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Home My WebLink AboutPermit Electrical 2011-5-10 .J Electrical Permit Application ; , j . ~ . ,CITY OF SPRINGFIELD, OREGON . 225 Fiftb Street+Springfield. OR 97477+PH(541)726-3753+FAX(54I)726-3689 DEPARTMENT USE ONLY ~~~ Y7 Date: This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is Dot started within 180 days of issuance or if work is suspended for 180 days. LOCAL' GOVERNMENT APPROVAL Zoning appro'Oal verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION o Residential gJ Government 0 Commercial JOB .SITE INFORMATION AND LOCATION Job site address: b I DO City: SPlitII\)c;.Ft- Reference: S{ "-' Name: \, Address: Z City: S fR Phone:5'(1-7J:.- "\S"\: E-mail: This installation is being made on residential or fann property owned by me or a member of my inunediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: DI T- ZIP: 9. CONTRACTOR.INSTAL:LATlON .' A '1-,)1'/6-/2- Address: City: Phone: E-mail: CCB license no.: ZIP: BCD license no,: Signing supervisor's license no,: "I- 0 Z. 3 5 Print name of signing supervisor: \<& Signature of signing supervisor: /G 44U-2584-J (9/08/COM) % ~7/.~ ~ ~.:u~"9 ~ FEE SCHEDULE Number of inspeetions per item ( ) Qty. Cost Total ea. cost Residential, per unit, service included: 1,000 sq. ft. or less (4) $134,00 $ Each additioual 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) Senrices or feeders: installation, alteration, relocation 200 amps or less (2) I $ 81,00 $5(~ 201 to 400 amps (2) $ 95,00 $ 40 I to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 '$ Over 1,000 amps or volts (2) $469.00 $ Reconoecl ouly (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 3 $ 6,00 \e~ 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 freder not included Each pump or irrigatioo circle (2) $ 63.00 $ Each sign or outline lighting (2) I $ 63.00 $(;3!?!!- Signal circuit or a limited-energy panel, $ 63,00 $ alteration, or extension (2) Eaeh additional inspeetion: (I) $58,00 $ ~i~~~l~:;~ll~~{{!HiK*;fAPpmCANT~~,(jSEI~{/~, -'.<,: ." .' (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) IbVE (B) Enter 12% surcharge (.12 x [AI) $ l'l~ (C) Technology Fee (5% of [AI) $ BtE- TOTAL fees and surcharges (A through C): $/8'lti- ;: www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00787 IVR Number: 811157253976 Issued ISSUED: APPLIED: 05/10/2011 05/10/2011 225 Fifth SI Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci.springfield.or.us EXPIRES: VALUE: 11/06/2011 $0.00 05/10/2011 SITE ADDRESS: 6100 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342100400 PROJECT DESCRIPTION: SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public New 200A Service and 4 other circuits Phone Number: OWNER: ADDRESS: WILLAMALANE PARK & REC DIST 250 S 32ND ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor # of Units: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Contractor Name OWNER CONTRACTOR INFORMATION I Lie Type OWNER BUILDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Lie No 0000000 lie Exp 08/12f2025 Phone o Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: . Lot Size: . S you to . " on law require A"jS,l8fnlill~lb""reg d b the Oregon Utility 101ISqIFf'2lifFFilR,c?pteTh:Se rules are set 10rth N tlfi"-"I~' l!l Center. R 952-001- . o~r ~'ffil~~~01 0 through OA b In <M}~t9 r.il<w., obtain copies 01 the rules Y OOI$~; u=, Note: the telephone ca~lfrtg:ffllPOOntoer. \nn Utility Notilicatlon ,,"""@thllI'.the reQI)" no"'''' '. 1_800-332-2344). occupJR~tllfa!l! Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit Site Information Sf10f2011 10:18:26AM I NonCE: ,".' ",.,:,ii;i'i"" ~HIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT . ~OMfV1ENCED OR IS ABANDONED FOR ;!iNY 180 DAY PERIOD. Page 1 of3 -~ .. 