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Home My WebLink AboutPermit Electrical 2007-10-22 ZON LDr2..- INITIALS N ~ DATE \0 ~d.~-[J., SOURCE ('(, 9~(\'~) Date ] 0 \ 2..-,-1 cSt 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number ~:". ~?-Co\.(J - ell:J. ('"'P1 Each Manufact'd Home or Modular Dwelling Service or "OU \Q,,,rler ~,eC&" 'J~wr.. e9P(\~ ~ ~0'fS'" O,e 0 '0'1 ,U\0$ ~~~ ~.\e$ ~ \\.-<.\O~'~oQ\e ~hOS~~')'(\ 0 ~ \'(\0 ~o(W1ps or less ~~t tu\e$ ce(\\e~~'(\\ ~\e$ 00 \e\~M.~s to 400 Amps \O\\~:\t'~\\O~~()\-~~~(\ ;o\e', ~~.... ~~~WrAmps to 600 Amps ....\0\.\\ - 9JfJ.. ~ v~ \)\\\\\.1;'~ · \~ O\>-~ -.J..ou~ce(\\e'~e9P(\ ~?;V6 1 Amps to 1000 Amps \~~~e ,~e 0 ../o~~ Over 1000 AmpsN olts c~~ ""e\ \0'....\0'\1>> Reconnect Only ,~~\I eel' c. Installation, Alteration~~~tttion 200 Amps or les~ ~ "\~ K 'CO ~ 201 Amps ~~,~~\ ~rv~ 401 ~~~~~CV ~\CV~. ~~ ~ ~OO Volts see "B" above. ...,~ ~ ~ \' '(-.\CO ~ ~ '\ ~~'\"'~ 'f ~Q~tion or Extension Per Panel IV\)~ ~~cuit ~ $ 48.00 ~~'{ ~ach Additional Circuit or with 2 Service or Feeder Permit $ 4.00 ('(OW-€- 1. LEGAL DESCRIPTION: 170Z ~"3>3 JOB DESCRIPTION: ,+J J ~ o ZO( ~ C f I" c.",,, "'\ 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 Supervisor License Numbe~/ / Expiration Date II constr.contr.N~er Expiration Date Signature of Supervising Electrician I .- Owners Name'~'( \ J f J). 0 ~o[..oru\ ~, Address 5;:)0, (~. ~'1-\JA f \ . L City5~h. \. Nj.c \-01 ti Phone I U I - ~ 0 OWNER INST ALLA TION The installation is being made on property I own which is not intended for sale, lease or rent. I Owne~s Fgnature: ~_O ~_I_. (0 U'J---- Inspection Request: 726-3769 3. A. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $117.00 $ 21.00 $55.00 $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 48 8 E. Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges 56 f{1{8 560 Z80 b 8 I?:!- 4. 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)/Building Forms/E1ectrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2006-01209 ISSUED: 11/03/2006 APPLIED: 09/19/2006 EXPIRES: 12/06/2007 VALUE: $ 19,230.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 539 S 49TH PL ASSESSOR'S PARCEL NO.: 1702333302018 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Dining Room Addition Owner: CROWE BRUCE L Address: 539 S 49TH PL SPRINGFIELD OR 97478 Phone Number: 541-285-5795 I CONTRACTOR INFORMATION I Contractor Type General Electrical Contractor KEYSTONE DESIGNS LLC OWN License 167560 Expiration Date 12/08/2007 Phone 541-942-2467 VB BUILDING INFORMATION I . . ATTENTlON: Oregon taw requIres you.~o # of Stor~e Ollow rules adopted by thEl-0r~ Ublity Height of _~m:;n Center. Those rtS<<lftras,,&~~h Type of filbAR 952-001-001 0 throu~a~NQ~: Water TYe~o. You may obtain copies.pFttm.~\!lft~.RY Range Typetalling the center. (Note: .~~~~R::arport Energy PathiJmber for the Oregon Utistv~Cf)~~.lon Sprinkled BuildingCenter is n/iOO-33~M~}ht Load: 180 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . R-3 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 25.70 37.20 19.10 Overlay Dist: # 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: Notes: Storm water to existing sytem, ending @ curb & gutter.JL~H)T~CE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Fully Improved Yes Sidewalk Type: Curbside 5' Curb and Gutter Downspouts/Drains: Pa!!e 1 of 3 Status Issued CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: cOM2006-01209 ISSUED: 11/03/2006 APPLIED: 09/19/2006 EXPIRES: 12/06/2007 VALUE: $ 19,230.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541~726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Dwellinl!s Patio/Porch V Wood Frame Use Bid Amount $ Per Sq Ft or multiplier $99.00 $1.00 Square Footage or Bid Amount 162.00 3,192.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $16,038.00 $3,192.00 $19,230.00 09/19/2006 09/19/2006 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $120.51 9/19/06 1200600000000001428 + 10% Administrative Fee $23.94 11/3/06 1200600000000001604 + 5% Technology Fee $11.52 11/3/06 1200600000000001604 + 8% State Surcharge $18.43 11/3/06 1200600000000001604 Building Permit $185.40 11/3/06 1200600000000001604 Fire SF Fee - Residential. $9.00 11/3/06 1200600000000001604 SDC Sanitary/Storm Admin $6.51 11/3/06 1200600000000001604 Storm Drainage Impervious Area $130.22 11/3/06 1200600000000001604 Storm Sewer - 1st 50 Feet $45.00 11/3/06 1200600000000001604 + 10% Administrative Fee $5.60 10/22/07 1200700000000001325 + 5% Technology Fee $2.80 10/22/07 1200700000000001325 + 8% State Surcharge $4.48 10/22/07 1200700000000001325 Add, Alter, Extend Circ $48.00 10/22/07 1200700000000001325 Add, Alter, Extend Circ Ea Add $8.00 10/22/07 1200700000000001325 Total Amount Paid $619.41 I Plan Reviews I Initial Review 09/22/2006 09/22/2006 APP SKG Planninl! Review 09/22/2006 10/19/2006 APP TAJ No Planning issues. Public Works Review 09/22/2006 10/05/2006 APP JLP Storm water to existing sytem, ending @ curb & gutter.JLP Structural Review 09/22/2006 10/04/2006 APP RJB 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. lJeouireCUnsnections I Footing: After trencbes are excavated. Foundation: After forms are erected but prior to concrete placement. Pal!e 2 of 3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2006-01209 ISSUED: 11/03/2006 APPLIED: 09/19/2006 EXPIRES: 12/06/2007 VALUE: $ 19,230.