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Home My WebLink AboutPermit Electrical 2007-9-13 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMITAPPLICATION I' City Job Number (OlAA. Zcs<::::> 7 - 0 /V 0 '0 Installation, Alteration or Relocation 01"Ct: b~~~1'H~sWORK $ 55.00 ~. , ". rEP.~I\\T SH~ll EMffi~M\l(J~t $ 76.00 I ~\~HOR\2ED UNDER '.it6p9\\mps $110.00 ~O\\jli{\cNCEO OR \~~~ver 600 Amps or 1000 Volts see "B" above. ANY ~ 80 DAY PER\'1j,' New Alteration or Extension Per panel! One Circuit $ 48.00 Each Additional Circuit or with Service or Feeder Permit ?J I~ Owne"Nome k-qQ~ (JJ f\~ Address 7 44 S- -b V7)~ da 1.12- City ~\(\qh'~ rJ Phnt $II I)Qs(;-ff1 fJ ) Pump ne irrigatinn U ATTEN;T~l1Cil~_requlres you to foll.~w tlfJRA\~8~WQ~R~s19~@JIflgOn Utility Notlflcatl()nJ~EjQter:"1 ~se ruleS~lilre set"iurih in OAR M!-If1t)I1~W' h~ff()1tR - OOMiJ1~~~~~'9~i!lM'6S ~Ii numb regon ~Ilt~ t'iU1\;8@&~32-2344). 10% Administrative Fee 5% Technology Fee 1. LEGAL DESCRIPTION: 1703Z>3'~ 6 7~O JOB DESCRIPTION: Ac(b 2- CeVc.CA\' h Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor Address City Phone Expiration Date ~~ OJ Supervisor License Number Constr. Contr. Number Expiration Date Signature of Supervising Electrician OWNER INST~A TION The installation s b<: ing made on property I own which i i~ended . or s, Ie, lease or rent. \, s ,')ignatme: W ~ -) Inspection Request: 726-3769 ~ 3. A. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder B. 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only C. $117.00 $ 21.00 $55.00 $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 ! l( f C{ $ 4.00 E. TOTAL $ 55.00 $ 55.00 $ 28.00 $ 50.00 + Surcharges S2 ~. , '- S(OJ CbO b3~ Shared Drive(T:)/Building FormslElectrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01406 ISSUED: 09/13/2007 APPLIED: 09/13/2007 EXPIRES: 03/13/2008 . VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2445 GROVEDALE DR ASSESSOR'S PARCEL NO.: 1703233309600 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace gas furnace and water heater Owner: RY AN CARNEY Address: 2445 GROVED ALE DR SPRINGFIELD OR 97477 Phone Number: 541-953-8771 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Contractor OWNER JUNG ENTERPRISES INC License Expiration Date Phone 102455 10/04/2007 541- 7 41-0002 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: R-3 n/a I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Notes: NOr~ClE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. I PUBLIC IMPROVEMENiij;NTION: Oregon law requires you to " r~r~s adopted by the Oregon Utility !'Jotlflcatl~~l!t.Tf"ese rules are set forth In OAR 95bi9~JsQgJQHn.gHa~ OAR 952-001- 0090.. You may BOtaln copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). Street Improvements: Storm Sewer Available: Special Instruction: Paee 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Appliance Vent Fixture Furnace - up to 100,000 btu Gas Outlets 1-4 MinimumlAdjustment Mechanical Minimum/Adjustment Plumbing Total Amount Paid CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-01406 ISSUED: 09/13/2007 APPLIED: 09/13/2007 EXPIRES: 03/13/2008 VALUE: I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value' Date Calculated Total Value of Project ~ Amount Paid Date Paid Receipt Number $20.00 $15.20 $7.60 $12.16 $48.00 $4.00 $14.00 $16.00 $14.00 $5.00 $17.00 $34.00 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 9/13/07 1200700000000001192 1200700000000001192 1200700000000001192 1200700000000001192 1200700000000001192 1200700U00000001192 1200700000000001192 1200700000000001192 1200700000000001192 1200700000000001192 1200700000000001192 1200700000000001192 $206.96 I Plan Reviews' To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eolJireCUnsnections . Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Paee 2 of 3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01406 ISSUED: 09/13/2007 APPLIED: 09/13/2007 EXPIRES: 03/13/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 ity of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANC; will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that L y contractors and employees who are in compliance with ORS 701.005 will be used on this project. I furt a ree to ens e hat all required inspections are requested at the proper time, that each address is readable from the stre t, that e perm t c rd is located at the front of the property, and the app.Ad set of plans will remain on the site at all ~~~~%J\ d~\fJ61- --- Paee 3 of 3 . . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052' Phone: 503-378-4621 Web Address: www.ccb.state.or.us . Permit #: CO l-1.I'\. 