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Home My WebLink AboutPermit Electrical 2007-2-7 ,.-~. I CITY OF SPRIN(~)ELD, ORE1GON WE~ L..QIL ~ a-~ (\1', '~ 225 F1ITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPliCATION City Job Number CO lY1 ~O 7 ~ f){) 1.3.5'- 1. I LOCATION OF INSTALLATION: c::?/t7 zs70/;: c r LEGAL DESCRIPTION: 1103 :;),3 ~~ 0 ~ ~ JOB DESCRIPTION: -2 I"J-""" ,.?-r-,I(Q../ //--Jrp()fl1r? 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. I CONTRACTOR INSTALLATION ONLY I Electrical Contractor Ad~ ~ " / Expiration Date " re of Supervising Electrician OwnersNarne (2",_ a./"v5';p~ Address ~ ,,0 70:; 7:;; ~ <,_-r- City _<5"1';/ d, /1'Y' Phone OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. !2if;;>,'V------ {' , _./'~ Inspection Request: 726.3769 ZON INITIALS' DATE SOURCE Date /2/7 /rn 3. I COMPLETE FEE SCHEDULE BELOW A, I New Residential- Single or Multi-Family per dwelling unit. ,I Service Included 1000 sq, ft, or less Each additional 500 sq. ft. or portion thereof $106,00 $ 19,00 Each Manufact'd Home or Modular Dwelling Service or Feede~ NOTICE: Tl'YplRI=4l'::THE-W0RK B. I Servic'UlcIS idiruMI \iliMtatltl?1 Xr~ratiq~ 0,1; Relocation: AUTIlOR1ZEO-tlNt)ER~TnIS-PERMI'H,:'.NU,' 200 AmptMfENCED OR IS ABANDONti!6:f6lfl 201 AmPl\Wq<StrffiW PERI on $ 75.00 401 Amps t0600 Amps $125,00 601 Amps to 1000 Amps $163,00 Over 1000 AmpsNolts $375,00 Reconnect Only $ 50,00 $50.00 c. I Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69,00 $100.00 Over 600 Amps or 1000 Volts see "B" abov~=" ,viol LU D. I Bra~PN~~~'~;lb~Q;~QOn Utility I New AW~tq'f{, rale~-a'.~f/~les are et fo11 MOtl\~ ct......,...., q,SE-001 JI..., One \.-Ii1fR952"()()1-0010th~Ug It 4t1l\,e :3 h '+-"l,{)O Each ,,t! o~fiJn~'G\)1t\tbn Copllltl ~ e - .3 Servi M'cre[M~nt.r (N,,'...,l.l'IfltES~llJ6l~e ,0/) 03"'0; ,_ ~~.Utlllty NotificatIon E. 1l\1iSco!'ll\lm~.!"1'l\1;OO"!:!l\CliiaM)-Each [nstallationl Pump or irrigation $ 50,00 , Sign/Outline Lighting $ 50,00 Limited Energy/Residential $ 25,00 Limited Energy/Commercial , $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ISUBTOTALOF.ABOVEl 4V,6V -.3, "$? 4'.(.n cY.,;W 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL .~.,~ Shared Drive(T:)IBuilding FormsfE!cctrical Pennit Application 8..Q6.doc . .CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00I35 ISSUED: 01/29/2007 APPLIED: 01/26/2007 EXPIRES: 07/29/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726.3753 Phone 541.726.3676 Fax 541.726.3769 Inspection Line SITE ADDRESS: 210 ESTATE CT ASSESSOR'S PARCEL NO.: 1703233302800 Springfield TYPE OF WORK: Heating System ATTENIIUI\j:Ur~9un JaW I tl4uIltl::. yOU.IU fo\lCllYR1l(oAA.Jswt~eay the Orego~iHt\ltial Notification Center. Those rules are set forti in OAR 952-001-0010 through OAR 952-001 0090. YOU maYPh~Ut''SF.g~m~!l oIJf'.'7If-~'Jlf~ calling the center.lfliote: the1elepilOr'ie numberforthe Oregon Utility Notification ,..._....,,_...J..... oM """ I")IJAA\ PROJECT DESCRIPTION: Install heat pump and air handler Owner: JOE JOHNSON Address: 210 ESTATE CRT SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Contractor OWNER MARSHALLS INC License Expiration Date Phone 25790 12/23/2009 541-747-7445 I BUILDING 1l',,'uK>..ATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Lot Size: Height of Structure: Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water:..!J.~: Sq Ft BI\~~I~ent: Rar{4@bf1ieE: II EXPIRE If SqlF.t1W..fll e/Carport En":ffil~~'C'RM\1 SHA ER~~"f~~th'Cl . spriR\'f'~~'I{\t\~lrUN_DE! ~~~~l'\N~60fflfl't Load: I DEVELOPl\fBMiVlj1.1f&WXT1~N-1 Am, H{f (,1.1 .- Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING R.3 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: Pa!!e I of 3 . Issued 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541-726-3676 Fax 541.726-3769 Inspection Line I Valuation D.escriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Fpp, P"W Fee Description -Mechanical Issuance Fee- + 1 0% Administrative Fee + 5% Technology Fee + 8% State Surcharge Air Handling Unit Up to 10,000 Heat Pump Minimum/Adjustment Mechanical + 1 0% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Aller, Extend Circ Ea Add Amount Paid Date Paid $10.00 $4.50 $2.25 $3.60 $8.00 $12.00 $25,00 $4,60 $2,30 $3.68 $43,00 $3,00 1/29/07 1/29/07 1/29/07 1/29/07 1/29/07 1/29/07 1/29/07 2/7/07 2/7/07 2/7/07 2/7/07 2/7/07 Total Amount Paid $121.93 Plan Reviews I . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00I35 ISSUED.: 01/29/2007 APPLIED.: 01/26/2007 EXPIRES: 07/29/2007 VALUE: Value Date Calculated Receipt Number 1200700000000000089 1200700000000000089 1200700000000000089 1200700000000000089 1200700000000000089 1200700000000000089 1200700000000000089 3200700000000000090 3200700000000000090 3200700000000000090 3200700000000000090 3200700000000000090 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. ~11~rti,nln\l 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. Paee 2 of 3 . .CITY OF ~rKJ1'l\.Jt<IELD. Building/Combination Permit PERMIT NO: COM2007-00135 ISSUED: 01129/2007 APPLIED: 01126/2007 EXPIRES: 07/29/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541.726.3769 Inspection Line By signatnre, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 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. 1 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 Paee 3 of 3 -' . . \. l "'. ..' '. .' , . . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit #: CD1Vl~~ OOI~ Address: cQln ES1-o..:/t'. (f- Issued by: ~ Date: .;r.h /0 I , I . 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 I and 2, and either box 3A or 3B: EI I. ~ 2. 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. o 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 m 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction 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. ay~ ~/Q/A~ ./........ -''{S'r:~fPermit applicant) r r(Date)' C (White copy to issuing agency permit file. pink copy to applicant.) PropertLowner.doc 06-01-04 AlCtnnn'~m~ .tlu1](Ow~ <Gennell"~n C!tll"~lCt({))ll"? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CbN~TRUCTION RESPONSIBILITIES . l,' ' 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 concerns. lEmlPnoyu lR~sJ!lloJIlsnbinitfi.es 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 Cons~ction Contractors Board to d\l,labor, in constructing or to assist in the construction or improvement of a residenti~1 structure. As tbe employer, you must comply witb tb.e following: Oregon's Witbbolding Tax Law: As 'an employer, you must withhold income taxes from employee wages at the time employces 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.usffonnsnav.htmll. for the app.avp.;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 Revenue Service: As an employer, you must withhold federal income 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 www.irs.l!ov. Other lRespo~sibmtfies and Areas of COlllcems 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 throug~ inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if yoli 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.: . .' j.. 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 app' vp' ;ate 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. c' Property_owner,doc 06-01.04 . 225.Fifth Street S~ringfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007.00 135 COM2007-00 135 COM2007.00 135 COM2007.00135 COM2007-00 135 Payments: Type of Payment Check cReceintl inillLD , . IliitT~"~-' "". J ..-'. '.' " ;. i .- . I ---.-. - # --." '- C_of Springfield Official Receipt _Iopment Services Department Public Works Department RECEIPT #: 3200700000000000090 Date: 02/07/2007 10:03:3IAM Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Amount Due 43,00 3,00 2,30 3,68 4,60 $56,58 Paid By JOE JOHNSON Item Total: Check Number Authorization Received By Batch Number Number How Received ddk 1531 In Person Payment Total: $56.58 $56.58 Amount Paid Page I of I 21712007