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.ws Building I Commercial Permit PERMIT NO: 811-SPR2011-00787 IVR Number: 811157253976 permilcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 05/10/2011 ISSUED: APPLIED: 05/10/2011 05/10/2011 EXPIRES: VALUE: 11/06/2011 $0.00 SITE ADDRESS: 6100 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342100400 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: New 200A Service and 4 other circuits DEVELOPMENT INFORMATION ~ Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of lot Coverage: Highest point on structure to north property line: REQUIRED PARKING PROJECT DESCRIPTION: Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description , Descriotion Tvee of Construction Unit Amount Unit TVDe Unit Cost Value FEES PAID ~ DescriDtion Branch circuits with service or feeder each circuit ~-_.__.------ State:.~!Jr~~on Sur5har3.=.J~!O of applicable f~es) Technology fee (5% of permit total) Services 200 amps or less Sign or outline lighting Amount Paid Date Paid $18.00 05/10/2011 $19.44 05/10/2011 _._--_.-.'-_.._--~"'-.- $8.10 05/10/2011 $81.00 05/10/2011 $63.00 05/10/2011 $189.54 RecilJt# 2011000913 2011000913 -------.._- 2011000913 2011000913 2011000913 Total Amount Paid Springfield Building Permit 5/10/2011 10:18:26AM Page 2 of 3 .. CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00787 IVR Number: 811157253976 225 Fifth 5t 5pringfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 . www.ci.springfield.oLuS permitcenter@cLspringfield.or,us PROJECT STATUS: STATUS DATE: Issued 05/10/2011 ISSUED: APPLIED: 05/10/2011 05/10/2011 EXPIRES: VALUE: 11/06/2011 $0.00 SITE ADDRESS: 6100 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342100400 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: New 200A Service and 4 other circuits Plan Review ~ Deoartment Permit Issuance Received Due Date Comoleted Result 05/10/2011 05/10/2011 05/10/2011 Issued Reviewer Chris Carpenter Initial Review 05/10/2011 05/10/2011 05/10/2011 Over the Counter Chris Carpenter Comments: Over the counter permit ~ff'~;~\!~r:~c~ePta:rc~~,::~':" ;~:?5?1?!2b,1'1";~195~1'~42~}~rO~!:1 W:W~~1' ~j:: ~v~r.ltjf_~qo~u~:t~h~~~_Or~~. r:'::"~;j, "~,~;'?~'$0,;F4'~:~:'~'T&~:\ {L~.:>;f '~'ffi~~, ;<"', ~c ~t..- :,~;',~ ~_~ '. i~ ;' :"~ 't', /..:.;"":~ ': '".'7' ~':'m'; <;hrj~Catp,~nter!!., -: r ~. '_ ~:hs~;t:.t::5-~~~1"~.~/-'~'- :i"- w -i-~~, ;:\ ~1':-21 ""","" ~ .. -"." , J . ':...., ...",.:,,', "", . .-," INSPECTIONS REQUIRED ~ Inspections 4225 Service or Feeder 4500 Rough Electrical Rough Electric: Prior to Cover 4610 Electrical Sign 4999 Final Electrical 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. ~~"f)/1Z-~/ .5/ltJ/:w/1 Owner or Contractor Signature Date Springfield Building Permit 5/10/2011 10:18:26AM Page 3 of 3 .. SPI'UNGF IEL~ k" 0," ,.... ~0: W . . ;~t OREGON www.cLspringfield.or.us TRANSACTION RECEIPT 811,SPR2011,00787 6100 THURSTON RD CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541.726-3753 permitcenter@ci,springfield.or.us RECEIPT NO: 2011000913 RECORD NO: 811-SPR2011-00787 DATE: 05/10/2011 [DElle: RIPJ:lON', ;:-:: ";.::;'i ,,<~:.~~.r.. 'r' ~",.;;;;";:;",, (,r;~;"'':_;';t~ "-<.Ae:COU N;ij;ODEj".i;;;.;;";;':,~:.:'KM6i.JNt~DlJE_ ;.:' I Branch circuits with service or feeder each circuit 224-00000-426102 18.00 Services.200.~rnl's .o-'.Ie~s 224-00000-426102 ___________ 81.00 Sign or outline lighting 224-00000-426102 .~. 63.00 _._~a!" of Ore!1..on Surcharge (12% of applica~~!.~~..s) 821.00000.215004 __._-2.9~._____. Technology fee (5% of permit total) 100-00000-425605 _____ _ __u____ 8.10 ___ TOTAL DUE: 189.54 <CQMNiI;NJs:~"-""~ . ;'"'~t;,."" AMOUNIEA!O.;r ., ' L 189.54 UAYMEN;"-IYPI;';:"':1e.J~,iQBr;i:AsH,,",;.ccA"[~r~TER,'F"t," ' Check WILLAMALANE PARK & REC OIST 86295 TOTAL PAID: 189.54