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Home My WebLink AboutPermit Electrical 2011-3-11 Electrical Permit Application 225 Fifth Street. Springfield, OR 97477tPH(541)726-3753t FAX(541)726-3689 "..PR'.NO.FIELD iij' ';". ~~~ -"<':J ~: .6.!.. --t t~_, \MJ' DEPARTMENT USE ONLY ".l-. C:;( (- T J~ Permit no.: Date: Y This permit is issued under OAR 918-309-0000. Permits are nontra~sferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for] 80 days. 'EOCAL'GOVERNMENT.'APP-ROVA12',:.,,', . ""'.".\ Zoning approval verified? DYes D No ;, :~.",,- .: .,C,6.TEGORY'OF:CONSTRUCTION";"" '. " ,0'Residential 0 Government. 0 Commercial ~!,!,~).:JOB}~SITE\~INFORMA:rIONt.'AND;1[O.CAT:IONi\'\W'4;\;f;1 Job site address: 02 c" City: 5 f' Pi...- f) ~vJ $"-ILVIC-t +- I C-\ (l (,.,.I.A \ r 'PROPERTY. OWNER Name: ZIP: 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 479.560(1. Signature: Business name: Address: City: Phone: E-mail: CCB license no.: ZIP: Fax: BCD license no.: Signing supervisorls license no.: Print name of signing supervisor: Signature of signing supervisor: ~.~ ~~ 440-2584-J (9/08/COM) ~:~;, ;'_:';ilP;:::i~~'~ff~Ej;;~l~FEE~SCHEP.U~E:?)it~%-\~~,'~i?r..~~:~~J)~ - . . '. ~- .. .~. . Cost Total ,Number'~f!n~peCtioris per)tem'() ";, Qty. ".'5 .', .' - \' ,..,,..'.... .-.: "j', .... ,," - . ':~":~ '. _'- , ':ea;'; cost , 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) J $ 81.00 $(( 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 of a service or feeder fee: Each branch circuit T, $ 6.00 $ b 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 ~ot 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 $ -,."''';!.?r.'~~r.il'Ll'-{'''"~'~'':;';''''''''ARPLiC :-"' -. ,..'-- so. F' .;,;,',; ..-":~;''''''''''J,-,", '-..'t:-~ ". .' "i~~W'0!i~kZif.1;--?;>;~i7~~~1;:~' ,,~," "ANTl~UE,f~_"";~ :]:t::;~:t;'}1.::::-'~~' >'. ".: (A) Enter subtotal of above fees $ "..- (Minimum Permit Fee $58.00) 87 (B) Enter 12% surcharge (.12 x [A]) $ 10 '/'1 (C) Technology Fee (5% of [A]) $ 'i 3.!> TOTAL fees and snrcharges (A through'C): $10'( ~- S):~N~L:ii ~~ ~OREGON CITY OF SPRINGFIELD Building I Residential-Permit PERMIT NO: 811-SPR2011-00385 IVR Number: 811140057269 www.cl.springfield.or.us 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 03/11/2011 ISSUED: APPLIED: 03/11/2011 03/11/2011 EXPIRES: VALUE: 09/07/2011 $0.00 SITE ADDRESS: 1026 J ST, Springfield, OR 97477-4011 ASSESOR'S PARCEL NO: 1703264413700 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New service and one circuit Phone Number: OWNER: ADDRESS: HELEN B BRUZER REVOCABLE LIVING TRUST 1026 J ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor Contractor Name OWNER CONTRACTOR INFORMATION ~ Lie Type OWNER BUILDING INFORMATION ~ # of Units: o # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Occupancy Type Construction Type R-3 Type VB Lie No 0000000 Lie Exp 08/12/2025 Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: ATTENTION:~{c!gtl\\I\W; requires you to follow rules iRio~~!iW1~q the Orei!!on Utility Notification CWl:!elipifdcyafu~d\eS are set forth EI t- IS - IlyC d Ed-t- in OAR 95?()(1j-0010through OAR 952-001- ec fica petla 0 e I IOn: ""200'6. . _ _ _ _ 0090. You may obtain copies of the rules by Springfield Flte Code Edlllon: calling the center. (Note: the telephone Mechanical Specially Code Editi'llllmber for the Oregon Utility Notification Municipal I Development Code: Center is-1-800-332-2344). Plumbing Specialty Code. Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Site Infonnation ~ Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: ~etaining 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 3/11/2011 9:03:42AM Page 1 of 3 S~~T~~~ ~7',~ "''l''i~}' OReGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00385 IVR Number: 811140057269 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 03/11/2011 ISSUED: APPLIED: 03/11/2011 03/11/2011 EXPIRES: VALUE: 09/07/2011 $0.00 SITE ADDRESS: 1026 J ST. Springfield. OR 97477-4011 ASSESOR'S PARCEL NO: 1703264413700 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: New service and one circuit DEVELOPMENT INFORMATION ~ 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 ~ Descriotion Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ DescriDtion State of Oregon Surcharge (12% of applicable fees) !echnol~gy fee_ (5% of permit totall. Services 200 amps or less Branch circuits with service or feeder each circuit Total Amount Paid Amount Paid Date Paid ReciDt # $10.44 03/11/2011 2011000448 $4.35 03/11/2011 2011000448 ------.---..--.,..-.----. -. .~.._---- $81.00 03/11/2011 2011000448 $6.00 03/11/261T.--~-261iOOo448 $101.79 Springfield Building Permit 3/11/2011 9:03:42AM Page 2 of 3 s~. ~IN GFIE~ D. . .~-- ".- rt1; ,-," .\ OREGON CITY OF SPRINGFIELD . Building I Residential Permit PERMIT NO: 811-SPR2011-00385 IVR Number: 811140057269 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 03/11/2011 ISSUED: APPLIED: 03/11/2011 03/11/2011 EXPIRES: VALUE: 09/07/2011 $0.00 SITE ADDRESS: 1026 J ST, Springfield, OR 97477-4011 ASSES OR'S PARCEL NO: 1703264413700 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New service and one circuit Plan Review ~ DeDartment Permit Issuance Received Due Date 03/11/2011 03/11/2011 Comoleted 03/11/2011 Result Issued Reviewer Chris Carpenter ~ret1(j9~1 R,evieW:-f.~\:!{?;if!:-'::"l~' ~~l} 1?20~:~, '~0~).1/2?1 ',1~':;':03/1;1~,20r11} :~P~~~~~i:';~~~-CTf~Rarpenter~f>:. ?~{-"r j -Comments:'- Overtlie-~o~nteOH~;rmit-~':;. .i-_;~:;~,~,:",~, ,,,~};;~ . :_ - ,"l:~~,:~.: \;;~, .-a..,v ;~. Initial Review 03/11/2011 03/11/2011 03/11/2011 Over the Counter Comments: Over the counter permit ~~P^Plj~~i<6n J;\cce.pt~nge,~'>~.< 09-: , 03/11/2011.:,~3t1'-2011:;:0)'.1,t12011,.. :t?: theC?Un~,{r INSPECTIONS REQUIRED I Inspections 4225 Service or Feeder ~~~-.-,.-._. - "t _. .<.,.,",.; ..i....:...-..._._~ Chris Carpenter :~.C!:trl~ Carp'ente~! <;: '\': ..- "'A . -~. 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. ,3-//-// Date Springfield Building Permit 3f11f2011 9:03:42AM Page 3 of 3 S.~1:~~~~ L~ ~ORfGON TRANSACTION RECEIPT. CITY OF SPRINGFIELD 225 Fifth 81 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00385 1026 J ST permitcenter@ci.springfield.or.us RECEIPT NO: 2011000448 RECORD NO: 811-SPR2011-00385 DATE: 03/11/2011 tbEsCRI~TlbN~:~:t':J3,~'.3.;;,P;'<!"; '~'~"'~2~i"~;;'~ ~l:ti€u:??Lf1~i';~i~ACC0UNt#~c6t>E'...~!~,," ,..:, -,' -'::i!&'AI\JI()UNT,-DlJEr::-~-~,~~,'f,i; Branch circuits with service or feeder each circuit 224-00000-426102 6.00 -------~-_._- ---.----...--.------ 224-00000-426102 81.00 821-00000-215004 10.44 100-00000-425605 4.35 _.._~._.........- TOTAL DUE: 101.79 Services 2?O amps or less ..__.___ State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) h- P A YIYII;NTl;Y..P.E':'" "', Credit Card 085944 0~~:Y~R~C\AsHfErr:'cc..n~"'"PENTER;;:;i;:if;;f:r;;:lqQM:MgN[$'Z~:S~'E~~:;;Y~~~~.;r'~4fx-AMO~NT'PAID., ':-', ':,'C ?)\:j~';:'k*";,1 Barbara seufert 101.79 TOTAL PAID: 101.79 . 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 filed 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 all subcontractors who work on the structure must be licensed with the Construction Contractors Board. tl or WI 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. ~#P'A ;=;;fU-.FfjQr / ." Print Name of P rmit Applicant s II ( J) ( Date ' I Permit#: >1 I - 3%') Address: r () 2-(" ~ IT Issued by: ~ate: ~ \ \ This Copy for Permit Offices