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Home My WebLink AboutPermit Electrical 2011-7-15 Electrical Permit Application . 225 Fifth Street+Sp,;ngfitld, OR 97477+PH(541)726-3753+FAX(541)726-3689 ~:,:?';:hf:"'O:' S~ "::) ," ':,'H.<>~ A. -",."_"-'"9\> :'!'DEPARTMENT:USE ONLVi-:: '.#//:Jj"'~ ",,,,,,'M1'+V__.v._"',.Cp,;w.,,.,,, ,-- :'(fj.,.Kl:illif:'w.;"/;/:,:::_-~",,"_,, -"<> 81i-.5f~2-8H- 1..152- PermIt no.: . Ii Date: "2 , 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. ., ,'I,': "LOCAL,GOVERIIIMEIllj;;,iAPPROVAL;':d>i 'ii Zoning approval verified? 0 Yes 0 No "f:'i" '. CA.:rEGORV:.OFCONSTRUCJ"lOIII:;:,:i'i.;' . ~esidential 1.0 Government 0 Commercial ,c:;,":IOSi:SlTE 'INFORMA'tION:A.1II0';LOCAfjO.':": ,i.', 1,000 sq. ft. or less (4) \ ""Q..\ t"!L f' Each additional 500 sq. ft. or portion Job site address:_ VI-- J\, Vl ~c. T' -'t"'T X thereof City. .~ \f\ ~ ,. !/'tdie: r \:.0 ZIP: 1..{"'l~l\( limited energy (2) Reference:' \~ ~ 'lI ,1..,.... Taxlot.' 1 ',i, :,"OESCR! .J"ION"iOI',::\IVORK-,:'::' :Lns-kd/ Fr-or(Je,c:.12.... ",,,0{ ~ PIAYI'1() L;nn1! Name: m/v~",,,,1 E.('lCI<'7ii>Y> Address: {;'3 (, <( c. 0; I-ree+ City: S'of/Vl",fid d State: 0(1.. Phone:S',J S; r {41-S n -lftIHFax: E-mail: :t, ' " ZIP: Q1Li7'l5 1 ion is being made on residenti.,J . property owned by me or a . late family. This prope. mtended for sale, exchange, , rent. OAR 1~40{l) and 479:56J{l)) Signature~A. 7 n Z1/V .,......."CON:J:RA.C'!:OR../NSTAaATION ..," "Urt ,,' Business name: l-k>JMe. OVvVl er Address: (,"'3 {,<t c. "it (eel-- City: SDflVJ..GleIO State: o fl.. I ZIP: '11Y7"i? - ~'11 -S17-'''I<,Oz.l Fax: Phone: E-mail: CCB license no.: Signing supelVisor's license no.: Print name of signing supervisor: Signature of signing supervisor: BCD.license no.: \P~ ~ \\ ~ 440-2584-) (9/08/COM) .', :"FEE. SCHEDULE , " ",. . '.... I, -c, I ":~lI~,~~~;_,~r~~~,r~~~I?nS peril~w'k);"o" J~!;r. .. .:. .. Cost, Total' .' '~.~/r: '" "c()~t J Residential, per unit, service included: $134.00 $ $ $ $ $ 25.00 $ 32.00 Each manufactured home or modular dwelling service or feeder (2) $ 63.00 Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ $ 95.00 $ $158.00 $ $205.00 $ $469.00 $ $ 63.00 $ 201 to 400 amps (2) 401 to 600 amps (2) 601 to 1,000 amps (2) Over 1,000 ~ps or volts (2) Reconnect only (2) Temporary senrices or feeders: installation, alteration, relocation 200 amps or less (2) 20] to 400 amps (2) 401 to 600 amps (2) $ 63.00 $ $ 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 I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit i ?- $ 55.00 $ $"5 $ 6.00 $ j'l. Miscellaneolls fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alteration, or extension (2) Eacb additional inspection: (1) :rt]'}'?';4-':''',' '::'.:" (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B) Enter ]2% surcharge (.12 x [AD (C) Technology Pee (5% of [AD TOTAL fees and surcharges (A througb C): $ 63,00 $ 63.00 $ $ . $ 63.00 $ $58.00 $ ,....... , $lJl ~ $a.. f'A $!l...~5 $ 5R. 'wl . . SP~I.,.\N.. G~ ..Fl~~ ~Chj ~ 1;-' '/'\1. ~.o;lI!- ..S':~, . OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01752 IVR Number: 811194195503 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax. 541-726-3676 permi1center@ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 07/15/2011 07/15/2011 Issued 07/15/2011 EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADDRESS: 6368 CST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342403300 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 Electrical Circuits Phone Number: OWNER: ADDRESS: ERICKSON MICHAEL D 6368 C ST SPRINGFIELD OR 97478 Contractor Type Contractor Name CONTRACTOR INFORMATION ~ Lie Type Lie No Lie Exp Phone # of Units: BUilDING INFORMA nON I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: o Occupancy Type Construction Type R-3 Type VB # of Bedrooms: Sprinkled Building: No 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: Lot Size: Sq Ft 1st Floor: Sq Ft2nd Floor: Sq Ft Basement:. Sq Ft Garage: Sq Fl Carport: Sq Fl Other: 0 Occupancy Load: 2011 2008 Site Information I Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: Retaining Wall:NOTlCE' . ".' "...... Soils Report Rerqri'rSdpERMIT SHALL EXPIRE