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Home My WebLink AboutPermit Electrical 2006-9-11 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)726-3689 ELECTRIC1L PERMI~ APPLICATION City Job Numbel.QY\ uJt'lp - C09.Q3 q -) \ ZON LD2- INITIALS N VV\ DATE C{" I I -(}.(:1 SOURCE Ma..{)~, -2~ ~ (\31. S.1Jif? QN(j)PINSTAELATI(j)N: 3. '-1 ~~(~~I;VZ. ~ LEGAL DESCRIPTION: l'ta~~~Lf6 1(j~O l , JOB DESCRIPTION: '01.:.-.&[ C; -c-v;f- X...s+~/1 &I("~.)." - .,L_\. .I~~.c~ It.! ~...,~ 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. '..,...,.,..:.:.:;';.........:......... ,...._........._.A.. ................ '..........;..._.:.... .......;.,............................, CTOR iNSTALLATION ONLY. Electrical Contractor Address City Expiration Date Signature of Supervising Electrician Owners Name -:r;. $' hl~'('1 ~ Address <1 3 S- C.e'~ +t'...~ :.. J 13(.-{ City ~~~:;~ (:t' Id Phone $'1 ( 7/:) b 7f 0 OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. .1~ig;?;4 \ Inspection Request: 726-3769 ----- Date COMPLETE FEE SCHEDULE BELOW A. New Residential- Sin~le OI'lV1ulti-.]1amiIy 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 $106.00 $ 19.00 $50.00 B..!: t~r.tfiJ~~H6~or'Relocation: r I ,'" " _ 0;"C>['O;i Lr~inty \ r;"" ."....:. 'r' l 'r 1" ~-, :jOQ.Amps;6r)€ss,:::r, j 1,:)S3 rules are se::S;C63tIDO Il,~, . ". _ J.'~', -I'~';O .," .."'lgl .", I c-" ~". C291.A!11P~ tQ400 A~ps. ,I I, '-~. 1 v,'ln .5~'--::vtsl"eo ~6tA~ps [b' 600~;n~:~ I CCpi8S or tile rL:;S$;l12)'.OO C; ,,: \' ,h", c< T..}P ("" v:",. t' " 60i.AiJ. s:t<i 1000"A:n s ,u...... 118 t8i8;:;!~C1~63"00 l,ulll~ P"., 1'-'>' r P,on UtT' . , Over 1000Am'p;J%JtsS ~~I{Y !'WU[lcatJ~V5.00 Reconne'ct80nly IS 1-800-3\:l.::::-2;;A<tj. $ 50.00 C. Temporary Services or }"eeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Arpps to 600 Amps $ 50.00 $ 69.00 $100.00 O~~t ~~b,~mps OJ; lO,OO_V;())t~'~r~c"lF f?-?Lei!\IlII"( D.UBfilrich':GitrUjt)nJ::R THIS PE~)MI r "'i>:~: It ";1':, Ij I~ "r', i "'r-() .' "\ '" '" " ...., -,," ~ '1-" I.) t "I u I N'.ljl,d.'I't \ t".' "'E"t" 1\;;) /, /n" p'rr-I FD" e'Y ft era IOn or '" enslOn c,erJ al1~ Ii /' 1'1 \ .," r, '"' 1\ " oJ. - Q 0 n . One CIrcuit);,:' ,tnl .. I $ 43.00 Each Additional Circuit or with LI3 ~ "}00 S.;nicc'OJ Fet:cic. PeIlnii I $ 3.00 E. eeder notincluded) -Ea~h Installation . -~L Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 MinimumElectric PerlIlit Inspection Fee is $45.00 + Surcharges [50 4. .. SupTOTAL OllABOVE ~ . 8% State Surcharge J, b g- 10% Administrative Fee ((, b (9 5% Technology Fee , . .3 0 TOTAL (;{'j' sf{ Shared Drive(T:)/Building Forms/Electrical Permit Application 8-06.doc 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 #:~ 2u Cf.p -ooQ'5 ~ . Address:Q;&5 Uun11vnn~ Issued by' If I ~ . Date, 9 -I 1- aCp Statement: Information Notice to Proerty 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 I 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 w~ll instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. ~ OR ~ r 3B. I will be my own general contractor. / . If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I 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.certifythat 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. v~ -- 1/&~~ . j/ (Si,ature of permit applicant) I I (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 . 'I! ~ ., ' "Acting asY our .Own General Contractor? . l . .... 'INFORMATION NOT~CETO PROPERTY OWNERS' ABOUT 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~s your own co~tractor to construct a new home or make a substantial improvemenUoan existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities . .. . . You wil.l, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you lise'contractors 11'0t licensed with the Constn.lctiot'rContractors Boa'td' to 'do' labor' in c.onstJ1.lcting or'tq as~ist in the. construction or improvement of a re~idential structUre. As the em~l?yer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from empioyee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call.the Department of Revenue at 50J-378-4988. . Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpose$\. on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. \, ..'. . '\ The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and, Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.oLus/formsoav.htmll. for the appropriate fonDS. .. . