HomeMy WebLinkAboutPermit Correspondence 2006-11-27
NDV-27-2006 10:03 From:AMERICAN EAGLE ELEC 6862275
. .
To: 5417263689
P.2/2
;Ml1crican Eagt~
.
7"~
EleClric
(541) 686-1999
cce 153834
ELECTRICAL CONTRACTORS LLC
11-27-2006
Lisa Hopper
City of Springfield
Elc:ctrieal P<::mlils
225 Fillh Street
Springlield, OR <)7477
Ms Hoppe.r
Cast week [ pulled a pem.iL li.r u hot tub installation at 3382 Game Farm Road, pennit nU111bel' COM20060 14R5
whieh the Oaniels wcre hiring me to do. They havc now ucciue.d Lo do the work themselves and will appic li.r
their own penn it. So will you pleasc refund American Eagle Fleelrie the 52.89 cost of this penni!.
Thank you,
Ray May 111
~a~~
eDio tlu1" 3\Jl~
tfC/o Mt\\ \ (\ " (;Y
\CO~O ~ ~~~ 3.lJ) .
.:II ~loD
AMERICAN EAGLE EIEC. U.C
"087 WE~T 11TH, EUGENE OR
PH. 686'1~)9 FAX 6B6'2275
.-"
, -'
CITY OF SPRINGFIELD, OREGON
~ ~ ::,~,v,
A!.. DATE III 3OIO(/),
~ SOURCE~. fYS(>2.I.~
Date //-JO - 0 b
225 FIFTII STREET. SPRtNGFIELD, OR 97477 . PII,(54t)726-3753 . FAX, (541)726,3689
ELECTRICAL PERMIT APPLICATION
City Job Number CoIN\ ?OO b - D ( S' ( a,
I. LOCATION OF INSTALLATION:
:3 38 'Z... GMe-t=M.W\
3. COMPLETE FEE SCHEDULE BELOW
LEGAL DESCRIPTION:
\ 703 z.'Z\"L
A. New Residential- Single or Multi-Family per dwelling unit.
DI/CO
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
JOB DESCRIPTION:
AJ! C.\....C.\.,~+ ~~ M.l..~
$ 19.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
2. ~ CONrRACTORINSTALLATIONONLY
B. Services or Feeders -Installation, Alterations or Relocation:
, ,.
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
City
Phone
200 Amps or less
201 Amps,to.400 Amps
t,o., ,..
401 Amps 10 600 Amps 'r, .
60 I Amps to ,I ~OO Amps
Over 1000 AmpsNolts
'Reconnect Only. .
!11'
Electrical Contractor
Address
Supervisor License Number ~(~
Expiration Date _ \.1
U
'__'_.. ~. ~~..t-.....__."':_ ~ ~.~''''' .~
C. , Temporar'~~ Seryic'~s'orFeeder:s;,~
.. .. - ~ -. _.- F - ~. -_. ...........""'"
Constr. Contr. Number
Installation, Alteratioibr Relo~atiirr
,. .
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Expiration Date
.l!9;/CE: 7ver .600 Amps or 1000 Volts see "8" above. ,
THIS PERMh,[.;Branch. Circui~.,~ ...'.' .__
AU TH 0 R I Z ED Ne~~\re. ' "'t!(51IlY~- ,rension Per Panel /
COM!1EN 61tl!!illr~irHI<: Pc: . THE WORI( $ 43.00
ANY 18 CEOElE/1/~ddi\i~'l~l CirgitlbT~"'OT
'- . 0 DAY f> i "r'ttee'il:;\{P,~ 'jy
Owners Name .'b:ANf;:" ~M/~1( ~ijJ~.,. ._____. ~OR~ ._
Address 331' Z G-1'h+C E:~ A$1'lJA..-\ E. I Miscenal~"o.~s ,<Se~ce/feeder not inclu~ed) .-Each Installation
Si>Ph Phone 9gt;- D ~~b
l{']
Signature of Supervising Electrician
$ 3.00
City
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
".. . - ,:- -,..- - -. -- - -. -"'~. -
OWNER INSTALLATION
The installation is being made on propertJI own hich
is not intended for sale, leas~t. )
~rs Signatur~ . r;
'Y )/t~ . e>. t.l/J7
Inspection Request: 726-3769
TOTAL
(fl
"3 bC>
tp~
~zr
:s~3'r
4. ' SUBTOTAL OF ABOVE
l.._ :__..:...~ .._u__ .._._._.---....:...._
8% State Surcharge
10% Administrative Fee
5% Technology Fee
Shared Drive(T:)lBuilding FonnsIElectrical Pennit Application 8-06.doc
-ilA:.BU!'
~
.
.ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01519
ISSUED: 11130/2006
APPLIED: 11/30/2006
EXPIRES: 05/30/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3382 GAME FARM RD
ASSESSOR'S PARCEL NO.: 1703221201700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Add 1 circuit for hot tub
Owner: DIANE DANIELS
Address: 3382 GAME FARM RD
SPRINGFIELD OR 97477
Phone Number: 541-988-0936
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Constrnction Type:
# of Bedrooms:
VB
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: , ; >" . .Sq Ft 2nd Floor:
Water Type: ., ,. ,,-- t""" ~q Ft Basement:
'Range Type: .'" ,'" _~,'t L:.~q Ft Garage/Carport
Energy Path:' ... " , ','. ~ ~q Ft Other:
Sprinkled Building: G'..," ~ ~:nia .' .Occupant Load:
...., 1 .~ ~ _.... .....;:) ".
R-3
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
. .' . 'Q
I DEVELOPMENTINFORMAT'ION ,."",:-
. '., ... ..:::::at:on
, .' . . ~
,~ . ...", "1' '.-!..2~'}1.~).
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I P.U6tI~ilMPROVEMENTS I
THIS PERMIT SHALL EXPIRE IFS,a[wiilmype:
AUTHORIZED UNDER THIS PERb'.J*rlfptm~Drains:
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of 2
.
.ITY OF Srt<ll'liuNf.,LD '
Building/Combination Permit
PERMIT NO: cOM2006-01519
ISSUED: 11/30/2006
APPLIED: 11/30/2006
EXPIRES: 05/30/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
F....s P3WJ
Fee Description
+ 100/0 Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
Receipt Number
$4.50
$2.25
$3.60
$43.00
$2.00
11/30/06
11/30/06
11/30/06
11/30/06
11/30/06
1200600000000001701
1200600000000001701
1200600000000001701
1200600000000001701
1200600000000001701
Total Amount Paid
$55.35
I Plan Reviews I
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.
IRffll'~
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.
1 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;D~:~~:trUNamJ' II hot,
.I' f
Owner or Contractors Signature Date
Paee 2 of2
~. ...
Construction Contractors Board
700 Summer St NE Suite 300
PO BOI 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
-.
. .
\. ./
" "
" ."
Pennit#: c...oVV'7'--6 - 0/)/9
Address: s3lSZ r..,..,4VV\E" h1/Z.vV\
~~ Date: If Ircj~ b
Issued by:
f
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 befiled with the permit.
Fill in tl1e appropriate blanks and initial boxes I and 2, and eitl1er box 3A or 3B:
..h- 1.
~2.
I own, reside in, or will reside in tl1e completed structure.
o
3A. My general contractor is
I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion. /
/ /) Jtr
~ame)
(CCB #)
I will instruct my general contractor tl1at all subcontractors who work on tl1e structure must be
licensed witl1 tl1e Construction Contractors Board.
OR
g 3B. I will be my own general contractor.
IfI hire subcontractors, I will hire only subcontractors licensed witl1 tl1e Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract witl1 a contractor who is
licensed with tl1e CCB and will immediately notify tl1e office issuing this building permit of tl1e
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 ofthis form.
V/flAU-- ~~/JmuJ
,
11/30 /01
(Signature of permit applicant) / (D'ate)
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner.doc 06-01-04
AdnIIDg ~~ I1lllIr (Q)WIID cG<eIID<eIr~n (C'IID~Ir~~~@Ir?
INFO~MATION NOTICE 10 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 as your own contractor to construct a new home or make a substantial improvement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and concems.
lEmJllllll!)yer JRe~JllImn~nJ]}nllntne~
You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if
you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the
construction or improvement of a residential structure. As the employer, you must comply with the following:
Oregon's WIthholding Tax Law: As an employer, you must withhold income taxes from employee 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 503-378-4988.
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes
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.or.us/formsoav.htmll for the
appl up'" ~ate forms.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation
insurance, you could be subject to penalties and be liable for all claim costs if one of 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. Internal R.evenue Service: As an employer, you must withhold federal income tax from employees' wagei'--.
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 \"VlW.irS.!!ov.
O~lhl.lell" IReSjploII1ls1i]))1ill1i~1ies amll All"eas olT COIIn<eeIl"ImS
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.
LiailiHty 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.
TIme: Make sure you have sufficient time to supervise your employees.
lEl1pert1se: 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 havc 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 Fiftb Street
Springfield, Oregon 97477
541-726-3759 Pbone
"'~AJNOF1"'" ,
. ............9... '..
Wit,'
. ,
" c~ ~
,~.,.._'.._{
",-,-.'-'.,.-.. ..-'"
Ci~f Springfield Official Receipt
D.opment Services Department
Public Works Department
Job/Journal Number
COM2006-0 1519
COM2006-0 1519
COM2006-0 1519
COM2006-0 1519
COM2006-0 1519
Payments:
Type of Payment
Check
cRccciot 1
RECEIPT #:
1200600000000001701
Date: 11/30/2006
Description
+ 5% Technology Fee.
+ 8% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Paid By
DIANE DANIELS
Item Total:
<":heck Number Authorization
Received By Batch Number Number How Received
djb
4063
In Person
Payment Total:
Page I of I
8:58:44AM
Amount Due
2.25
3.60
4.50
43.00
2.00
$55.35
Amount Paid
$55.35
$55.35
11/30/2006