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Home My WebLink AboutPermit Electrical 2011-9-7 225 Fiflb S,......Springfield, OR97477.PH(54I)726-3753tFAX(54I)726-J689 I I _.:,.*'N :..:.>:.',_"",,_;_ ~ ,+ .....,,- "_' ".. "i:'-';j;. ~"" DEPARTMENT,USE ON!!)':, ".' ~~ ::::::;/;~S~""f"""-&67<j , rA'--'7 Date: -I { '" This permit Is Issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work Is not started witbin 180 days ofissuanoe or if work Is suspended for 180 days. "' F'M ::- ,,-;s.:..';:;"*, ';;":~--. 'FEE' SCHEDULE '>';e,::-,''''.,: , . . " - ._,'>----:--.....-;\f;"<,-~.'_..L-: _ , ,Cost ,Total 1:" ....' ,Nu!"b.tr.~~iDspe<tio~~r,item.<..).,,,' Qty. ';',;eo. ...ioost.. ",..,.,!;;." ,._..___c__~, .._ ,." Residential, per unit, service included: ial i ",;j.,,,"; 1,000 sq. ft. orless (4) $134.00 $ Each additional 500 sq. ft. or portion thereof $ 25.00 $ ?S? Limited energy (2) $ 32.00 $ ~ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) vi Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ I 40 I to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ 7"f5' Over 1,000 amps or volts (2) $489.00 $ I Reconnect nnly (2) $ 63.00 $ Temporary services or feeders: installation. alteration, relocation 200 amps or less (2) $ 63.00 $ I R1 20 I to 400 amps (2) $ 87.00 $ . 40 I to 600 amps (2) $128.00 $ , Over 600 amps or 1,000 volts, see services or feeders section above ';;';;;',;1, Branch circuits: new, alteration. extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: ,/ Each branch circuit I $ 8.00 I $ I b. Fee for branch circuits without purchase of a selVice or feeder fee: First branch circuit (2) $ 55.00 $5b , Each additional branch circuit $ 8.00 $ I Miscellaneous fees: service or feeder not included , Each pump or irrigation circle (2) $ 63.00 $ , Eaeh sign or outline lighting (2) $ 63.00 $ , I Signal circuit or a limitedooenerg,Y panel, $ 63.00 $ alteration, or extension (2) , Each additional inspection: (1) $58.~ $ J-- ;'''''.C.' '''''''~!'E'''' "Aeel:ICA.Nl1"IJSE . c'. Mi . ''''~''ii'' ""',",",,. ' ))1'" ';.:~~;~i"".'"":;:"";~ -oq- Enter subtotal of above fees ~ )f'. (Minimum Permit Fee S58.:.!l1'r $ 5 . surcharge (.12 x [Al) $ (r, "fV (C) Technology Fee (&% of [A]) $ zqo S0 TOTAL fees and surcharges (A through C): $/-'7 -c: ffCJ ,,,:,",,'LOCALGOVERNMENT' APeROVAL;" " -;; Zoning approval verified? 0 Yes 0 No .. :,,::;i:'i!i';'CATEGORV 'OF"!CONSTRUCTION,: ""PROPER'tYc:.OWNER~'~ Name: C OvJ' G-;--O ^ e., i Address: 4'2.,'il3 0\ IS' ST. City: S;1-,^ f-'.(.. , State: 0 ((, ZIP:C(Jlf Phone:sr! I.. 5"2 Z 6 '5' 7 E-mail: CeltIfSI~flII!;;~.Co "'" This installation is being made on residential or farm property owned by me or a member of my immediate fumily. This property is not intended for sale, exchange, lease, or rent. OA 479.540(1) 479.560(I)"{ I SIgnature Ir . ~;. ~CONTRA:CTOR"INS'TALLATION :~,0!~TJ:\ Business name: Ad City: Phone: E..mail: CCB license no.: Signing s isor's license no.: Pri ame of signing supervisor: Signature of signing supervisor: 44().2584-J (9/08/COM) - , -' -, ~. SP~ING.. FIEL~ -~ '-.(~ .-. OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-02074 IVR Number: 811148190043 www.ci.springfield.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:' APPLIED: 09/07/2011 09/07/2011 Issued 09/07/2011 EXPIRES: VALUE: 03/04/2012 $0.00 SITE ADDRESS: 4283 DAISY ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702323406301 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: One circuit for pond and shed. Phone Number: OWNER: ADDRESS: HEGI CARL TON 4283 DAISY ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor Contractor Name OWNER CONTRAcrOR INFORMATION I Lie Type eeB BUILDING INFORMATION I # of Stories: Height of Structu~e: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o # of Bedrooms: Sprinkled Building: Fire Alarms: Ener9Y Path: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Speci~lty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential speci~lty Code Edition:.' Structural Specialty Code Edition: Site Infonnation Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Lic No 000000 Phone Lic Exp 08/01/2025 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: 2011 f~I;ENTION: Oregon law requires you to j~O~i~~~~;g~l~~:eO~th~~~~~I~;~~~~eY~~;rh 00 . rough OAR 952-001- 90.. You may obtam copies of the rules b callmg the center. (Note: the telephone y number for the Oregon Utility Notification Center I~ 1.AnrL')')f") "'''A H -~. 