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Home My WebLink AboutPermit Electrical 2011-4-19 Electrical Permit Application _ i .4ll:r::. ~ . . ,~ CI'(Y"OF SPRINGFIELD, OREGON ., ~ " 225 F;[th Stmt+Springfiold, OR 97477+PH(541)726-3753+FAX(541)726-3689 DEPARTMENT USE ONLY 3U~5f Penn it no.: 9PAINCP.ELD ~^~ ..~~{;:< ~ - Date: Tbis permit is issued under OAR 918-309-0000. Permits are nontr-tnsferable. Permits expire if work is not started witbin 180 days of issuance or ifwork is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes DNa CATEGORY OF CONSTRUCTION !&.Residenlial D Government D Commercial JOB SITE INFORMATION AND LOCATION Job site addiess: ;;J I S"b L OC D City: Sp~lD Reference: \ '1 "- DESCRIPTION OF WORK CO\! tflw PATIO B((.I N G- CoDE 'VP o PROPERTY OWNER Name: ~ F:f::c.eK Address: 2--1..5"2 [.{)CH- 7?/l. City: IU.J{rPlp Phone: E-mail: This installation is being made on residential or fann 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). 117-- Signature: CONTRACTOR INSTALLATION Business name: e A.ST SIDf: EL Enf( Ie Address: 2.> ~).S":5 8oSCAG- E L-N. City: 5 P ~ cD State: 0 R ZIP: 9747"6 Phone: - 7lfl-IY99 Fax: -731:,' 1960 E-mail: RIC/c.U,S75/0E YANo6. (OM CCBlicenseno.: }liT70 BCD license no.: 10 -YOS-c lJ7J.7S ()G. Ell. Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: '~W, ~~. ~~ 440-2584-J (9108/COM) FEE SCHEDULE Number of inspections per item () Qty. Cost Total 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: ins/aJ/a/ion, 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) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: ins/aJ/a/ion, ai/era/ion, relocation 200 amps or less (2) 201 to 400 amps (2) 401 to 600 amps (2) $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,900 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: ....r J First branch circuit (2) t $ 55.00 $~ ':J /--' Each additional branch circuit 2--- $ 6.00 $ ~~ ::,.'rM- Miscellaneous fees: service or feeder not included ~ r,r;DD' Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, alteration, or ex~ension (2) Each additional inspection: (I) $ 63.00 $ $58.00 $ APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee SS8.00) (B) Enter 12% surcharge (.12 x [AD (C) Technology Fee (5% of[AD TOTAL rees and surcharges (A througb C): $lofl.al> $ ?Y.Ur-- $ .A. ~f) $7??~ . .sP.R.ING..F.IE~D ~;:~. ....7 ~ ;..;....'.2. '''''. ......X. OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00637 IVR Number: 811102298186 www.ci.springfield.or.us 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: APPLIED: 04/19/2011 04/19f2011 Issued 04/19/2011 EXPIRES: VALUE: 10/16/2011 $0.00 SITE ADDRESS: 2158 LOCH DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703251202400 SCOPE: Electrical Only WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 circuits' Phone Number: OWNER: ADDRESS: FICEK KATHLEEN M 2158 LOCH DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION '1 Contractor Type Contractor Name EASTSIDE ELECTRIC INC Lie Type CCB BUILDING INFORMATION 1 # of Units: # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: o Occupancy Type Construction Type R-3 Type VB # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Lie No 117770 Lic Exp 10/04/2011 Phone 541-741.1499 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: 2008 Site Information 1 Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: >!OTlCE: :'-IIS PERMIT SHALL EXPIRE IFTHE WORK .UTHORIZED UNDER THIS PERMIT IS NOT OlVlMENCED OR IS ABANDONED FOR >JY 180 DAY PERIOD. l Springfield Building Permit I 4/19/2011 1:49:08PM ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001. 