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Home My WebLink AboutPermit Electrical 2011-1-20 Electrical Permit Application CITY OF SPRINGFIELD, OREGON 225 Fifth Street+Springfield, OR 97477+PH(54I)726-37S3+FAX(541)726-3689 ~~ DEPARTMENT USE ONLY ~ H -SfIC"2..;1J--J. Permit no.: Dale: L - 'I-B- - H Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuaDce or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION o Residential Govemme ~ Commercial JOB SITE INFORMATION AND LOCATION Job site address: 260 S,"3 Z. "')> ST. City:SPRt '" Reference: t""t..D TaxloL: DESCRIPTION OF WORK ~ t": 1:>", 'iT PROPERTY OWNER t City:sP uzU Phone:S"tr-'''''' "r5'r'+' E-mail: \...e...=.f(.@:c........ic..LArt.-ALA. ~ .6/Z.d.. This installation is being made on residential or fann property owned by meOTa 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: CONTRACTOR INSTALLATION Business name: O(..vN~ Address: A):>" ZIP: City: Phone:S'II-7!G E-mail: CCB license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: BCD license no.: 402..35 '"R. AL l>?~ ..,. 440.2584-1 (9108/COM) FEE SCHEDULE Number of inspections per item () Qty. Cost Total ... cost Residential, per unit, service included: 1,000 sq. It. 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 $ Reconoect only (2) $ 63.00 $ Temporary services or feeders: instal/ation. alteration. relocation 200 amps or less (2) $ 63.00 $ 20 I to 400 amps (2) $ 87.00 $ 40 I 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 $5~"'" Each additional branch circuit Z $ 6.00 $ I'l..- 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 lirnited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ .. APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Permit Fee S58.OO) "'I~ (B) Enter 12% sorcharge (.12 x [AD $ ~ (C) Technology Fee (5% of [AD $ 3~ TOTAL fees and surcharges (A through C): $'] 8.3''1 .i. S!~IN, G flE,~ .~- -.~ ~ ,>7' OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00093 IVR Number: 811183617890 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield,or,us PROJECT STATUS: STATUS DATE: Issued 01/20/2011 ISSUED: APPLIED: 01120/2011 01/20/2011 EXPIRES: VALUE: 07/19/2011 $0.00 SITE ADDRESS: 200 S 32ND ST, Springfield, OR 97478-5824 ASSESOR'S PARCEL NO: 1702310000502 PROJECT DESCRIPTION: OWNER: ADDRESS: Contractor Type # of Units: Occupancy Group Construction Type # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public J circuits o A-4 Type VB Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal! Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Phone Number: Lic No Lie Exp Phone WIllAMAlANE PARK & RECREATION DISTRICT 250 S 32ND ST 'res 'IOU to SPRINGFIELD OR 97478 ", reaon \aW,(:~\"aon Uti\it~, p;., . :.ciE?~'MAcf'O)NfORMAffoN'~ '~ni Contractor ~'"'lbation L,~~"~~ 0 t\1fOUg" '::',Q~j'yp"e3s b'l . 01\"" 9~"- _,,, tain CO\)I~~h:' \,,180\1on8 009 :,_~ \ '~Uli!DMG'Ir-!.F.QRM!P:IONO\\1\"'" V" C ~ ~ lort \~ ~,. ~ 0-33,,,-"0~-' J' I1Ur<ll'Q)frStoriesr is '\ -aD lie\n..... Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: o Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit Site Information . :' ..;..~,?'- NOTICE: P\RE \n\-\E \NORK , 1\-\\S pERMIT S\-\p..\..~ V\-\\S PERMIT IS NOT. AUTHORIZED UNDES ABANDONED FOR , ' COMMENCES Op~~\OD. ANY 180 DAI 1/20f2011 11:10:37AM I Page 1 of3 \ \ Sr~N;~~ .