'J. ~ "onCE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield B.uilding Permit 9/7/2011 19:22:22AM Page 1 of 3 ;;. . SP~IIN~?ij ~~ ~OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-02074 IVR Number: 811148190043 , 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 09/07/2011 ISSUED:! APPLIED: 09/07/2011 09/07/2011 EXPIRES: VALUE: 03/04/2012 $0.00 SITE ADDRESS: 4283 DAISY ST, Springfield, OR 97478 ASSES OR'S PARCEL NO: 1702323406301 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: One circuit for pond and shed. DEVELOPMENT INFORMA nON ~ Overlay Dist: # Street Trees Req'd: Paved Drive Reqd1 % 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 Tvee of Construction Unit Amount Unit Tvpe Unit Cost Value FEES PAID ~ OescriDtion Amount Paid State of Oregon Surcharge (12% of applicable fees) $6,96 T~!,nol.o9Y Ie! _\~o~erm~~_. ~2,90 Branch circuits without service or feeder - 15t circuit $55.00 -.--.------ .._-_. .. ..---.--___--t-______ Balance of Minimum Electrical Permit Fees $3.00 -----.- ~--_. Total Amount Paid $~7.86 , Date Paid 09/07/2011 09/07/2011 09/07/2011 09/07/2011 ReciDt # 2011002399 2011002399 2011002399 2011002399 Springfield Building Permit 9nt2011 10:22:22AM Page 2 of 3 .- CITY OF SPRINGFIELD , 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 PROJECT STATUS: STATUS DATE: Issued Building I ReSid~ntial Permit PERMIT NO: 811-SPR2011-02074 I iVR Number:'811148190043 I ISSUED:i APPLlEq: permitcenter@ci,springfield.or.us www.ci.springfield.or.us 09/07/2011 09/07/2011 09/07/2011 EXPIRES: VALUE: 03/04/2012 $0.00 SITE ADDRESS: 4283 DAISY ST, Springfield, OR 97478 ,ASSESOR'S PARCEL NO: 1702323406301 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE; Residential PROJECT DESCRIPTION: One circuit for pond and shed. DeDartment Application Acceptance Received Due Date 09/07/2011 09/07/2011 Plan Review comDrete~ ! Result 09/07/2011 , Reviewer Nancy Machado Electrical Review 09/07/2011 09/07/2011 09/07/201 Not Required Nancy Mac.hado Comments: Over the counter permit \ lr1itia!':~~~JeWr=~ ,0/ ffw,i~f!?;;'," ',,;,~,._~9~O!:~O:1;~~~~gW.07!1~;?1'~>?~~/~1/~g.~11:~?,S:,_:-~:~er:~!~~\C&~rt~rL,':' Comments:' ,Over:the,counter permIt:"':; . "\;',fj', ;"4:: ';0it;:.fli ".' ~i;.;~ ',,:;' J,~,~;';;!'0.:tS~T>f:5~Y;<~", ,",4"~' ',;;,:'2;;:"":,"""... ..~' +~~"'h>:;;+" ,'- '.p,Dr;',";;"..',' " ""..;,:C,;''''':r'''P':'''\'''0C<;F,y INSPECTIONS RE,QUIRED I Inspections 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior ~o Coyer Final Electric: When ~II electrical work is complete. By signature, I state and agree, that I have carefully examined the po~pleted 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 DiYision, 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 reque~ted 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. I I I C -- ~ :CJ-7-1! Owner or Contractor Signature I Date Springfield Building Permit 91712011 0:22:22AM Page 3 of 3 ~ I I i , . I Property qwner Statement Regarding Constr~ction 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 701.325 (2)) , i 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 w.ith the permit. ..~"'~ Please check the appropriate box: : D I own, reside in, or will reside in the ~omPleteb structure and my general co~tractor is: I I I I I I I I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Bo'ard. , , or I 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 , 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 I , Name CCB# Expiration Date ~ 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. i I I (1 tAl' l+ov1 L~ ( i Pnnt Name of Penmit Applicant CA__ IJ- 0; - ?-I/ Signature of Permit Applicant Date Permit #: S I \ - 2D'I Lf Address: L(Z(f3 \>Aq;' L( 5 ( S-{>PU) tJYl- '11'1'1'1, Issued by: ~ Date', q (I (I ( This Copy for Permit Offices www.cLspringfield.or.us I I I I , , TRANSACTIOt'J RECEIPT 811-SPR2'011-02074 I 4283 DAISY ST , CITY OF SPRINGFIELD 225 Fifth $t Springfield, OR 97477 541-726-3753 . . permitcenter@ci.springfield.or.uS " ' RECEIPT NO: 2011002399 RECORD NO: 811.SPR2011.02074 DATE: 09/07/2011 lDESCRIP...TION~ c> [;, t;,:; ""'>:;:L::f.::::...:;c.;;,.~;'~" ,'~..AcCOUNJ.:.CODEd:' .', ~AI'iIOUNEDJJE't""-:J Balance of Minimum Electrical Permit Fees 224-00000-426102 3.00 Branch circuits without service or feeder - 1st circuit 224-00000-426102 55.00 State 01 Oregon Surcharge (12% of applicable fees) 821-00000-215004 6.96 ~chnol~~ fee (5% of permit Iotal) 100-00000-425605 2.90 ; TOTAL DUE: 67.86 L::~",'(M~NLTIeE~e"':(()8 :;;-CASHiER'~~"<>::;;:L~f~c:J:;MIV!E't.(f~T'Jc ';.::;",. ,:.4Z. ""-, iAMO.UNTPAID.';'> . Credit Card HEGI CARLTON 67.86 077455 TOTAL PAID: 67.86