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Home My WebLink AboutPermit Electrical 2011-6-27 Electrical Permit Application 225 Fiftb Streett Springfield, OR 97477. PH(S41)726-3753t FAX(541)726-3689 't'~~'D"E" 'P'''A'';R''T~'M'''E''N'':;;-tJ, "'E~;'''~'; ""'.,,,__., ,.,,,~,_;!,;t,~~~l,,"X~ Permit no,: Date: 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 suspeuded for 180 days, 11Jt~i!QG~!-~Gf5Mg8JilMgN[f:l~~e[{QYZ~~" Zoning approval verified? 0 Yes 0 No ~i:';~'I(I;G;(!j'RYI,Q~~:<,iN$JE~I!)l:!:iiIQr\l_~~l o Residential 0 Government 0 Commercial l'i_itGI}'!tS))iI~IINF.(ij~M~illrQN)\f~NJ:;)iI!Ql:;*i1t:Qi5l~~';ll\ Job site address: 20 S, 1 M City: 5fF(..-I) State:z:J?L- ZIP:q?'-!'i') Subdivision: 70] 3(,00 Lotno,6!X}OO ':~~0'g.$QBr~m[oI'lWiQF,iW:OJ~,ISi~~"l~ e~LF-Lt' f.UU\ __ "",=71-- ~-ill!!"">fA-~~"\WiER-OFiER;Hifif(!jWN'E"R","il;""ilt,"~;;j~;""",0;~,(;! ~~;;rz~'fqi9.J.\fij{,;'iLL.~i..ti".'m;tal,I,,:!..J_ ',C."",_" -"''';;:;.:Y~~'f~.s:~k\f;j{~~?n''''!1.. Name: Q,ITL( tJr 5('~,tV~ Abev StAB Address: .;;0 L <; I f City: ZIP: Phone: Fax: E-mai!: 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(\), Signature: ~PQf:\lm~l:;jIlQ~If.!sm~~1ll~1lIQ&~t~1i~~1fi cC-2. .l72ft:!. LL c: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~~~ ~~\\ \(J~ 440-2584-J (9/08/COM) 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: instal/ation, 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: installation, alteration, relocation 200 amps or less (2) 201 to 400 amps (2) 40 I to 600 amps (2) $ 63.00 $ $ 87,00 $ $t26.00 $ 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 $ b. Fee for branch circuits without purchase ofa service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55,00 $ $ 6.00 $ Miscellaneous fees: service or feedet' not included Each pump or irrigation circle (2) Each sign or outline lighting (2) $ 63,00 $ $ 63.00 $ Signal circuit or a limited~energy panel, alteration, or extension (2) Eacb additional inspection: (I) $58,00 $ ~~,,~ "".1nR'RiP.'IG"'N'''m1.~;,:rS-E,~<Il!''~~~\5r~,'''!'~..llJJE ' .." ~Wh1*-~,~ "tf!""_:>.,-~~__~~"I1_",,;\-~.,_,,,_l!J~~~~~" (A) Enter subtotal ofabove fees <; 00 (Minimum Permit Fee $58.00) $ 5' d (B) Enter 12% surcharge (.12 x [A]) $ {p 3.- (e) Technology Fee (5% of [A]) $ "). ";:. TOTAL fees and surcharges (A through C): $ (P 7 -rc. $ 63.00 $ S.PRING..FI E.L~ iaJ,\ .-.. ~J? ,~ .. ...~'h... OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01597 IVR Number: 811150698345 www.cLspringfield.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 STA TUS: STATUS DATE: 155 ued 06/27/2011 ISSUED: APPLIED: 06/27/2011 06/27/2011 EXPIRES: VALUE: 12/23/2011 $0.00 SITE ADDRESS: 201 S 18TH ST, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703360000500 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: Replace circuit breaker Phone Number: OWNER: ADDRESS: CITY OF SPRINGFIELD 202 S 18TH ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION ~ Contractor Type Electrical Contractor Contractor Name GONRICH ELECTRIC lLC # of Units: o Lie Type CCB BUilDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Lie No 149509 Lie Exp 11/02/2011 Phone 541-359-1192 Lot Size: Sq Ftlst Floor: Sq F12nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy load: Electrical Specialty Code Edition: Springfield Fire Code Edition:. ~f'f"'N'fION: Oregon law requires youto PI. ," ' 'b the Oregon Utility Mechanical Specialty Code Edition: fgflgw rilles adoptea Y t forth . ,. . enter Those rules are se Municipal I Development Code: Ngll!U:;l\t\gn e 0'10 th ough OAR 952-001- " .. ~ in OAR 1li:l2,001.0 r. . Plumbing Specialty Code EdItIon: (j (j, Vgy may obtain caples 01 the rules by Residential Specialty Code Edition: (j :Il.llih\llhli canter, (Note:.the