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Home My WebLink AboutPermit Electrical 1990-9-5 .. SPRI.:ELD ~"m9.PI~C/ as subml!t9d has tho foil ",,/&rD?)f~oe',?Ill(\\SI"':l>-""tJ~~ h" , owing . pproval, not require s .:: P, as rhine!le ~. ,. L f:'l-'.:ml"; lar!d us; I .ling 225 FIFTH STREET ,Zbpitjgf:Y2.. "_'" '" ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477' Ditta::::.. ......, ~ - ~ - q C.' 0 (q q INSPECTION REQUEST: 726-3A~~ ~A City Job Number ~J OFFICE: 726-3759 orlzadSi9~;(yY.\ ,.......... ~-_COl!fLETE..FEE SCHEDULE BELOII 1. k9(:W~ OF,...;r~~ALLA.JAO..N / - <-l(.:"-I'd.) r.H 10)( U,1 X\l. d A. New Residential-Single or Multi-Family per dwelling unit. \,ri7~ ~N(J~c() Service Included: Items Cost - ~B fft~~~ 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. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular. 'Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to, 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only Sum $ 85.00 $ 15<00 $ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 c. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number Expiration Date Signature of Supervising Electrician Own(!rs Name7!l%H"'!;f//,a'rt!/J Fivn5 t.Jorrti D. Address_t/~<;O f-C(~M'WYl1 SrJ ,,' . ./ Ci ty Sf~Phone -? 1./7 Ll-L7 =? O\INER INSTALLATION The installation is being made on E. property I ~wn which is not intended for sale, lease or rent. 7;;;~ture:r;;A~' ----.u-----~;{i;;r. -----------ij/-- 5. DATE:. L;" .J.,'1tf7 "f RECEIPT II:. l~ ,_, \.Ii RECEIVED BY: ';0.., 'j.,)'o--/ 200 amps' 'or less 201 amps to 400 amps Over..401 .~0 .600 ,amps Over 600 amps or 1000 Branch Circuits New, Alteration or Extension One Circuit J Each Additional Circuit or with Service or Feeder Permi t '? $ 40.00 $ 55.00 .$ ,80.,00 volts see "B" above .' Per Panel $ 35.00 ~ .,j k $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ $ $ $ 36.00 ~~. .\ \ . t.->1 ""'.~ ~!)jL 40.00 40.00 20.00 71 ;'(ifh.y <i PJ.adi'CL , ~~50 ~Ap~~~ _~v R-~SIR.ENTIAL f'ERMIT APPLICATION Inspections: 726.3769 Otflce: 726.3759 LOT' OWNER: ADDR~<"" CITY: . BLOCK' Farn.f~ /ct i STATE: &u .- ~ C; 50/99 I JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 ---- PHONF' 7c!7 ctJ.71 ZIP' 17<{?P DESCRIBE WORK:Aib &7 ~ .t;-;~~,(j~u k::..:.......~ I!~~ A'~ ~ a- ~/ ...t-~.!.c...;,lJ"./-:-,-" 0 ~e:t.--..- . NEW REMODEL ADDITION. DEMOLl~H OTHER CONTRACTOR'S NAME GENERAl' A:d/A/1 '?'/. y. ~A"..'" ADDRESS r~) CON ST. CONTRACTOR' PHONE PLUMBING' Pl MECHANICAl' C,_ ELECTRICAl' ~~~~ . To request an Inspection, you must call 726.3769. This Is a 24 hour recording. Alllnspectlons requesled 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, REQUIRED INSPECTfoNS' ~OU9h Mechanical - p'rl~-' to cover. , ...'.,' ;~. ~Ugh Electrlc~1 - Prior to cover. , QUAD AREA: -3Q~ . OF BLDGS: \ OCCY GROUP: ?- ~ ~ \ . OF STORIES' WATER HEATER' D Temporary ElectrIc' D Site Inspectlon- To be made - after excavatlon, but prior to setting forms. [J Underslab Plumbing/Electrical I Mechanical - Prior to cover. [Xl Footing - After trenches are excavated. o Masonry - Steel location, bond .beams, grouting. / , L:::J roundatlon - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. . [2(Underlloor Plumbing/Mechanical - Prior to Insulation or decking. ~ost and Beam - Prior to floor Insulation or decking. ~oor Insulatlon - Prior to decking. D Sanitary Sewer - Prior to filling trench, ~torm Sewer - Prior to filling L:::J ~rench. 0' Water Line - Prior to filling trench. ~...6oU9h Plumbing -(~rlo~..tq' ,....., ~~vet " t.. -.,;. ;-..... ~. - OFFICE USE - LAND USE: -11\\ \' · OF UNITS: J CONSTR. TYPE: V HEAT SOURCE: RANGE: _ ., ., o Electrical Servlca - Must be approved to obt'aln permanent electrical powei. f o Fireplace - Prl~r to racing materials and framIng Insp. . .. ~ramlng - Prior to cove;;- '-. - ~ . '. , ' I ~all/Celllng In~ulatlon - PrIor to cover. I ..' -.. ". . ~wall - Prior to tapln9'. I I I o Wood Stovo - After Installation. o Insert - After f'lreplace approval and Installation ~of unit. o Curbcut & Approach - After forms are erected bllt prior to placement of concrete. o Sidewalk & Driveway - After excavation Is compietc, forms and sub.base material In place. I O Fence - When -completed. . I o Street Trees - When all r.Etqutred trees are planted. -.. -. . r: , EXPIRES " FLOOD PLAIN' ZONING CODE: illV . OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: ,-~~4 'O,' \ (~. . " I\fil Firtaf Plu"'mbing - When all Lf"-' plumbing w9rk Is complete. r\n FInal Electrical - When all '-'\J electrical work Is complete, IVl Final Mechanical - When all ~ mechanical work Is complete. m Final Building - When all ~ required Inspections have been approved and building Is . completed. i' L ',. ". " ',. ; . /j.l. 1. 