IF THE WORK. AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield Building Permit 7/15/2011 11:35:08AM ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility ~otification 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 SPRINGFIE~.. . ;~ . =. ",'OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01752 IVR Number: 811194195503 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspeclion Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/15/2011 ISSUED: APPLIED: 07/15/2011 07/15/2011 EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADbRESS: 6368 CST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342403300 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 3 Electrical Circuits 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 Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID I Descriotion Stale of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit tolal) Branch circuits without service or feeder ~ 1 st circuit Branch circuits without service or feeder ~ each additional Total Amount Paid Amount Paid $8.04 $3.35 $55.00 $12.00 $78.39 Date Pa id 07/15/2011 07/15/2011 07/15/2011 07/15/2011 ReciD! # 2011002033 2011002033 2011002033 2011002033 Springfield Building Permit 7/15/2011 11:35:08AM Page 2 of 3 . . ~~ ." -OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01752 IVR Number: 811194195503 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pennitce nter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/15/2011 ISSUED: APPLIED: 07/15/2011 07/15/2011 EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADDRESS: 6368 CST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702342403300 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 Electrical Circuits Plan Review ~ DeDartment Received Due Date Electrical Review 07/15/2011 07/15/2011 Comments: Over the counter permit ComDleted Result 07/15/2011 . Not Required Reviewer Kip Kaufman Application Acceptance 07/15/2011 07/15/2011 07/15/2011 Application Accepted Kip Kaufman [inllial ReView' '-~"': 07/15/29)'l""',9,!'15/20"f1" 'q7/,15/~01,~", L! Comments: :Over the co~nteLPerrrll( .:'~:-,':, :J~~','~:~~'~:'{ ~-';.: 'I' 1 .__.__.~~_~__"- I>oi.. Initial Review 07/15/2011 07/15/2011 07/15/2011 ~:~e:'\P~5:~~::; ~~1,;,~i?,~~~!~~~;/'~, ,~" , ' Over the Counter Kip Kaufman , ,.- '"'] ~ : ,:' . .....- .~, . ~...~i INSPECTIONS REQUIRED ~ Inspections 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover 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 t~at all reguired inspections are requested at the proper time, that each address is readableJrom 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. ~~~ /-1')"-)/ Owner or Contractor Signature Date Springfield Building Permit 7/15/2011 11 :35:08AM Page 3 of 3 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can.be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: .~ I own, reside in, or will reside in the completed structure a~d my general contractor is: '. . Name CCB# Expiration Date D ~ I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 1h1,-:i10~/ I), Erickson Print Name of Permit Applicant 'iJijdl Ift/vr Signature of Permit Applicant 7-/')-// Date Permit #: Issued by: Date: Address: This Copy for Permit Offices S.~RING.FIE~ a, . ''''~ OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 www.cj.springfield.or.us 811-SPR2011-01752 6368 C ST permitcenter@ci.springfield.or.us RECEIPT NO: 2011002033 RECORD NO: 811-SPR2011-01752 DATE: 07/15/2011 IOESCRIPTION: ".:.,i'i,.~: i :~. .\ ,."i ;0:~:'C" :i'::.~ i';?.Z:i."".i,,,i'liY'TfAcco' UNT'C'O" 'OE' ~ ,i'-:'-' ,/....,. "A'MOi. U'N',.,O"'U' 'E" ;. ;F.. >1 ~ .' _, m --",_~_~~,~~""""~~,,, " ,_. _~.~.A~. .. ;1;,.,. ',~ Branch circuits without service or feeder - 1 st circuit 224-00000-426102 55.00 - - Branch circuits without service or feeder - each additional 224-00000-426102 12.00 State of Oregon Surcharge (12% 01 applicable fees) 821-00000-215004 8.04 Technology fee (5% of permit total) 100-00000-425605 .. 3i~5 TOTAL OUE: 78.39 l1;i;'pAYMEN'ttT-,YPE,lc ,,1..P~YOR7~;'7:i:-q-As~i~li~YFMA~[~::: C'OMI'IIENTS ""\c-, ;~:i"E:1::::"AJIIIOUNT' pAID~;liS:::S-~";, "''; 1 Check Michael Erickson ck #2017 $78.39 2017 TOTAL PAlO: $78.39