tele~ho~e Structural Specialty Code Edition: f'H1m~@r lor the Oregon Utility Notification ~ .... ,_ , onn_,<'<??:i44\. # of Bedrooms: Sprinkled Building: Fire Ala rms: Energy Path: Site Information Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: ~ \J~l L~V' ,~ . . "~'nCE: RE IF THE WORK rHIS PERMIT SHAL~ ~~~ PERMIT IS NOT :\UTHOR!ZED UONRDE1S ABANDONED FOR COMMENCED ANY 180 DAY PERIOD, Springfield Building Permit 6/27/2011 1 :40:06PM Page 1 of 3 SP1~HG:H~ ~. ~OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-0159i IVR Number: 811150698345 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 06/27/2011 ISSUED: APPLIED: 06/27/2011 06/27/2011 EXPIRES: VALUE: 12/23/2011 $0.00 SITE ADDRESS: 201 S 18TH ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703360000500 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Replace circuit breaker 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: Valuation Description ~ Descriotion Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ DescriDtion State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) _. Branch circuits without service or feeder - 1 st circuit Balance of Minimum Electrical Permit Fees Total Amount Paid Amount Paid $6.96 $2.90 $55.00 $3.00 $67.86 Date Paid 06/27/2011 06/27/2011 06/27/2011 06/27/2011 ReciDt # 2011001804 2011001804 2011001804 2011001804 Springfield Building Permit 6/27/2011 1:40:06PM Page 2 of 3 SP~.I.N. G.f IEL~ .~' .... ~.k. .":: _:>w ~^:^t. OREGON 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.us Building I Commercial Permit PERMIT NO: 811-SPR2011-01597 IVR Number: 811150698345 permitcenter@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 06/27/2011 ISSUED: APPLIED: 06/27/2011 06/27/2011 EXPIRES: VALUE: 12/23/2011 $0.00 SITE ADDRESS: 201 S 18TH ST, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703360000500 SCOPE: Electrical Only WORK INVOLVED: Alteration TYPE OF STRUCTURE: Public PROJECT DESCRIPTION: Replace circuit breaker Plan Review ~ Deoartment Application Acceptance Received Due Date ComDleted Result 06/27/2011 06/27/2011 06/27/2011 Over the Counter Reviewer Chris Carpenter Electrical Review 06/27/2011 06/27/2011 06/27/2011 Not Required Chris Carpenter Comments: Over the counter permit fnitial ~evjevi;, ':: _ - ;;" - :}j6/27/201{:__~~fotiT',P6;2"7!2011~ ~omm,~,m,s:,'~verJhe'~{lJ~rf'p,e:[mll" - ,,;,~.~~ ;00~.< ~~".- '. ':..J;;:.T Ovetthe~Counter ~~.-:::.~.f';:;~l " ._~--_.....--~~""'~_. ';""::-. ~C.br!s'9?rpent~r '. '.. ,,"' . - '>"', " .0 .~ ";';-;,:;1 '-r ~ . "- - ",' -'''<~' ---~ ..,.......1. , --1 INSPECTIONS REQUIRED ~ Inspections 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 ar:'Jd 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 10 d at the front of the property, and the approved set of plans will remain on the site at all times during construction ~4 Date Owner or Contractor Signature Springfield Building Permit 6/27/2011 1 :40:06PM Page 3 of 3 TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield, OR 97477 541-726-3753 www.cLspringfield.or.us 811-5PR2011-01597 201 5 18TH 5T permitcenter@ci.springfield,or,us RECEIPT NO: 2011001804 RECORD NO: 811-SPR2011-01597 DATE: 06/27/2011 [DESC:RIRTION': 0 "'," ;2;;':;:;; ,~:':":.:"':~ j:::?.A:c:c:otiNi~C:00E::: - '::y , Al'vlOUN:tOUE Balance of Minimum Electrical Permit Fees 224,00000A26102 3,00 Branch circuits without service or feeder M 1st circuit 224-00000-426102 55.00 SIale of Oregon Surcharge (12% of applicable fees) 821-00000-215004 6.96 Technology.!ee (5% of P'O~mil tala I) 100,00000,425605 2.90 TOTAL DUE: 67.86 l:;RAYMENT_D'eE::':LpAV:QR~~'T cA!,HIERlc~~I!ftE~1ER-,,';:;':3.0JlllriilENIS 't':, ;'L::_~:!.':~MOUNTPAID :~...--J Check CONRICH ELECTRIC LLC 67.86 3751 TOTAL PAID: 67.86