HomeMy WebLinkAboutPermit Electrical 2011-5-13
Electrical Permit Application
. .
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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Date:
5//3/1
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.
',~OCAL:'GOVERNMENT' AP.P~OVAI!!;;;r'~r~'),:);'Y
Zoning approval verified? 0 Yes 0 No
fi.;I'{1'~,ta,CArEGORXfOI';1CONST:RUCTI()N~;"";i: ""::
o Residential 0 Government Commercial
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Job site address: 143 )\J, '2...\ g, t,
City :-Re.ld O~ P,7Y77
Taxlot.:
'DESCRIPTION;OFWORK';,t,
b e: \ -r \ 2- Gl,c.t.L:+S
Name:
Address: Lj 't> tJ.
City: C;; - ..\ J
Phone:.,5 ~ 1..:3 z.- II i '7
E-mail:
This insta tion is b ng 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: '11'171
ZIP: '1.1<{D
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
~ \\
S:\'.o'AiD
~~
\;
440-2584.) (9/08/COM)
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Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thefeo[
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amRs or less (2) I $ 81.00 $~f
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158,00 $
60] to ] ,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 $
20] 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 1:2- $ 6.00 I $1'-
b. Fee for branch circuits without purchase of a, service orfeeder-fee:
.--- ----
First branch circuit(2) ( $ 55.00 $ ---I>
Each additional branch circuit -- -$-6:00'- --'
$
Miscellaneous fees: service or feeder ':lot 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 additionaJ'inspection: (1) $58.00 $ ,
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f'l,'i'~'W<r'y)..,.,~j;"~,,,~:'~:';")1i:; ,,'C.i' -m' ...' h:, _ ,":i:-"'~ii>,,;,"7:t,t,'7:;il.l.\;t<:JtWM~:;fi:,',}
(A) Enter subtotal of above fees /5-::>
(Minimum Permit Fee $58.00) $
.--
(B) Enter ]2% surcharge (.]2 x [A]) $ IK, ,
(e) Technology Fee (5% of [A]) $ '7, ;>
TOTAL fees and surcharges (A through C): $/ /<t
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~~ ">70. OREGON
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: 811-SPR2011-00812
IVR Number: 811177860000
www.d.springfield.or.us
225 Fifth St
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:
05/13/2011
05/13/2011
Issued
05/13/2011
EXPIRES:
VALUE:
11/08/2011
$0.00
SITE ADDRESS: 143 21ST ST, Springfield, OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 17033642027?~ ,-~o<I( WORK INVOLVED:
}1\"5k~' L~ TYPE OF STRUCTURE:
PROJECT DESCRIPTION: I~n of 100 amp sub-panel and 12 circuits.
Electrical Only
Alteration
Commercial
OWNER:
ADDRESS:
PARAMOUNT CENTER LLC
PO BOX 26125
EUGENE OR 97402
Phone Number:
Contractor Type
Contractor Name
CONTRACTOR INFORMATION ~
Lic Type
Lie No
Lie Exp
Phone
# of Units:
BUILDING INFORMATION ~
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Hazmat:
o
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Energy Path:
Electrical Specialty Code Edition:
Springfield Fire Code Edition:
Mechanicaf Specialty Code Edition:
Municipal I Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Code Edition:
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:
I
Site Information I
ATTENTION: Oregon law requires yout,o
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).
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall...
_ 1'I.'lrI1r'..".
So,ls ReportReqUlred: EXPIRE IF THE WORK
THIS PERMIT SHALL NOT
AUTHORIZED UNDER THIS PERMIT IS
COMMENCED OR IS ABANDONED FOR,
!I,I,IY 180 DAY PERIOD.
Springfield Building Permit
5/13/2011 11 :44:28AM
Page 1 of 3
S.P.RIN~.FIE L.O~.
~lll.".
" ~'*
-::=. . OREGON
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: 811-SPR2011-00812
IVR Number: 811177860000
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspeclion Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@cLspringfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
05/13/2011
ISSUED:
APPLIED:
05/13/2011
05/13/2011
EXPIRES:
VALUE:
11/08/2011
$0.00
SITE ADDRESS: 143 21ST ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703364202700
SCOPE: Electrical Only
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Insualtion of 100 amp 5ub.panel and 12 circuits.