~:~~'GON 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.oLuS Building I Commercial Permit PERMIT NO: 811-SPR2011-00093 IVR Number: 811183617890 permilcenler@ci.springfield,or.us PROJECT STATUS: STATUS DATE: Issued 01/20/2011 ISSUED: APPLIED: 01/20/2011 01/20/2011 EXPIRES: VALUE: 07/19/2011 $0.00 SITE ADDRESS: 200 S 32ND ST, Springfield, OR 97478-5824 ASSESOR'S PARCEL NO: 1702310000502 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: 3 circuits Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: DEVELOPMENT INFORMATION I 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 I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description. I Descriotion Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ DescriDtion Branch circuits without service or feeder - each additional !ech.nology f,,'05% of permit total) Branch circuits without service or feeder - 1 st circuit State of Oregon Sur.~harge (12% of applicable fees) Total Amount Paid Amount Paid $12.00 $3.35 $5,5.00 $8.04 $78.39 Date Paid ReciDt # 01/20/2011 2011000132 01/20/2011 2011000132 -.-"'-"'-....--.-->.--....-",- 01/20/2011 2011000132 01/20/2011 2011000132 Springfield Building Permit 1f20/2011 11:10:37AM Page 2 of 3 ... .~ 5P~~N~~. . ~. ~OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00093 IVR Number: 811183617890 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield,or,us PROJECT STATUS: STATUS DATE: Issued 01/20/2011 ISSUED: APPLIED: 01/20/2011 01/20/2011 EXPIRES: VALUE: 07/19/2011 $0.00 SITE ADDRESS: 200 S 32ND ST, Springfield, OR 97478-5824 ASSESOR'S PARCEL NO: 1702310000502 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: 3 circuits Plan Review ~ Deoartment Permit Issuance Received Due Date Comoleted Result 01/20/2011 01/20/2011 01/20/2011 Issued Reviewer Kip Kaufman Initial Review 01/20/2011 01/20/2011 01/20/2011 Over the Counter Kip Kaufman Comments: Over the counter permit lApplk;atiOh:A~~tance~"i..r;:f '161120/201'Yf~~:0112 20t1~01/20/20-i-1~1'_';Oe'e(th'e;CiruntJi'~'1~~'':i,Kip~Kaufm"ani" ..-':-::_-;J,;;;'0~7~'~~' ~. ;. ?, fL~:l 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. 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. ~w~ , / / Z/// Z//// , Owner or Contractor Signature. Date Springfield Building Permit 1f20f2011 11:10:37AM Page 3 of3 SPRINGFIElD ~>'h~ ~\t.~ . ' 0~'" OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 www.cLspringfield.or.us 811-SPR2011-00093 200 S 32ND ST permitcenter@ci.springfield.or.us RECEIPT NO: 2011000132 RECORD NO: 811-SPR2011-00093 DATE: 01/20/2011 I;DESCRf~j:foN :' ~:~, ';;;,;~ ,',,8#" ;,"; ":"7"~'ii"P;;~;;;:V2:t"",:'J:r;"A.CC~QUNJ:CODE;;YjiW",; '"iii', ;;""i,;)!.MOU N:tblJ E;:": t. 0,4 Branch circuits without service or feeder - 1st circuit 224-00000-426102 55,00 -.-'-- Branch circuits without service or feeder - each additional 224-00000-426102 12.00 --~------ 821-00000-215004 8,04 1 00-00000-425605 3~35 TOTAL DUE: 78.39 Lj>,AYMgt.jJEfoY;ae:J..r~-ie...J'Q~':",l,:f;'i:ASHIERT:EiAU~MAN '~~ ;::';QOn.fMENis~'1tj~'~~1':~;l:~,Js'~i,\nn_()JJJ'!tR""I[) '", _'_:l ~:.J Check Willamalane ck#85109 $78,39 State of Oregon Surcharge (12% of applicable fees) Technolo~y fee (5% of permit total) 85109 TOTAL PAID: $78,39