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Home My WebLink AboutPermit Electrical 2011-9-8 'Electrical Permit Application CITY OF SPRINGFIELD, OREGON ~\-t12. - DEPARTMENT USE ONlY'-' -nDiii ~. Penn it no.: 5/ _ 2-2- ~y~ ;.;~iil S:lt~:-=c,:-:;";::,d~, 0~ "'7..17; .FH(_:;,;j)i2(;.37:::+F:~X(::;,!iYi16-36,E9 ! i Date:9-~-(( This I,ermit is issued uuder OAR 918-309-0000. Permits are Lutransferable. Permits expire if work is uot started witbin 180 days of issuance or if work is suspended for 180 days. ~'-,... "'_ ~"""J:-:-.~:=',;~~2rr '-,-I4._.rp~~'..'.;~.L: Zoning approval verified? ~Yes 0 No CATEGORY OF CONSTRUCTION .8iRcsidcntial 0 Government 0 Commercial JOB SITE INFORMATION AND lOCATION I .. -- .. 3:0 -r =- ,llJO ~Ilt:: aUGr\.:ss: v.5"'t.o c= City. State: W.'c.L1l e- PROPERTY OWNER C Name: Addtess:3> CityS PhoneS E-mail: b This installation is being made on residential or farm property I owned by me or a member afmy immediate family. This property is not intended for sale, eXChange,. lease, or rent. OAR I 479.540(1) an 9.560(). L.,..--r SlgnaM . ou,.# CONTRACTOR INSTALLATION Busmcssnaonc: Wf'Jb~ Address: City: Phone: E-mail: CCB license no.: ZIP: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~ ~~ f~ 440-2584.) (9/08/COM) ~EE~ ~C~~~LI!....E Numhcr, of inspections per. itCIII,() Qty. Cnst Tot.' e.. cost Residential, per unit, sen!ice included: 1,000 sq. ft. or less (4) $134.00 $ Each additillnAI 500 so. O. nr not1inn S 25,00 . thcr~of .. , Limited energy (2) $ 32.00 $ Each manufactured home or modular $ &3.0C $ dwelling service or feeder (2) Sen'iccs or feedcrs: installation, alteration, relocation i-- 200 amps or less (2) $ 81.00 $ 20 I to 400 amps (2) $ 95.00 $ 401 to GOO aiHjJ5 (2) $156.00 $ 601 to 1.000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ TempQrary servi{'t"s or feed!."rs: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ 20 I to 400 amps (2) $ 87.00 $ 40 I to 600 amps (2) $126.00 $ Over 600 amps or I ,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel A. Ft:'p. fnr hnln(:h cir~llifs with purchase of a service or feeder fee: Each branch circuit I $ 6.00 $ b. Fce lor branch circuit<i without purchase of a service or feeder fce: First branch circuit (2) I $ 55.00 $~ Each additional branch circuit 2- $ 6.00 $ I ':l-- Misccllaneous fees: service or feeder not included Each pwnp or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ al1t::ration, or extension (2) Each additional inspection: (l) $58.00 $ APPLICANT USE (A) Enter subtotal of above fees $ 07~ (Minimum Permit Fee S58.00) (B) Enter 12% surcharge (.12 x [A]) $ o!l!- (C) Technology Fee (6% of [A]) $S~ TOTAL fees and surcharges (A through C): $n~ SP.lI.NG..:L~ L~ t.t; ~OReGON I I I I CITY OF SPRI'NGFIELD Building I ReSidJntial Permit PERMIT NO: 811-SpR2011-02090 , IVR Number: 811,112158473 ISSUED: I 09/08/2011 I APPLIED; 09/08/2011 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 09/08/2011 SITE ADDRESS: 3856 EST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702311301000 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@ci.springfield.or.us EXPIRES: VALUE: 03/05/2012 $0.00 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Add three circuits Phone Number: OWNER: ADDRESS: HAMBRICK GILBERT G & SUE 3856 NEST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor Contractor Name OWNER Lic Type eeB CONTRACTOR INFORMATION ~ Phone Lie No 000000 Lic Exp 08/01/2025 # of Units: BUILDING INFORMATION ~ # of Stories: Height of Structu~e: Type of Heat: I Water Type: I Range Type: Hazmat: o # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: I Springfield Fire Code Edition: I Mechanical Specialty Code Edition: Municipal' Develhpment Code: I Plumbing Specialty Code Edition: Residential Specialty Code Edition: I Structural Specialty Code Edition: I I Site l~fonnation Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit 9/8/2011 1".29'17AM lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: ATTE~~Td9t~bth1rf:gon law oequires you to follow rUles adooted hy the Oregon Utill'ty Not'f' tOcclIPancy Load: , I Ica 'VII "'"" ""r. I nose rules are setforth m Ote01~52-001-001 0 through OAR 952-001- 0090., You may obtain copies of the rules by callmg the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). ~ NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Page 1 of3 www.ci.springfield.or.uS I I I I CITY OF SPRINGFIELD Building I ResidJntial Permit , PERMIT NO: 811-SPR2011-02090 