HomeMy WebLinkAboutPermit Electrical 2007-2-7
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CITY OF SPRIN(~)ELD, ORE1GON
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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~
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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.
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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
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.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
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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
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.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
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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
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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.
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./........ -''{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.
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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.
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Time: Make sure you have sufficient time to supervise your employees.: . .'
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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
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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 ,
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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
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