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Home My WebLink AboutPermit Electrical 2011-5-4 Electrical Permit Application , -)"" _", J .....~-=.~-!t'o:. '~<""_{ '~' ~ "'. "'''''~,.~.", j:i ,:~,\'O\,;r.-:'.:r. 'f:. l:'~";:",~' .. CITY 0}JtSPRIN GF.JEIiD~ ORE60N;:;i~ "" ':r;-: ~"~,*.~ .___.":'. ..; "'7i.~......tl..";, ,i"....:~,,-t~," ! 225 Fifth Street. Springfield, OR 9747H PH(541)726.3753 tFAX(541)726-3689 '-=.' DEP!6.RTMENT USE ONLY SPR:NGFIELD ~. ~~~'~' _'" '"' - " ., '.~1k~J it<M~:,,'t~ ~- :'~ ~-." ""' 8i1 ~5:ft?- z.e-U ~ Permit no,: Date: 5-4'- 1--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. .EOC~VGOVERNMEN:r' ~~F'ROVAIO",,!.' Zoning approval verified? 0 Yes 0 No ,", . .:::,,'CATEGORY "OF ::CONSl'RUCTION~"'~ :',;. ',.,.' .' ~' :-;;: ;;';f..~~^.~,i:~7-~w~~;~:;,"='~;~I:I;-E-~5CH ED,I) ~E:~.:lf~if;jt~~~~~tl:~~~~~~~7? ,N~"l~er,~(f,ii~ipe<:t!~~~s.~~~,-;~t'~.~, (r~'+~;~_: q!~. .;,~~~~ J, ~~~~~ " Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof ZIP: Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ "i'. 'i \;,~,~'~~-'~" . "."- dwelling service or feeder (2) Name: Address: 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). ZIP: Signature: " CONTRACTOR INSTALLATION ~(L- 1I/3CJ ZIP: 171..fYO E-mail: CCB license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: rOq.~4;- 440.2584.) (9108/COM) Services or feeders: installation, alteration, relocation 200 amps or less (2) 201 to 400 amps (2) 40 I to 600 amps (2) 60 I to 1,000 amps (2) Over 1,000 amps or volts (2) Reconnect only (2) I $ 81.00 $ $ 95.00 $ $158.00 $ $205.00 $ $469.00 $ $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) 20 I to 400 amps (2) 40 I to 600 amps (2) $ ~ $.81@) $ 87.00 $ $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) Each additional branch circuit $ 55.00 $ $ 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 $ 7';i;"t''''I'-'-;l~JX:.~'i;':;j;1;:;'''<'i;i>:'(.k0~''''<C '.-n-1-" -,""";r,-" .-<~. ,':-",.'-,~"';~"-"'~" ','- '.' ti(\l'id..fJrtl:.-SjtK&ici~i~f~\I1,'l~'l':<::J(~/!.Ret:;ICAN:r?:,;'USE:>';,,,\,,',~~~;;~G"jt:C~~~'r~:.;" -'7 (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B)-Enter 12% surcharge (.12 x [A]) (C) Technology Fee (5% of [A]) TOTAL fees and surcharges (A through C): $ $ $ $ -I"T. -r t-- .- CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811.SPR2011.00746 IVR Number: 811104679472 www.cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 05/04/2011 ISSUED: APPLIED: 05/04/2011 05/04/2011 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us EXPIRES: VALUE: 10/31/2011 $0.00 SITE ADDRESS: 5690 MAIN ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702334103002 SCOPE: Right of Way Permit WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: In public right-of-way: Qwest 100 amp service for OSL. Phone Number: OWNER: ADDRESS: ROBERTS FAMILY REVOCABLE TRUST PO BOX 167928 IRVING TX 75016-7928 CONTRACTOR INFORMATION ~ - Contractor Type Contractor Name TONY KOTH Lic Type CCB BUILDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o Occupancy Group Occupancy Comments U 100 amp service for Qwest # of Bedrooms: Sprinkled Building: Fire Alanns: Energy Path: 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: Lie No 59748 Lic Exp 05/19/2012 Phone 541~688.8996 Lot Size: Sq Ft 15t Floor: Sq Ft2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: 2008 Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: NOTICE: ' _, Soils Report Required: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 5/4/2011 9:56:46AM 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 of3 ;.. ,- SP~I..N G. FIEL~ ~\. --.. J;~'. a'I .