The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2007-9-12 L-D~ INITIALS N y-- C) ~ I'.~/b, rv--r S-p/U ZON 3. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number C O...c..1 'Z..C>O 7 - c::> 1 "3 / ? Date NOTICE: I Hl~ PI:HMI r SHAll ~. AUTHORIZED UNDEf\. T COMMENCED OR IS ~fgRExtension Per Panel ANY 180 DAY PERIOrbne Circuit 1 Each Additional Circuit or with Service or Feeder Permit Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 OWNER INST ALLA nON Limited Energy/Residential $ 28.00 The installation is being made on property I own which ATTEN1i~e~Bn~m~ you t~ $ 50.00 is not intended for sale, lease or rent. foll~oN" fd~ti' ttt\eI@ml:fJ:lt1JfiHtys $50.00 + Surcharges Notifiiati S Z In OAR 952' 0090. Yo&O_tG~~ies of the rules by L/ Ib calling t~~d~.M~nis(Ntitv:ltne telephone S.ZO::> number~Th$1(j)re,~IfUtility Notification 7.60 Center is 1-800-332-2344). / 3 ~b TOTAL b Shared Drive(T:)/Building FonnslElectrical Pem1it Application 7-07,doc 1. LEGAL DESCRIPTION: 170"3 Z S 3'-( JOB DESCRIPTION: AJi z 6S>CS~ C I / c.."",-'- + _ S' 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 Supervisor License Number ~f J o Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician v' , /, f. Owners Name L.I1.17P(' --- <)..JjAH~ Address / C-. 7 ~ "J-: 51-. City ,~r/~A)~.Cfzfn Phone 7~6-Y?7R- Inspection Request: 726-3769 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 $117.00 $ 21.00 $55.00 B. 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNoIts Reconnect Only $ 70.00 $ 83.00 $138.00 $ I 80.00 $413.00 $ 55.00 c. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps $ 55.00 $ 76.00 $ I 10.00 I $ 48.00 $ 4.00 L{~ l( E. Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01399 ISSUED: 09/13/2007 APPLIED: 09/12/2007 EXPIRES: 03/13/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1670 J ST ASSESSOR'S PARCEL NO.: 1703253405300 Springfield TYPE OF WORK: Bathroom TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Convert closet space into bathroom Owner: ROBERT HOLDING Address: 1060 26TH ST SPRINGFIELD OR 97477 Phone Number: 541-746-9578 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone BUILDING INFORMA nON I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: ATTENTtON: Oregon taw r~~~tp . follow rules adopted by the~~~ng: NotlTlcallOIl vtml.olo -;heee FUlge arc C:~ml- In OAR 952-001-001~(\)ftI@N ~URMA TION I 0090 You may obtal~ VI ,"v.... J caliing the center. (Note: .t~:r:::n number for the'lSo~~ggg~~~~~t Trees Rqd: eenter Paved Drive Rqd: % of Lot Coverage: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: NOTICE: Downspouts/Drains: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Notes: Paee 1 of 3 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-01399 ISSUED: 09/13/2007 APPLIED: 09/12/2007 EXPIRES: 03/1312008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 2,000.00 Value Date Calculated Description Type of Construction Total Value of Project $2,000.00 $2,000.00 09112/2007 ~ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $20.00 9/13/07 1200700000000001193 + 10% Administrative Fee $20.20 9/13/07 1200700000000001193 + 5% Technology Fee $10.10 9/13/07 1200700000000001193 + 8% State Surcharge $16.16 9/13/07 1200700000000001193 Add, Alter, Extend Circ $48.00 9/13/07 1200700000000001193 Add, Alter, Extend Circ Ea Add $4.00 9/13/07 1200700000000001193 Building Permit $50.00 9/13/07 1200700000000001193 Fixture $48.00 9/13/07 1200700000000001193 MinimumlAdjustment Mechanical $43.00 9/13/07 1200700000000001193 Minimuml Adjustment Plumbing $2.00 9/13/07 1200700000000001193 Sanitary Sewer - Improvement $102.02 9/13/07 1200700000000001193 Sanitary Sewer - Reimbursement $134.17 9/13/07 1200700000000001193 SDC SanitarylStorm Admin $11.81 9/13/07 1200700000000001193 Vent Fan $7.00 9/13/07 1200700000000001193 Total Amount Paid $516.46 I Plan Reviews I Public Works Review 09/12/2007 09/12/2007 APP BRC SDC's applied for three new fixtures. 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. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Paee 2 of 3 CITY OF SPRINGFIELD. Status Iss u ed Building/Combination Permit PERMIT NO: cOM2007-01399 ISSUED: 09/13/2007 APPLIED: 09/12/2007 EXPIRES: 03/13/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. 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 of 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. .~/.1 Jf,(j/~ 4-= Owner or Contractors S~ 1'J9/13~7 . W Date Paee 3 of3 Construction Contractors Board 700 Summer St NE Suite 300 PO Box14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit#: CO"",l.CC""1- 0/3 99+ Address: I 6 '7 0 c..i S I I~slledby: ~ Date: ~r7 .Statement: Information Notice to Property Owners . About .Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. 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. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ I own, reside in, or will reside in the completed structure. ~ I understand that I must become licensed as a construction contractor if.the structure is sold or offered for sale before or on completion. D 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. Il~ OR. Y 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors. licensed with.theConstruction 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 contractor. I hereby certify that the above information is correct and that I have read and do understand the Information · Notice to Property Owners about Construction Responsibilities on the reverse side of this form.' .