I IVR Number: 811~12158473 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 SPRI.N...GFIE~ D' . ~-. ';,; ..!;b ., ~-'.. OREGON permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued I ISSUED: I APPLIED:, 09/08/2011 09/08/2011 EXPIRES: VALUE: 03/05/2012 $0.00 09/08/2011 SITE ADDRESS: 3856 EST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702311301000 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Add three circuits Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: DEVELOPMENT INFORMATION ~ Overlay Dist: # Street Trees Reqd: Paved Drive Reqd:1 I. % 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: I Valuation Description ~ Descriotion Type of Construction I I Unit Amount UnitTvDe ; Unit Cost Value FEES PAID ~ DescriDtion Branch circuits without service or feeder ~ 1 st circuit State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit totai) Branch circuits without service or feeder - each additional Total Amount Paid Amount Paid $55.00 :$8.04 ,$3.35 $12.00 $78.39 Date Paid 09/08/2011 09/08/2011 09/08/2011 09/08/2011 ReciDt # 2011002417 2011002417 2011002417 2011002417 Springfield Building Permit 9/8/2011 I , I j".29:17AM i I Page 2 of 3 SPRIN. G. FIE. ~ ~.Il"" F.'''~ , ,'\, OREGON I I I I CITY OF SPRI.NGFIELD I Building I Resid~ntial Permit , PERMIT NO: 811-SPR2011-02090 I IVR Number: 8111112158473 www.cLspringfield.or.us 225 Fifth 5t 5pringfield.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: I APPLIED; 09/08/2011 09/08/2011 Issued 09/08/2011 EXPIRES: VALUE: 03/05/2012 $0.00 SITE ADDRESS: 3856 E ST. Springfield. OR 97478 ASSESOR'S PARCEL NO: 1702311301000 SCOPE: Electrical Only WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Add three circuits I DeDartment Application Acceptance Plan Review Received Due Date Comoleted I Result 09/08/2011 09/0812011 09/08/2011 !Overthe Counter I Permit Issuance "' 0~/08/201j ~.09/08/201J;'09/08/2011~ ,~~sLJed-,:','c?c;';' 'ro:~ ~. ~ ..~:\<\~ 2 - ~~~:"-'-"'-'''-7;'''~- ,'.."., -4 ...-,." ;....-<'-,"'-.<...>..~ Electrical Review 09/08/2011 09/08/2011 09/08/2011 1 Not Required Comments: Over the counter permit Reviewer Chris Carpenter Chris Carpenter . :;.;":,:Chr(s};;arpent,;,rt' "l~ O~;'A"" -.--- _". ,. "'..L rlnitial Review" -~-~ 09/08/2011 . '09/08/20,1.1 f Comm~nts:. Over the_'count~r,permi~ " . _____ ; Over the Counter --I -. . ,~,-, . 09/08/2011 ~ .. - ---_. -~ - - .__.. _.._- INSPECTIONS REQUIRED I Inspections 4500 Rough Electrical Rough Electric: Prior 'to Cover , C~ris' CarpenieG ,.,-', '.' :..J 4999 Final Electrical Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully examined the cojpleted 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 timJ, 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 :~4~~F' i 9-J-f/ Owner or Contractor Signature Date I I I I Springfield Building Permit 9/8/2011 11:29:17AM Page3of3 , , I I I I Property Owner Statement Regarding Constru,ctionResponsibilities 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 .J 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 ~ith the permit. Please check the appropriate box: D I own, reside in, or will reside in the complet~d structure and my general contractor is: I 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, la residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire dnly 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 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. Print Name of Permit Applicant I ~dk~k~ . ature errmtA cant ' f-p-/! Date , r- Permit#: I~sued b ~ Date: I r:~ I I C\.e,. ~L , , lli' ~a..~\ 1 I Address: ~CC;E:~Ao This Copy for Permit Offices SP~~N.G.::E~ .;~~ ,J.';t"\. OREGON www.ci.springfield.or.us TRANSACTION RECEIPT I 811-SPR2011-02090 3856 E ST I CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 permitcenler@ci,springfield.or.us " C.Q.M)'IIEt'!T.S." . DATE: 09/08/2011 ":.~'AMo.UNtDUE 55.00 12.00 8.04 3.35 78.39 AMo.UNT PAID, 78.39 '1 RECEIPT NO.: 2011002417 RECo.RD NO.: 811.SPR2011.02090 [DESCRIP-Tlo.N 'co "'" "'"'.. : :,..... P".:' . .ACCQUNf..'cO'OE::......:.'.. Branch circuits without service or feeder - 1st circuit 224-00000-426102 Branch circuits without service or feeder - each additional 224-00000-426102 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 Technology fee (5% of permit total) 100-00000-425605 TOTAL DUE: LPAYMENTTJPE Cash . '. p ~-Y.oR '.., CASHIEFb CCARPENTER HAMBRICK GILBERT G & SUE I To.TAL PAID: 78.39 , I I , I I I I I I i , I