0090. You may obtain copies of the rules by calling the center. (Note: the telephone . number for the Oregon Utility Notification Center is 1-800-332-2344). Page 1 of 3 ~S~~.INGFIELD ,:'.~ : '~i!:c+^' OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00637 IVR Number: 811102298186 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: 155 ued 04/19/2011 ISSUED: APPLIED: 04/19/2011 04/19/2011 EXPIRES: VALUE: 10/16/2011 $0.00 SITE ADDRESS: 2158 LOCH DR, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703251202400 SCOPE: Electrical Only WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 circuits , 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: I Valuation Description ~ Description Tvoe of Construction Unit Amount Unit Tvee Unit Cost Value FEES PAID ~ Descriotion State of Oregon Surcharg.e. (12% of applicable fees) Technology fee (5% of P~rTlittc:~__.___ Branch circuits without service or feeder - 1 st circuit Branch circuits without service or feeder ~ each additional Total Amount Paid Amount Paid $8.04 $3.35 _0,"~_'_"____~___~_. $55.00 $12.00 $78.39 Date Paid 04/19/2011 04/19/2011 04/19/2011 04/19/2011 Recio! # 2011000752 '2011000752 2011000752 2011 00075'2 Springfield Building Perm'lt 4/19/2011 1 :49:08PM Page 2 of3 . SP,~~N~:E~ ~(~ ~OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00637 IVR Number: 811102298186 www.ci.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 04/19/2011 ISSUED: APPLIED: 0411912011 04/19/2011 EXPIRES: VALUE: 1011612011 $0_00 SITE ADDRESS: 2158 LOCH DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703251202400 SCOPE: Electrical Only WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 circuits Plan Review ~ DeDartment Application Acceptance Received Due Date ComDleted Result 04/19/2011 04/19/2011 04/19/2011 Application Accepted Electrical Review 04/19/2011 04/1912011 04/1912011 Approved Reviewer Kip Kaufman Kip Kaufman !lniliAI,R'e,Vlew: ,~;, ::-" j" .04/~~/fSl'll..;9~t9(201T:~0,~/19'?R'i:l,;, " ;,~i;r?~~~: _ .. _:""KllITa?!~,,~,:,'_1:c,~__...L<;_,,:.{;,:-_:S,. -. -;:':T',' . ::-'~_~""'~'l! b.,,~{~' ~.~:,,~l:(: ":,M". ~~"~;!:: ~<".; _~~,.):~,~;~''*:.~ :i; "'t")-' J-"--0f' #;:">::,. P: _ ,J::::, I:~ :'~'w.4\~:T:~~~ ~~'~ .,~ ";.' _ -: "" _ I 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 a9ree, that I have carefully examined the completed application and do hereby certify that all information hereon ;s 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. ~)l1 ~ Owner or Contractor Signature +/1- (;!L , I Date Springfield Building Permit 4/19/2011 1 :49:08PM Page 3 of 3 . S~RtN, G, FIEl~ . fl~,~~_. ",:':~ :,.,.:, OR.EGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00637 2158 LOCH DR permltcenter@ci,springfield.or.us RECEIPT NO: 2011000752 RECORD NO: 811-SPR2011-00637 DATE: 04/19/2011 't'O'E'S,CR,""T""'O N", , ,'. ";' :!;?.c:\;;';';4ii::sii ;,.:.i,~\;;~.;:;d'?y,,:,,;):? :'Ie "'A"-C'C 0' UN'I",C 0':0' 'Ed';;;,"",-",-"'; liR.:oY1'A'MO,U'N'I, "'DUE ,,:-:-, ,:.'., . ~,_~.......... _' ~', -. _ ~ . '. .- .~#:." . _ _ ._, . ........_ . ~ _ _... ,_. _____-.J Branch circuits without service or feeder -1st circuit 224M00000-426102 55.00 Branch circuits without service or feeder - each additional 224-00000-426102 12.00 State of Oregon Surcharge (12% of applicable fees) 821,00000-215004 8.04 __I.:chnology..!.e!. (5% of p~~mit total) 1 00,00000,425605 u,'~_.. ,n ~__ TOTAL DUE: 78.39 Le"'XNrEElf:l);I~E5: ";g..,Y9R CASHlIiR,"IKAUFMAN:":"t,li';.: ~c6MNlI;NJ:~.: '"'''B~...::i!....;j:...':;r AMOlJNT;PAID,-,:~ ,,~.s.L,J Credit Card Roger King 78.39 04544C TOTAL PAID, 78.39