1_ o Other .~ MOBILE HOME INSPECTIONS o Blocking and Set.Up - When all blocking Is complete. o Plumbing Connections - When home has been connected to water and sewer. D Electrical Connection - When blocking, set.up, and plumbing Inspections have been approved and the home Is connected to the service panel. o Final - After all required Inspections are approved and porches, skirting, decks, and venting have been Installed. Lot faces , Lot sq: ftg. Lot coverage Lol TYP. ,./' InterIor Corner Topography Total height \~,."'Gwt) n~' BUILDING PERMIT ITEM SO. FT, Panhandle Cul.de.sac X $/so. FT, = ~2.0 Main ~~d f Garage Carport Tolal Value Building Permit Fee Slale Surcharge 1<~~-+ '!. 'e Tolal Fee (A) Setbacks I PL. I HSE I GAR I N I I I S I I Iw I I I I ~~ VALUE "2Js-s,.O I - " ~I.S~r\ \5~<5() \a..~ \bl.t11 SYSTEMS DEVELOPMENT CHARGE (SDC) j4(/~ zy (B) PLUMBING PERMIT ITEM Fixtures ::? Residential Bath(s) N' Sanitary Sewer FT. Water FT. Storm Sewer FT. ~ $""a Mobile Home Plumbing Permit :2. ~4 ,,'r , Slate Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood StovellnsertlFlreplace Unit Df~'8r \~nt ... Mechanical Permit Issuance ,';ir -r , cf.r State Surcharge Total Permit , (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State SurchaTge Sidewalk It Curbcul ft Demolition State Surcharge FEE ~~ p, zs-:- 5$,C'O . 4,4D . 59.~ 5.~ J c,?" ..l9~. gQ L~O --.~ i:7t"e..- ~ Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrlcal)1 Uz [.'''1 (A, B, C, 0, and' E' Combined) (~ .0f . ,,;~: ~, ,~. /. I:: ". ~IS THE PROPOSED WORK IN ...rE:...... "HfSTORICAL DISTRICT, OR ON THE HtSTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. ACC I I I APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit Is granted on the express condition that the said constructIon shaUl In all respects, conform to the Ordinance adopted by the Clly of Springfield, Including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon vIolation of any provisions of said ordinances. Plan Check Fee: CJ9. /3 _2-,?/7/9S Receipt Number: /h 7, -{ <fb --r,f>r::-L Date Paid: Received By: p~wed By ~~<;s DAte Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS r'< t\,g:\., I. . ..1.o~~nl -Sl, ~~.:.< ~..Ql\~ ~ .\1 ~ ~.LH<lI ""J ~, . By signature, I state and agree, that I have carefully examined the completed eppllcatlon 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 tho work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Bul/dlng Safety Division. I further certify that only contractors and employees who are In compliance with ORS 701.055 will be used on this project. I further agree to ensure that al/ 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 I II s du~ co Iructlon. X,gnatur j.. ~ Datf'l VALIDATION: \ \ Ll r 11 RECEIPT NUMBER ' ~ \V DATE PAID -U -::z.,.'G~ ') . , AMOUNT RECEIYEf\ '~'Yn5is1. I (~f5!;; RECEIVED BY 'fT'\~ , .. '-... .- - . Permit #: tl. ~\<:J..fl\ Address: 42>..ffi P\r\ ~o yY7 1 / Issued b~Th _) Date: ~c:; Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered 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 registration 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. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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 pert Own~bou onstructi Responsibilities on the reverse side of this form. /-~, j"/5--YS (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) .... . ./ . . "-... .,. . ~ I . ][nformation Notice to Property Owners . t ~bout C~nstru,ction Responsibilities _. ; \0.. ~ _ . Note:" This Information Notice t~ Property Owners about Construction Responsibilities . . .. \ ~, ,. ~ ,'... -" '. wa~ developed by the Constrtlction'Colltractors Board in accordance with ORS 701.055(5): 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 responsibili~ies and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do. labor in constructing or assisting in the construction or i!TIprovement of a residential stru,cture, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, yO\! 