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Home My WebLink AboutPermit Electrical 2011-7-5 ElectriCal Permit Application 225 Fifth StreettSpdngfield, OR 97477tPH(541)726-3753tFAX(541)726'3689 , , ," , 'ci ..., ~... , ... 'OE'P..ARTMENTUSE ONLY.. ..~.-. - Permit no. ~ ( - /h0.:3 Date: II This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if wurk is nut started within 180 d,ays of issuance or if work is suspended for 180 days. ;;>;:'.'1',:" 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). Signature: ::CONTRACl;OR INSTALLA'fION' LG 7 t/ liD E-mail: CCB license no.: ';;;Q7 y 5' BCD license no.: W _z.~~C Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~(f7 ~ <\~\\ <\' ~~. v9 440-2584-J (9/08/COM) ,'" ~~~~~~~~~~~~~W1FEE$SCHEDU~E~~~~~~~~~~W~~~ , ... "~'.,.., <<' -." "_'^~.,..."j-. ..., , ~ - - -- " .. - ...>.>;...,.:,,-, -':.;' .' _. ... .' '..., "",', " , "'-', "t;,'-'" ',,",,"" '.;,..", ...',..' CllSt Totilf d.N u ~_~er'- ~J:in.sp~~#o'~~ :p~.~J~~:m ~'(,)::,l.~', Q'~Y. :i, . "_,_.",_,...' - ".,<,.... '. ..,."-,.,,,,,,. .1,' I 'I ~ i._"."" .,'_"C .,;.:;ea:, ': cos!.. 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) Servfces or feeders: installation, alteration, relocation 200 amps or less (2) i $ Bl.00 $%7 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $15B.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) $ 63.00 $ 201 to 400 amps (2) $ B7.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section abo~e. Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a s~rvice or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch cireui! (2) $ 55.00 $ Each additional braneh circuit $ 6.00 $ Miscellaneous fees: service or feeder l!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, o~ extension (2) Each additional inspection: (1) $5B.OO $ ~~[:ifJt~~w~I~~'*)\i~~}i~%~rA~pGR::A-Nif~~U.s.-i:1~~,~GiM;~~~}~41]l~,~;~~~~~ ~;,; (A) Enter subtotal of above fees $J7 (Minimu~' Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [AD $ tJ?!=. (C) Technology Fee (5% of [AD $ yo~ TOTAL fees and surcharges (A through C): $ ~l.JIj'1 ; I ' 'S /IS i .' SPR,.\.I:~.G~:. IE.L.~ ~"" "... ; A;~ ':;e ;,1,'WFi:"+",,,, OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01663 IVR Number: 811100566201 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 07/05/2011 ISSUED: APPLIED: 07/05/2011 07/05/2011 EXPIRES: VALUE: 12/31/2011 $0.00 SITE ADDRESS: 4350 MT VERNON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802052108400 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Qwest DSL Service meter Phone Number: OWNER: ADDRESS: WILLAMALANE PARK & REC DIST , . 250 S 32ND ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor Contractor Name TONY KOTH CONTRACTOR INFORMATION ~ Lie Type CCB BUILDING INFORMA nON ~ # of Stories: # of Units: o Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # 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: Lic No 59748 Lic Exp 05/19/2012 Phone 541.688.8996 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: r--:'s1iFt'Ba~ementl law requires you to ,"1' iSq'FtG~tilgJ~d by the Oregon Utility , ,i'G"'soIFli;ntAr .Those rules are set forth I , Ol\f1 !ob'\2-uu~~B~7b throuoh OAR 952-001- 0:190 ySq F,ltOther:,. ' ,U " vC,' 'Qy'o':l<aln copu;s of the rules by caI/Jn[p,cC!JR.3.~~Y3"'0~!I!ote: the telephone nUlT2'o11 for the Oregon Utility Notification Center is 1-800-332-2344). Site Information Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit 7/5/2011 10:05:57AM I NOTICE: .j ",""" THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR. .: ANY 180 DAY PERIOD. , ,. <,';,,' ..:: ~,;,);\":,; '-, Page 1 of 3 SP.~~H~EL~ ~et; ~OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01663 IVR Number: 811100566201 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitce nter@ci,springfield.Of.US PROJECT STATUS: STATUS DATE: Issued 07/05/2011 ISSUED: APPLIED: 07/05/2011 07/05/2011 EXPIRES: VALUE: 12/31/2011 $0.00 SITE ADDRESS: 4350 MT VERNON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802052108400 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: awes! DSL Service meter DEVELOPMENT INFORMATION' Overlay Cist: # 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 I Descriotion State of Oregon Surcharge (12% of applicable fees) ~ervice~3~O ame~_oL~~~~____.._~.__.__~_~_ Technology fee (5% of permit total) Total Amount Paid Amount Paid $9.72 $81.00 $4.05 $94.77 Date Paid 07/05/2011 07/05/2011 07/05/2011 Reciot # 2011001866 2011001866 2011001866 Springfield Building Permit 715f2011 10:05:57AM Page 2 of 3 S. PRING...FI.EL~ .~" .~~ . ", 0~L'0 OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01663 IVR Number: 811100566201 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 STATUS: STATUS DATE: Issued 07/05/2011 ISSUED: APPLIED: 07/05/2011 07/05/2011 EXPIRES: VALUE: 12/31/2011 $0.00 SITE ADDRESS: 4350 MT VERNON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802052108400 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Qwest DSL Service meter Plan Review ~ Deoartment Application Acceptance Received Due Date Com Dieted Result 07/05/2011 07/05/2011 07/05/2011 Over the Counter Reviewer Chris Carpenter Electrical Review 07/05/2011 07/05/2011 07/05/2011 Comments: Over the counter permit rni,i;a;:R~V;ew " .:: ~";-ii7705,'2iTIFo7705/2o11 ~07/2p/2011 l ,Comllients:Overthecounter,permir: 'c0 ^. .,,-'Sl;, . : , .' ~~.,l;_', ,_~.._,,_~...~._...:I,,-_,d:-=--tiL'~L.._L_",:..~L~"_-,-,-.""":"- ____. Not Required Chris Carpenter Ov~rJ~e,~O~9!~(,'.r,<'~1. .ChrH!/Carperite[- r "'~.l , , i INSPECTIONS REQUIRED I _~._~. ',~,~='~z~~\~;::~~_~:~_ ".-' 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 J 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. (/~ Owner or contraio? Signature -; - c; .- /( Date Springfield Building Permit 7/5/2011 10:05:57AM Page 3 of 3 S;~\N:~L~ ~ ~OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 5t Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-01663 4350 MT VERNON RD permitce nter@ci.springfield.or.us RECEIPT NO: 2011001866 RECORD NO: 811-SPR2011-01663 DATE: 07/05/2011 iDESCRIe.tION '''", - . ,2':7" ;";;'_''''~~ _ -- . ,irCCClUNJ':CODE- ... - .- -..,; , -AMOUNT-DUE' - I Services 200 amps or less 224-00000-426102 81.00 State of Oregon Surcharge (1?% of applicable fees) 821-00000-215004 9.72 Technology fee (5% of permit total) 100-00000-425605 4.05 TOTAL DUE: 94.77 '~PAYMENT-TYPE.;'>PA YOR.-- - ~CASHIER:CCAR;;ENTER-':- COMMENTs;;~~-~~' ~_.:'~2AMOUNT-pAfD--:;-__h- . ~ _. ...:., ':'... .. ." ".' ~ - - . Check TONY KOTH $94.77 7531 TOTAL PAID: $94.77