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Home My WebLink AboutPermit Electrical 2007-9-18 3. ZON LDf2../' INITIALS ~ \---- ~ DATE C\-\C1-o-' "'" SOURCE'(;Y'\.. 03\,0.J ~/7 I COMPLEPE FEE SCHEDULE BELOW 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATIOP City Job Number (ONl~O 7 -ofl( (b 1. LOCAPIONOF INSPALLAPION: S . .b/J+ .st /873 LEGAL DESCRIPTION: /~OZO]JC( 00(2- 7 JOB DESCRIPTIONA-dd c ~.)f' (A J- ?vvv11J C.Cr~\ l-r 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. CON1'RACPOR INSPALLAPION ONLY Electrical Contractor Address City Phone Supervisor License Number v-\' ~tI / (l)~ /' Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Date A. New Residential - Single or Multi-Family per dwelling unit. 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. Services()r Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 ATT€tm~~~~~~~~ '.Ct. follow rules adopted by the Oregon Utility Notificaftrm~ tlmtailMl._'IINI. InOARm_.pg~lt'roughOAR952-001. $ 55.00 Aftft Vi gbj P}~88 of the rulea-by VViiJOit ~,.trlt~. NBi~Pihe telephODA $ 76.00 :~!'i~r.>> Bri'-0t1Rty Notification $110.00 cG00811OCOiaIltl~~~ee "B" above. D. BhinchCircuits New Alteration or Extension Per Panel I One Circuit $ 48.00 Each Additional Circuit or with I ,^ ^' I (~/J Service or Feeder Permit $ 4.00 Owners Name .UV\t1~ c..,.,^(~' V\..dt~) Address I ~ q 3 s. (., I ~ E. Miscellal1eous(Service/feeder not included) -Each Installation City~~ I\d.j ~ eJ ~ Phone ~ Pump or irrigation $ 55.00 -', V b /../1 - 6of.-oSE.l Sign/Outline Lighting $ 55.00 OWNER INST ALLA nON Limited Energy/Residential $ 28.00 The installation is being made on property I own which Limited Energy/Commercial $ 50,00 is no~t :ntend~d for sale, lease or rent ~ Minimum Electric Permit Inspection Fee is $50.00 + Surcharges Ow e*s Sig lature: (~ 4. SUBPOPAL OFABOVE 5 Z I '\A O/(A..lNV W - ~ \h. J NOTICE: 8% State Surchar~ l{fb v - - - HIS PERMIT Sdd~~tate M WORK :5 ZoO AUTHORIZED UrH),ffilflitQg:PERMIT IS NOT z'o ~~~~:~~~~ 11~:~:~~~~~I:.~:g '.m""'",,'''' P,m" AP~'~":~d", Inspection Request: 726-3769 l(B V Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-01416 ISSUED: 09/17/2007 APPLIED: 09/17/2007 EXPIRES: 03/18/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1893 S 61ST ST ASSESSOR'S PARCEL NO.: 1802033400127 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Air handler and heat pump Owner: MICHAEL DUNKS . Address: 1893 S 61ST ST SPRINGFIELD OR 97478 Phone Number: 541-726-1006 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Contractor OWNER SUNSET HEATING & AIR INC License Expiration Date Phone 171706 08/17/2008 541-988-3181 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 Garage/Carport 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 nist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: NOTICE: Notes: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR . ANY 180 DAY PERIOD. Sidewalk Type: .~ \M rJKW.lreS yoU to ATTENTION: ~6~tN~~Of~?fon Utility follow rules adopted yes are set forth Notification Center. Those ru~eOAR 952-001- lOnOOgOAR ;05~~~~ -~gt~~~~g~~s of the rules by . (Note' the telephone calling the center. Ut'lity Notification . number for the Oregon I Center is 1-800-332-2344). Pae:e 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Total Value of Project ~ Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Air Handling Unit Up to 10,000 Heat Pump Minimum/Adjustment Mechanical + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $20.00 $5.00 $2.50 $4.00 $9.00 $14.00 $27.00 $5.20 $2.60 $4.16 $48.00 $4.00 9/17/07 9/17/07 9/17/07 9/17/07 9/17/07 9/17/07 9/17/07 9/18/07 9/18/07 9/18/07 9/18/07 9/18/07 Total Amount Paid $145.46 I Plan Reviews I CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01416 ISSUED: 09/17/2007 APPLIED: 09/17/2007 EXPIRES: 03/18/2008 VALUE: Value Date Calculated Receipt Number 1200700000000001204 1200700000000001204 1200700000000001204 1200700000000001204 1200700000000001204 1200700000000001204 1200700000000001204 2200700000000001463 2200700000000001463 2200700000000001463 2200700000000001463 2200700000000001463 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. ~eouiredJnsnections I 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. Pa2e 2 of 3 CITY OF SPRINGFIELD - Status Issued Building/Combination Permit PERMIT NO: COM2007-01416 ISSUED: 09/1712007 APPLIED: 09/17/2007 EXPIRES: 03/18/2008 VALVE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 tim, during construction. \At~' IAi. ~ Cf.jy;.O"":f- Owner or Contractors Signature Date Paj!e 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#:{OPfll~u7- O/Lfl(; 1- Address: / <Ie; :3 ~ bl ),J- ~ ~ Date: 9/;8~"7 / I Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055 (4) 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. 