2.c::s-c 7- D / L{ 0 b . G-rov~~ d'04--{~ Y~;;7 . Z-4L{ \ .~(y . \ Date: . . Address: . . Issued by: . Statement: Information Notice to Property Owners About Construction Responsibilities. Note: OregonLaw,.ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement befor,e a building . permit can'.l?e issued. This statement is required for residentiat building, electrical, mechanical and "plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701. 01 0(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and:eitherbox 3A or3B: ~l. ..~. I own, reside in, or will reside in the completed structure. I understand that 1 must become licensed as a construction contractor if the structure is sold'or . offered for sale before or on completion. . 0 3A.My general contractor is . (Name) (CcB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. .' OR . ?B. I will be my own general contractor. . -. ,. . . If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board,' If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the cCB and will immediately notify the office issuing this building permit of the . name of the con actor. . , I here~tify that the b ve information is correct and that I have read and do understand the Information Notic<ftoP,,\:perty Ow rs about Construction Responsibilities on Ibe reverse r' oHbis form. ~.~,1, ,pO\ C.~-1 . L/~JW ~ ~ (Sign~eYofpe it applicant) .l l (Date) ( ( whIte co' y to issuing agency permit file, pink r;ppy to applicant.) . Property_owner. doc 06-01-04 . :. - \ ) : Acting as -Y"otlr J ,) INFORMATION~NOTICE TO PROPERTY OWNERS ABOl:JT CONSTRUCTION RESPONSIBILITIES --- c. General Contractor? .. '- _J<' ',,- NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new structure, you can prevent many problems by being aware or make a substantial improvement to an existing following responsibilities and concerns. You will, in most inptances, beruled to be an "employer" you use contractors not licensed with the COI\stTu,ction construction or hnprovement of a residential str,ucture. As contractors you contract with will be ,"employees" if Board to do labor in constructing or to assist in the you must comply with the following: As an employer, you must will be. liable for the tax more information, call the Departrrlerit income tax~s from employee wages at the time even you don't actually withhold the tax from your_ at 503-378-4988. Tax: As an employer, you are on the wages of aU employees. For more information, can to pay a taX for unemployment insurance purposes. , Employment Department at 503-947-1488. " '...., The Oregon Identification Number (BIN) is a number for both Oregon Withholding and Insurance To file for a BIN, call 503-945-8091 or w\vw.dor.state,oLus/formsnav.htmll for the Insunm.ce: As an employer, you are and compensation insurance for yom: insurance, you be subject't6 penalties and 'be for job. more information, call the Workers' Services at 593-947-7815. to the Oregon Workers' Compensation Law, If you fail to obtain workers~ compensation costs if one of your employees is injured on the at the'Departirient of Cmlsumer and Business 1J.8. Revenue Service: As an employer, you must You will be for the tax payment even if you didn't IRS at 1-800-829-4933 or visit their, web site at www federal income tax from employees' wageS':-., '. the tax. For a Federal EIN number, call the "" of Concerns, . As the permit holder for project, you are responsible for resolving any failure to meet code that may be brought to your attention Insurance: omissions such as f , '- ~ " " ' , , , to see 'if you adequate insurance water damage from pipe puncfures,;:fire or 1 . / ~\ . ~ \ . .", I . time to J' sure you have' the skills to act as youI' own to notify building officials as , - contractor, to"coordinate the - so they can perform <if rough-in inspections. (503-378-4621) or the agency at PO call the Construction OR 97309-5054. 06-01-04 225 Fifth Street SpriIigtieid, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01406 COM2007-01406 COM2007-01406 COM2007-01406 COM2007-01406 COM2007-0l406 COM2007-01406 COM2007-01406 CO M2007 -01406 COM2007-01406 COM2007-01406 COM2007-01406 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200700000000001192 Date: 09/13/2007 Description Fixture Minimuml Adjustment Plumbing Furnace - up to 100,000 btu Appliance Vent Gas Outlets 1-4 Minimuml Adjustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By . RYAN CARNEY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 071872 In Person Payment Total: Page I of I 10:03:10AM Amount Due 16.00 34.00 14.00 14.00 5.00 17.00 20.00 48.00 4.00 7.60 12.16 15.20 $206.96 Amount Paid $206.96 $206.96 9/13/2007