DEVELOPMENT INFORMATION ~
Overlay Dist:
# StreetTree. 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:
DownspoutJDrains:
Valuation Description
~
Descriotion
TVDe of Construction ./
Unit Amount Unit Tvpe
Unit Cost
Value
FEES PAID
~
Descriotion
State of Oregon Surcharge (12% of applicable fe~~)
T~,~hn~l~gx J:: i5.% '?.f ~~~m.!!..t~t~~L_'__0__~_____~"
~,~rvi:.:s 200_~m!:s_~ l:;i~~"__ .
Branch circuits with service or feeder each circuit
---.-~-~--
Amount Paid
$18.36
$7.65
$81.00
----~,~
$72.00
$179.01
Date Paid
05/13/2011
05/13/2011
05/13/2011
05/13/2011
Reciot #
2011000938
2011000936
-'._"--"~'~._-"_.'-"'-"""-
2011000938
2011000938
Total Amount Paid
Springfield Building Permit
5113/2011 11:44:28AM
Page 2 of 3
SP~IN_ G_F__IE_~D. ..
.-
" '., i!!JJl..
~~^_. OREGON
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: 811-SPR2011-00812
IVR Number: 811177860000
www.ci.springfield.or.us
225 Fifth St
Springfield, OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permilce nter@ci,springfield,or.us
PROJECT STATUS:
STATUS DATE:
05/13/2011
05/13/2011
Issued
05/13/2011
ISSUED:
APPLIED:
EXPIRES:
VALUE:
11/08/2011
$0.00
SITE ADDRESS: 143 21ST ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703364202700
SCOPE: Electrical Only
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Insualtion of 100 amp sub.panel and 12 circuits.
Plan Review
I
DeDartment
Application Acceptance
Received Due Date COnlDleted Result
05/13/2011 05/13/2011 05/13/2011 Overthe Counter
Electrical Review 05/13/2011 05/13/2011 05/13/2011
Comments: Over the counter permit
jni!i~~~~J~~;,::1!~~~:;""~ t,> jg?!2~~?~1'. ~~~~3i~O~? :Q~:~20;1
;;,,^Commehts:'?i~Over.ttletcountet peimll~#jLf :J~~ @%m~ :"'''i-'~;.~,-::';~~lh;; 'if\..
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Not Required
Reviewer
Nancy Machado.
Nancy Machado
INSPECTIONS REQUIRED
Inspections
4220 Electrical Service
,;-""".-.,
: %~j^
,o;;J:}' ',tv
4500 Rough Electrical
4999 Final Electrical
Electric Service: Approval required prior to utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, , 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 ag'ree
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.
.~
~
5//3/1\
I f
Owner or Contractor Signature
Date
Springfield Building Permit
5/13/2011 11 :44:28AM
Page 3013
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00812
143 21ST ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000938 RECORD NO: 811-SPR2011-00812 DATE: 05/13/2011
lDESCRIIHlON"- p ~","::.-;S5",.#(). ; ."~""i _[50';" (,1;<__ ,:: >"l!iJ,\CCdUNTICQOE "l",l:'i:::',,:/-'i-..;:ANfduMj:)(JEIi:1Ji,- ~-'
Branch circuits with service or feeder each circuit 224-00000~426102 72.00
Services 200 amps or less 224-00000-426102 81.00
State of Oregon Surch_arge (12% of applicable fees) 821-00000-215004 18.36
--2,,-chnolo~'y fee (5% of permit ~otal) 100-00000-425605 7.65
TOTAL DUE: 179.01
i'"::~e~){IVI~NI~txR~' ':t..~~j~AX5~f~c~c,::~CAsi0HtER~NMACH'ADo~:i1t~~~G_c:>MM~:Nr~~;;:c:~,~:':~~?t,;, ~~,'" -~$L :::,:L IfkAMOUNT~PAID.-;t,:0V02':;' ,.' ,>~,!
Credit Card Ingrid k. Tucker 26.01
872788
Check
glory days antiques
153.00
TOTAL PAID:
179.01