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Home My WebLink AboutPermit Electrical 2011-7-11 Electrical Permit Application 225 Fifth Street+Springfield, OR 97477+PH(541)726-3753+FAX(S41)726-3689 DEPARTMENT USE ONLY Date: ? Permit no.: -/r;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. LOCAL: l;>()VERNMENTAf>PROVAlF,"''',> ::', Zoning approval verified? DYes D No CATEGORY.OF CONSTRUCTION'. "',:. Name: Address: ~ (j;( ZIP: E-mail: 0l1S il/l Q mS'A) , ~ 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 ftrr-sale;- c ease, or rent. OAR 479.540(1) and 47~. Signature: Business name: Address: City: Phone: E-mail: CCB license no.: ZIP: Pax: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~ ~ ~ 440-2584-J (9/08/COM) :hi:,;);r~A'~'~t;;wr~0~~'?:;FfEE:&,SCHED_1JJffiE:_~;:.~i;J;{[';\!1;~l~-17]R,if~q~~~{?Ti;J~ . ".,'. "'," .. Qt)'. Cost Total :Nu~~e~'-~f.)nsp~c_t:i~'~<s ~e.r .~t~.~,' (,) " ea.'. cost 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: installation, 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) l $ 63.00 $ &'5 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 $ 6.00 $ 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 feeder not includecj Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or illimited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ i'~i~;5D~:,~t~3;~~li~t?tJ{f;';~@::AReLfc:ANtf~~iJS'E\;~':,~/;:.'_,xt}{:'~/~.;S~i(')/::-i' .' , .. (A) Enter subtotal of above fees "oJ (Minimum Permit Fee $58.00) $ (of) (B) Enter 12% surcharge (.12 x [A]) $ 7)(P (C) Technology Pee (5% of [A]) $ y;i... TOTAL fees and surcharges (A through C): $ ')'5?J.. .. CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01721 IVR Number: 811165314145 www.cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/11/2011 ISSUED: APPLIED: 07/11/2011 07/11/2011 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci,springfield.or.us EXPIRES: VALUE: 01/06/2012 $0,00 SITE ADDRESS: 2878 WAYSIDE LOOP, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703224101900 SCOPE: Electrical Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Raise service mast to meet specifications Phone Number: OWNER: ADDRESS: SMITH DUSTIN M & PATRICIA L 2878 WAYSIDE LOOP SPRINGFIELD OR 97477 Contractor Type Electrical ContraCtor Contractor Name OWNER CONTRACTOR INFORMATION ~ Lie Type OWNER BUILDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o # of Bedrooms: Sprinkled Building: Fire Ala rms: Energy Path: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal! Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: lic No 0000000 lic Exp 08/12/2025 Phone Lot Size: Sq Fllst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq FI Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy: Load: "" 1 ""~ liON' Oregon I 20liJilow rules ~do ted aw requires you to Notification Cent~ Th by the Olegon Utility in OAR 952-001-00'10 those rules are setforth 0090, You ma ,rough OAR 952-001. calling the c~~t~;am(NcootPJ,etSho/ the rules by n b ,e, e telephone urn ere/or the, Oregon Utiiity Notification enter 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 7/11/2011 11:00:19AM ::mCE: !