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 th,is statement. This statement will befihid with the permit. , Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ' ~L yf 2. I own, .reside in, or will reside in the completed structure. I understand that I must become licensed asa 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. OR , 3B. I will be my own general contractor. IfI hire subcontractors, I will hire only subcontractors licensed,with the Construction Contractors Board. IfIchange my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and willirnmediately notify th~officeissuing 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. \\~\iI\A^,,^ f I_AI ,~\)" ~ (Signature of permit a;;tdant) cq, /~ - () 7::f- (Date) (White copy to issuing agency permit file, pink copy to applicant.) . . Property _ owner.doc 06-01-04 " .\.,~, i,", :.. <, '~',", ",to. "\' ~ '\,:\ . Actfng'as\Your' awn General 'Contractor? -~ IN~ORMA!io~ 'NOTICE TO PROPERTY oWNERS ABQut~ONSTRUCTIO~ RESPONSIBILITIES , NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legis/ature. If you are acting as your own contractor'to construct a ne~ horpe ~r make a substanti'al iUlplovement to an existing structure, you can prevent many problems ,by being aware Of the following responsibilities and concerns. . Employer Responsibilities . -. ," You will, in most instanc~s, be ruled to be an "emp19yer" and,the contractors you contr~ct with-will.be "employees" if youuse contractors.no~ licensed with the Construction Contractors,Board to do ,labor in coqstnIcting or to assist in the construction or ilUpLovement of a residential structure. As the employer, you}~mst comply with t~e following: . ~ .'. ". . . .'.}. :' . ! .. .. ~ . .., - : . Oregon's Withholding Tax Law: As an employer, you must withh01d incorrie taxes from employee 'wages 'at the time employees are paid. You will be liable for the tax payment~ even if you don't actually withhold the tax from your employees. For more information,' call the Departn'1ent'ofRevenue at 503:'-3784988. . -..' ., .' " \ Unemployment Insurance Tax: As an employer, you are required to pay a tax f6r' tinemployment insurance purposes on the wages ,~f all employees. For more informatio~, .~all the or~~:~~ ~\ployment Departn1~nt at 503-947-1488. \, The Oregon Business Identification Number (BIN) is a combine~.puwber for. both ,Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-809i' or wvv\v.dor.state.or.us/formspav.htmll for. the appropriate forms. ' '. - WorkeJrs' Compensation JInsuJr2ll1lCe: As an employer, you are stlbjecUo the 'Oregon Workers' Compensation Law, and must o.btaln workers' ~ompen9ation insurance for your eI!1ployee~. If you fail to obtain workers' compensation insurance, you could be ~ubject to penalties and be liable"fo~ all chiim: tosts iibne of your employees..i~ inJured on the job. For more information, call the Workers' Compensation DivisJon 'at the Department of Cons'umet. and Business ,. Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax.,from employees'. wages.\. You will be liable for the tax payment even lfyou 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\.\-'\v.h:s:l!ov:. " ., ' ..:Otb.e~ReSpOJIll~ibiUties and Are.as .of Con~erri.s- .... .1.,1: . Code Compliance: As the permit holder for this project, you are responsible for resolving any failure'to'meet code requlrements that may be brought to your attention through inspections. .. 'f" Liability and Property Damage ;hlS1lllIrallce: - Contact youi-insurance agent to ~ee 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 reQ9J1e, , . Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor,io coordin'ate 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 ~ owner. doc 06-01-04 225 Fifth, Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01416 COM2007-01416 COM2007-01416 COM2007-01416 COM2007-01416 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001463 Date: 09/18/2007 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By MICHAEL DUNKS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 158 In Person Payment Total: Page 1 of 1 IO:15:50AM Amount Due 48.00 4.00 2.60 4.16 5.20 $63.96 Amount Paid $63.96 $63.96 9/18/2007