT NO: 81'~ -SPR2011-00030 IVR Number: 811162324337 I 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitce nter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 01/06/2011 ISSUED: ! APPL,!ED: 01/06/2011 01/06/2011 EXPIRES: VALUE: 07/05/2011 $0,00 SITE ADDRESS: 1394 T ST, Springfield, OR 97477.2432 ASSESOR'S PARCEL NO: 1703252300605 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Residential Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Reconnect AH- HP - Add to circu:its DEVELOPMENT INFORMATION I Overlay Dist: ;f # Street TreesiReqd: . " Paved Drove Reqd: % of Lot Coverage: Highest point on structure to north property line:'! I REQUIRED PARKING Total: Handicapped: Compact: PROJECT DESCRIPTION: PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: DownspoutfDrains: Valuation 'Description I Description Tvpe of Construction Unit Amount Unit Tvpe Unit Cost Value "FEES PAID I Description Amount Paid ~tate of Ore!!~n Surcharge (12% of applicable fe~s)~i $8.04 Technolofl~~~(5% o! e"rmit~otal) '''''._ ....._____.'-..-!.32~__... Branch circuits with service or feeder each circuit $12.00 -', Branch circuits without service or feeder - 1st circuit $55.00 ----- Total Amount Paid $78.39 Date Paid 01/06/2011 01/06/2011 01/06/2011 01/06/2011 Reciot # 2011000048 2011000048 2011000048 2011000048 Springfield BUilding Permit 'I 1f6/2011 10:40:26AM Page 2 of3 ., '.' 5.PR.ING.fIE~' , Ik~-' , "'..... ~"'W 01:h. 'OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00030 IVR Number:,1811162324337 www.ci.springfield.or.u$ 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.u$ PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: I 01/06/2011 01/06/2011 Issued 01/06/2011 EXPIRES: VALUE: 07/05/2011 $0.00 SITE ADDRESS: 1394 T ST, Springfield, OR 97477-2432 ASSES OR'S PARCEL NO: 1703252300605 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Reconnect AH. HP . Add to circ~its ~Ian Review ~ DeDartment Application Acceptance I ComDleted 01/06/2011' Result Over the Counter Received Due Date 01/06/2011 01/06/2011 Reviewer Nancy Machado l~~r_' Tit- Issuan~ge.: <:-:'\--','~-'}~':..,~ ,,~';,O:!J9Blt:Q.,1:,t:,~~PN9pl_g..qj.'~~,:N.:1,I,o,~f_l~.9~]::p.'j~'J;~:uf,d~;p_}4~;~i:'7.:: ~::"~'"_':N,~." ~y:.F1~,~hado ~ ",~ -', >,','" .' ..:] I' -'" - ,., - . .' ;;}. -" .,," .. -J( .. ~$ -. . ~ -~~?:~.?_':~,.'.~:,'",':'J'~ ,l ~~-~l5~ ,,'~~"~~~~.~~ -,'~~~r:::co~:;:, ,''''i ,~<r0 ,;;"'-.~.:<'-J,.:~:\Gt,:~~~,:i~t:~Y;::~'A~,::r1i""'~7''';Y\'.; i" '::"~:" -"'-''';~',~ ~:i~~::~1:e;~ ' ~'> ~.:. 'i"'~ - ; _T , -. -~ 't.,: , .. ~ Electrical Review 01/06/2011 01/06/2011 01106/2011, Not Required Nancy Machado Comments: Over the counter permit i In'tl_al-R~~~~ ' ff'."., .,:-;. ~,01/06/2011 ',,~1L06/~0,11, ~:/g6/201~, ,--;;O':'.;:lh:;,~~U:r\~[, ~, '; _ ~a~5Y-MaC~~a~,o_, . .. - CommenJs: 1~ Over the cou~nter pe~m!t , "'. '''' "," t 't' ~~ !tfu:~::~ ". \. c ;, --' .. ~ ~_.- ~, .. ~~~&;,,; -~~~~ -'~ ~ ~-* ~ "~ I INSPECTIONS REQUIRED ~ Inspections 4500 Rough Electrical Rough Electric: ~rior to Cover 'j 4999 Final Electrical Final Electric: Wilen all electrical work is complete. I 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 It he 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 approve9 set of plans will remain on the site at all times during construction. ~ /-6-// Owner or Contractor Signature Date Springfield Building Permit 1f6/2011 10:40:26AM Page 3 of 3 . }' J 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 buildi~g, electrical, mechanical, and plumbing permits. licensed architect and engineer applicants, ex~mpt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be fil~d with the permit. . Please check the appropriate box: D I 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 alii subcontractors who work on the structure must be licensed with the Construction Contractors Board. ii .~ or I will be performing work on property I owh, 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 a'nd 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 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. /JAIi~/J J. /c.S'J,Aek Print Name of Pennit Applicant 7~; 7-~ /-I.,-/( Signature of Penni! Applicant Da!e Permit#: Issued by: Date: Address: This Copy for Permit Offices ~ SP'i:tl..G~=L~ ~fJ;y>",- ~. ~g ~OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fffth Sl Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00030 1394 T ST permitcenter@cLspringfield.or.us RECEIPT NO: 2011000048 RECORD ,~O: 811-SPR2011-00030 DATE: 01/06/2011 lDElrCRf~tION C.;'i0~.,&'7:,;? ~ ;;:4', _ ',:' <,,::'it, ':;;', "'.J: \-c-: tlC.c:OUNTcCODE'" '- Ui;MbUNT,DlJE' . :;'1 Branch circuits with service or feeder each circuit 224-00000-426102 12.00 Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00 _ __'V_,~_." State of Oregon>~urcharge (12% of applicable fees) >__.___~>821-00000-215004 8.04 Technology fee (5% of permit total) _______...!.90-00000-425605__ _~5__ TOTAL DUE: 78.39 L.;p AY.MI:~T T:YB.El:i<t::;:~~Y_<:lJ~' c;;' > "CASHIER:NMA.CHAD9"'$..:.9QiviMI:t<lcIS.:.,..::':: >i'" :", " .' '~MQlJt<ll..R~JP.;:;_:L; ;, A;3.:J Credit Card Charles Osgood $78.39 340486 TOTAL PAID: $78.39