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building 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 d;uunrinnf).,. con;truCtiOD. fI ~ /'U-- \/-' /(j /22- / fj- Owner or Contractors Signature Date Pal!: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 Pennit #: COvvt Z-c cb - () / ZO '1 5> ~ '7 ;; Lf ')..J-~ fJ ~ ~~ Date: /6/Zz.-/d7 / / Address: 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 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: ."- ...--B . .1. I own, reside in, or will reside in the completed structure. ~. I understand that I must become licensed as a construction contractor ifthe 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 ~B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. In 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 ofthe 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. \ . () A fiJ.. AL," /O/22-/(J 7 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) (V >---- Property _ owner. doc 06-01-04 . .. , ---- Acting ~s GeneralCQntractor?' , , ~ \ - INFORMATiON TO PROPERTY OWNERS :' \ ABPUT CONSTRUCTION ,RESPONSIBILITIES . , , ' \ NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with t:?RS 701.055(5), passed py the 1989 Oregon Legislature. ,.: If you are acting as your own 'contractor to construct anew home or ma~e a substantial i111~1 ovement to an existing structure, you can prevent many problems by being aware of the foUo\ving responsipilities and concerns. ! Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use con~actors not licensed with the Construction Contractors Board to do. lab~r in constructing or to a~sist in the construction ,or improvement of a residential strucmre. As. the employer, you must comply witb the following: Oregon's Withholding Tax Law: As an employer, you must withhold income tax~s from employee wages at the time employees are paid. You will be liable fQI the tax payments even if you don't actually :withhold the tax from your employees. For more infonnation, 'call the Department of Revenue at 503-378-498~. Unemployment Insurance Tax: As an employer, you are required to pay a tax for~unemployme:rit insurance purposes on the wages of all employees. For more information, call the Oregon EmploymentDepartment at 503-947-1488. , . I .... The Oregon Business Identification Number (BIN) is a combined munber fqr both .Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.usiformsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must ~btain worker( co,mpensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and he liable for all claim costs if one qf your employees is injured on the job. For more information, can the Workers' Compensation Divisl'on at the Department of Consumer and Business Services at 503-947-7815. , . U.S. Internal Revenne Service: As an employer, you must withhold'federa1 inCfome tax from employees' wages., 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 W\vw.irs.lwv. " ~ .' . Other Responsibilities and Areas of Coincerns '- 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 jnspections. I , .. 'i I Liability and Property Damage Insurance: Contact your insurance' agent to s~e '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. i I I I . "Time: Make sure you have sufficient time to supervise your employees. '. .1- . . .' , . . ' . , . .' .,.' '. I . .. .~', . Expertise: Make sure you have the skills to act as yoUr own general' contractor, tp coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they carl perfonn the required inspections. I If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO . Box l41~0, 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 COM2006-0 1209 COM2006-01209 COM2006-0 1209 COM2006-0 1209 COM2006-01209 Payments: Type of Payment CreditCard cReceint1 RECEIPT #: 1200700000000001325 Date: 10/22/2007 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By BRENDA CROWE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 329509 In Person Payment Total: Page I of 1 10:13:39AM Amount Due 48.00 8.00 2.80 4.48 5.60 $68.88 Amount Paid $68.88 $68.88 10/22/2007