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVHtpensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you cOlild be subject to penalties and be liable for all chlim costs if one o{your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. , >,...... U.S. bntemalRevenue Service: As an employer, you must withhold federal income tax from employees' wages~ '. You will be liable for th.etax payment ev~n if you didn't actu.allywitJ1hold the t.ax.. For a Federal EIN number, call the' IRS at"l-800-829-4933 or visit their web site at wwwoirs.l!ov. ' , . . Other Responsibilities and Areas of Concerns. Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to 'meet code requir~ments that may be brought to your attention through inspections. . ~ .;, t... 1. . Liability and Property Dalnage Insurance.: Contact . yo~r insurance agent to see if you have. adequate insurance coverage for accidents and omissions such as faUing tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. \ \. . .~.~,;.\ \'4~_.\. \} "~.' ,.',\ Time: Make sure,you,have suf~,cient time to supervise your employees.; Expertise: Make sure you have the skills' to act as yoUr oWn general contractor, to 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 B.ox 14140, Salem, OR 97309-5052. . '. . Property _ owneLdoc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ( of Springfield Official Receipt h..l'elopment Services Department Public Works Department Job/Journal Number COM2006-00953 COM2006-00953 COM2006-00953 COM2006-00953 COM2006-00953 Payments: Type of Payment Check c Receint I RECEIPT #: 2200600000000001261 Date: 09/11/2006 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JOSHUA V. NECKELS Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 298 In Person Payment Total: Page I of I 1 :43:49PM Amount Due 43.00 3.00 2.30 3.68 4.60 $56.58 Amount Paid $56.58 $56.58 9/1 1/2006 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00953 ISSUED: 07/31/2006 APPLIED: 07/28/2006 EXPIRES: 03/11/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 935 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264314201 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install heat pump and air handler 'I' "'.f(nr'.I'I'a~Vl./ ~,. ~:-, _ l !.! :0 Contractor Type Electrical Mechanical Contractor OWNER PACIFIC AIR COMFORT INC '1P:~oneNu'm~.~W~ :5dIit913-6798 .'1. '- '- I L,' '-''-J c.f c 58"( "forth '~IO' - ""'-,11'''>-" r,' rl - " ....I'-\-'~'j. ',-~', \I1S:5?-OO~j_ c. ,'l".I,', CO>2S ol niP n ,k,,, I". .. L,. vl:;.I,.::r. ("; 'Ie' i:1", t, I _I 'J :-_., . _,..,;.... u. l, t.:i d Gunone I CONTRACTOR INFORMATI.ON 'I. l..~'C90n Utility Notiiication . \"~I"vl IS ,,800,332-2344) License Expiration Date Phone j, Owner: Address: JOSH NECKELS 935 CENTENNIAL BLVD SPRINGFIELD OR 97477 39237 03/25/2010 541-672-9510 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # 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 INFORMAVfION I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: I ~.,(':';' '.,' Handicapped: I rf!~ PERMIT I Compact: ,~TriORfZED SHALL EXPIRE IF .; (:IViMENCr-n ~~~~R THIS pr:Dr.;,~E WORK I PUBLIC IMPROVEMENTS I" J I fj[j D<W PER;~D~fjANDONED' ~~~ /VaT Sidewalk Type: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: "1 Street Improvements: Storm Sewer Available: Special Instruction: Downspouts/Drains: Notes: Pa!!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 + 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 $10.00 $4.50 $3.60 $8.00 $12.00 $25.00 $4.60 $2.30 $3.68 $43.00 $3.00 7/31/06 7/31/06 7/31/06 7/31/06 7/31/06 7/31/06 9/11/06 9/11/06 9/11/06 9/11/06 9/11/06 Total Amount Paid $1l9.68 I Plan Reviews' CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2006-00953 ISSUED: 07/31/2006 APPLIED: 07/28/2006 EXPIRES: 03/11/2007 VALUE: Value Date Calculated Receipt Number 2200600000000001077 2200600000000001077 2200600000000001077 2200600000000001077 2200600000000001077 2200600000000001077 2200600000000001261 2200600000000001261 2200600000000001261 2200600000000001261 2200600000000001261 To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. UeouirecUnsnections 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. Pal!e 2 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00953 ISSUED: 07/31/2006 APPLIED: 07/28/2006 EXPIRES: 03/11/2007 VALUE: 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 times during construction. Owner or Contractors Signature Date Pa!!e 3 of 3