~' '\ OREGON www.cLsprlngfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00746 IVR Number: 811104679472 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfieJd.or.us PROJECT STATUS: STATUS DATE: Issued 05/04/2011 ISSUED: APPLIED: 05/04/2011 05/04/2011 EXPIRES: VALUE: 10/31/2011 $0,00 SITE ADDRESS: 5690 MAIN ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702334103002 PROJECT DESCRIPTION: SCOPE: Right of Way Permit WORK INVOLVED: New TYPE OF STRUCTURE: Commercial In public right-of-way: Qwest 100 amp service for DSl. Fronlyard 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 Tvee of Construction Unit Amount Unit Tvee Unit Cost Value FEES PAID ~ Description State of Oregon Surcharge (12% of appl!<:::ble fees) Services 200 amps or less Technology fee (5% of permit total) Total Amount Paid Amount Paid $9.72 $81.00 $4.05 $94.77 Date Paid 05/04/2011 05/04/2011 05/04/2011 Reciot # 2011000870 -.- ~_._- - 2011000870 2011000870 Springfield Building Permit 5/4f2011 9:56:46AM Page 2 of 3 SPRIH. ~.~L o. ~.14 _. '-'.. .IM" ".,:\ ~EGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00746 IVR Number: 811104679472 www.ci.springfield.or.us 225 Filth 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 05/04/2011 ISSUED: APPLIED: 05/04/2011 05/04/2011 EXPIRES: VALUE: 10/31/2011 $0.00 SITE ADDRESS: 5690 MAIN ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702334103002 SCOPE: ,Right of Way Permit WORK INVOLVED: New TYPE OF STRUCTURE: Commercial In public right-of-way: Qwest 100 amp service for DSL PROJECT DESCRIPTION: Plan Review I Department Application Acceptance Received 05/04/2011 Due Date 05/04/2011 ComDleted 05/04/2011 Result Over the Counter Permit tssuancf,':.,,:;. ,'.> '" {i1 'my"",>"" .,.;: ''-05/04/201 1.,,",05/04/2pt1, -';,05/04/2Q1 f '$'~\:'::::,:~,,:;~' :~,; ,i::':+f0'O.....~~.',~...,t~;t~;~~I~:.;." ..,. ";'.H Electrical Review 05/0412011 05104/2011 Comments: Over the counter permit Ilnitiai'Review . -, <.., 05/04/201~."'05/04/20f1 I "., . -.' ., ; _ Comment~: Ove~ the counter permit .' 05/04/2011 Not Required Reviewer Kip Kaufman ,~ Kip~Kaufman' /! ,F'tJ:f-$ "., ~ ....:'t..,\_-~'_. ' Kip Kaufman "-... o '05/04/20tt "Over,tlie Cou'nle</" .' Kip..'~~ufm~n' p """".,Y 0:........ INSPECTIONS REQUIRED ~ Inspections 4225 Service or Feeder 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. r:;;-t/~ II Owner or Contr Oate Springfield Building Permit 5/4/2011 9:56:46AM Page 3 of 3 SP~~N.~. ~EL~ ~~ ~.OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 8t Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00746 5690 MAIN ST permitcenler@ci.springfield.or.us RECEIPT NO: 2011000870 lDESCRI~JION , . Services 200 amps or less State of Oregon Surcharge (12% of applicable fees) Techn'?logy fee (5% of permit total) . ,d"' ~. ,.,.h, RECORD NO: 811-SPR2011-00746 ';;. ":,.:,' Cc. ;""Att6uNLC'ODE_:.:_:f'-"'," 224-00000-426102 821-00000-215004 100-00000-425605 TOTAL DUE: DATE: 05/04/2011 . ';"AMOUNLDUE 81.00 9,72 4.05 94,77 . AMOUNTPAID ' 94.77 '~ ......'. UAvMENTTYPE Check 7481 PAyqR' CASHiER: KKAUFMAN Lite Electric Service ,';':. - COMMENT,5 - .- ck#7481 also covers #811-SPR2011-746 "" , TOTAL PAID: 94.77