&/--R~#' ,. ~2~O>> -. - (Signature of permit applicant) /' --- (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 A~fing,,~s Your ,Own General Contractor? INFORMA.TION,NOTICE TO,PROPERTY OWNERS . . AB'OUT -CONSTRUCTION RESPONSIBILITIES' .. . ,.' ,- . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contra~tor to construct a new home or make a substant~~l improvement to an existing structure, you can prevent many problems by being aware of the 'following responsibilities and concerns. Employe:r ResponsibiUtie~ You will, in most instances, be ruled to be.an "employer".'~nd the con:tractors you contract with will'be"empi~yees" if you use contractors not licensed with theC'onstruction Contractors Board to. do labor in constructing or to assist in the construction or improvement,?f a re~ideniiafstriictuie.,As t~e empioyer, you must comply with. the fono~)ng: . .. Oregon's Withholdi~g Tax Law: As a~'employer, you'mu~t withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payment~ ~ven_if you don't actually withhold the tax from your employees. For more infonnation;call the Department of Reverl1.ie it 503-378~4988.' : ...... . '. . " Unemployment Insurance Tax: As an employer, you are'reqtiin5dito pay a tax~forunemploym'6nr.jnsurance purposes.'..:..,. on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488'. " . ,".' i, ,'. .... '," :, ," .... '. ",.:' ~ 2 : .;. ' , .' "~"'-. The Oregon Business Identification Number (BIN) is a combineq ~urqber for both : Or.egOtl Wjtl$olding and. " Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the . appropriate forms. . Workers' Compensation hisu'rance: 'As an employer, yd~ ~re subject to the Oregon Workers' Compensation Law, and must obtain wor~ers' compensation insurance for your employees~ If you fail to obtain ,workers' cvwpensation insurance, you could'be subject to penalties anobe liable' for all claim'costs if one OfY01lr"emplby~es is injUred on the job. For more information, call the Workers' Compensation Divislonat:the'Department of €onsurnet and' Business Services at 503-947-7815. . U.S. intemal Revenue Service: As an employer, you must withhold federal incomet:ix.' froin employees' w;~' , You will.be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the '-....... IRS at 1':'800-829-4933 or-Visit their web site at \....'\V\vjrs'.'l!bv~ ..' '\ '. : Other ~espon.sibilitiesal1ld Areas of COl1lcerns . Code Compliance: As the permit holder for this project, you are responsible for resolving any failure' to meet code requirements that may be brought to your attention through inspections. _ ... . - ',' r . . ' .' , ,. . Liability and Property Damage Insurance: Contact your insurance' agent 'to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. ......' ';;r '~~")~.~~ :" .....; " ' t.. <t."- ':~ Time: Make sure you have sufficient time to supervise your employees: . - .' . ..... .... ."~ . Expertise: Make sure YO'u have the skills' to act as 'yo'ur own' gelleral contractor, t6 coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ O\vner. doc 06-01-04 225 Fifth Street , . Spring'fiela, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-0]399 COM2007-0]399 COM2007-0]399 COM2007-0] 399 COM2007-0] 399 CO M2007 -0] 399 COM2007-0]399 COM2007-0] 399 COM2007-0]399 COM2007-0] 399 COM2007-01399 COM2007-0 1399 COM2007-0 1399 COM2007-0]399 Payments: Type of Payment Check Check Job/Journal Number COM2007-0I399 COM2007-0 1399 CO M2007 -01399 CO M2007 -0] 399 COM2007-0]399 COM2007-0] 399 COM2007-0]399 COM2007-0]399 COM2007-0] 399 COM2007-0]399 COM2007-0] 399 COM2007-0]399 COM2007-0]399 COM2007-0]399 Payments: Type of Payment Check Check cReceintl RECEIPT #: 1200700000000001193 Description Building Permit Vent Fan Minimum/Adjustment Mechanical ~Mechanicallssuance Fee~ Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Minimum/Adjustment Plumbing Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin + 5% Technology Fee + 8% State Surcharge + ] 0% Administrative Fee Paid By WESTERN UNION MO WESTERN UNION MO Received By Check Number Batch Number djb djb Description Building Permit Vent Fan Minimum! Adjustment Mechanical ~Mechanicallssuance Fee~ Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Minimuml Adjustment Plumbing Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC SanitarylStorm Admin + 5% Technology Fee + 8% State Surcharge + ]0% Administrative Fee City of Springfield Official Receipt Development Services Department Public Works Department Date: 09/13/2007 Item Total: Authorization Number How Received 2355 2336 In Person In Person Payment Total: Item Total: Check Number Authorization Received By Batch Number Number How Received Paid By WESTERN UNION MO WESTERN UNION MO djb djb Page 1 of] 2355 2336 In Person In Person Payment Total: 10:10:54AM Amount Due 50.00 7.00 43.00 20.00 48.00 4.00 48.00 2.00 ] 34.] 7 ]02.02 ] 1.81 ]0.]0 ]6.]6 20.20 $516.46 Amount Paid $500.00 $] 6.46 $516.46 Amount Due 50.00 7.00 43.00 20.00 48.00 4.00 48.00 2.00 ] 34.1 7 ] 02.02 ] 1.81 ]0.] 0 ]6.]6 20.20 $516.46 Amount Paid $500.00 $] 6.46 $5 I 6.46 9/] 3/2007