-HIS PERMIT SHALL EXPIRE IF THE WORK liUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD . .. . Page 1 of 3 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01721 IVR Number: 811165314145 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 07/11/2011 ISSUED: APPLIED: 07/11/2011 07/11/2011 EXPIRES: VALUE: 01/06/2012 $0.00 SITE ADDRESS: 2878 WAYSIDE LOOP, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703224101900 SCOPE: Electrical Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Raise service mast to meet specifications 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 ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Descriotion Tvpe of Construction Unit Amount Unit Tvee Unit Cost Value FEES PAID , Descriotion State of Oregon Surcharge \.1.2'/, of applicable fees) ~:~~_jce re:~onnect~JL-~____~ ______ Technology fee (5% of permit total) Total Amount Paid Amount Paid $7.56 $63.00 -""._---'-~.~-~ $3.15 $73.71 Date Paid 07/11/2011 07/11/2011 07/11/2011 Reciot # 2011001943 2011001943 2011001943 Springfield Building Permit 7/11f2011 11:00:19AM Page 2 of 3 SPRINGFIELD ~:A ,," Au.. :;1'N~~J "~ OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.cLspringfield.or.us Building I Residential Permit PERMIT NO: 811-SPR2011-01721 IVR Number: 811165314145 permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/11/2011 ISSUED: APPLIED: 07/11/2011 07/11/2011 EXPIRES: VALUE: 01/06/2012 $0.00 SITE ADDRESS: 2878 WAYSIDE LOOP, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703224101900 SCOPE: Electrical Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Raise service mast to meet specifications Plan Review ~ Deoartment Application Acceptance Received Due Date Comoleted Result 07/11/2011 07/11/2011 07/11/2011 Over the Counter Reviewer Chris Carpenter Electrical Review 07/11/2011 Comments: Over the counter permit ilnitiil""R~vi.~~~~:; .' ".<,:,,:~~",~9.\/JJ1?O,11 Comments: '\Overthe;counter permif; "" '._'\.. '-'_i:..:...--._"'"-'i~4'_'C ~~ 07/11/2011 0711112011 Not Required Chris Carpenter "07/1112011~.~'o7/1172(}tt:: < Over the Counterr-'~Chns Carpenie~ .t' ,"'_ ..J.':. ',"_ '_ _, ~ ' ~ - \ ~'" 1,0>",:'7 ~~ < '" . "_""... ", .. \ .; - - c .' - c', 1i"YC'~' -- , ':' ~ __~': '\ ~~ :4 " ~ ",1';:; w'''.~ _~,__ _~. ,. __~ ,....._'\...;';..,,1....'-"-.' ,}. ,:.<\ INSPECTIONS REQUIRED I 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 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~ ;:::.~ --.. () 7-,/11/1 r Owner or Contractor Signature Date Springfield Building Permit 7/11/2011 11:00:19AM Page 3 of3 ,I \ 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: D I own, reside in, or will reside in the completed structure and 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'l 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. C)U;)T;/f/ k cJJq/TIT Print~.amM~ ~ Signature of Permit Applicant ---.. tJ?-I/- ::J-6/! Date. Permit#: Sf (- /7 2/ Address: 2['1 Z t-J1I'f Sf 'Pt.' ~ SfFlD mz Q'71(17 Issued by: ~Date: ///1 II I , , This Copy for Permit Offices TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-01721 2878 WAYSIDE LOOP permitcenter@ci.spri ngfield. or. us RECEIPT NO: 2011001943 RECORD NO: 811-SPR2011-01721 DATE: 07/11/2011 l[)ESCRII~,TION;"" "-ci~~";~,'i:Jc~4,>~:i~~~~,~~ ,:~AccoiiNt";O[)E;" " :;;,~_AMO@t,[)UE:1::"!,,&_-{hj Service reconnect only _~4-000~:_43.61 02 63"00 State of Oregon Surcharge (12% of applicable fees) 821.:9000~-215004 7"56 _""!::.9~nology fee (5% of permit total) 100-00000-425605 3"15 TOTAL DUE: 73.71 k;:P)\yMEN'fifYPE; ?:;,r'PAYOR".' '-CASHIER:CCARPENTER '"COMMENTS-;;~'i'--' '};._,'<"iAMOUNI pAI[);:' ,- --;;'.-~ 'ie. .. .".. . 'N'~'.'..__,'... .~.~._...........,. _.." '$.r '.l~.. '~"'''''.''''''.=~",.'''_M__ . ,. _."" .. ...._"'" Check SMITH DUSTIN M & PATRICIA L $73.71 1950 TOTAL PAID: $73.71