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 Oregon Dept. of Revenue at 945-8091 : 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 Division at the Department of Human Resources at 378-3524. 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 may be subject to penalties and will be liable for all daimcosts if one of your employees is injured on the job: For more information, call the Workers' Compensation Division at the Department of Consumer and Bl1siness Services at 945-7888. 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 more information, call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code reql1irements that may be brought to your attention throl1gh inspections. Liability 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 overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertiseto act as your own general contractor, to coordinate the work of rou~h-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. ' , . \ '\ I, '.-'.' \ ,f,' '," If you have additional questions, write or call the Construction ContractorslBo;mfWo Box '14140, Salem,\0R 91309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94 AITACHMENT Bl . liB NO. 9'5~6/9"? CITY OF SPRINGFIELD SYSTEMS DEVELOPME~CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NPJ1E OR COMPANY: ~;, ~ )b'~ J LOCATION: 4'5~'O ~~ 5/'. DEVELOPMENT TYPE:_~ / ~ ,wv.,,'. .f.uf..-. .7. ~ r ) . tOT SIZE' BUILDING SIZE: 1M;) 1 1. ~TnRM nRAIN~ IMPERVIOUS SQ. FT. '} I?f 2. SANITARY SFWFR-CITY NO. OF PFU'S . 1 (See Reverse) 3. TRANSpnRTATTnN. SQ. Ft. X $0.209 PER SQ. FT. C'f ?O~ X $43.26 PER PFU .,~o~ NO OF UNITS X TRIP RATE X COST PER TRIP ~ X X $436,19 / c.~) X X $436.19 X $436,19 $ X $ SUBTOTAL (ADD ITEMS 1.2. & 3) s ~ ?'5.o'l? 4. SANITARY SFWF~-MWMC NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN.FEE (Use PFU Total From Item 2 Above) $ MWMC CREDIT IF APPLICABLE (SEE REVERSE) IQIAI -MWMr.'snc SUBTOTAL (ADD ITEMS 1,2.3 & 4) __ tf/i~o/),e.t $- -i. . ~1 -,-- ) $ J 8:1. "S: 5. ADMINISTATIVF FFFS -- B^:~GE (S~B;YTAL ~OVEl X .05 ~ #~0V' Date: ;2.-.23-7;) / Mary HQrnig. P.E. SDf-cOOrdinator ~9'./s) IQIAI Snr; $ -f02.23 B2.SDC fiXTURE UNIT CALCULilON TABLE: Number of New FieS X Unit Equivalent = Fixture Units (NOTE: For remodels, calculate onl Nfl additional fixtures) . NUMBER OF UNIT FIXTURE FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS Bathtub..................................................................... . Drinking Fountain.... ......... ........ ..... ...... ....... ....... ... "" Floor Drain..............................,.................................. Interceptors For Grease/Oil/Solids/Etc................. Interceptors For Sand/Auto Wash/Etc.................. Laundry Tub/Clotheswasher .......... ........ .....,........... Clotheswasher - 3 Or More..............................."'... , . . . Mobile Home Park Trap (1 Per Trailer).................. Receptor For Refrigerator/Water Station/Etc........ Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall...............,.......,..,.................,..... Shower, Gang..... ..........................................,.......... Sink: Bar, Commercial, Residential Kitchen........................ Urinal, Stall/Walt.:...........,.............,... ..................,.... Wash BasinlLavatory, Single.................................. Toilet, Public Installation............... ......,.................. Toilet , Private....................................................... Miscellaneous: , TAHI ",p~ $.IH.t" / I TOTAL FIXTURE UNITS 2 1 2 3 6 2 6 6 1 3 2 l/Head 2 2 1 6 4 ~ = z I 4 ':f CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table, calculate credits separates. I Year Rate per $1.000 Annexed Assessed Value I 1979 or before $3.46 1980 3.38 1981 3.32 II 1982 3.21 1983 3.06 1984 2.92 1985 - 2.73 Year Annexed 1985 1986 1987 1988 1989 1990 1991 1993 )1__ Credit for Parcel or Land Only If Applicable X $ (Rate X Assessed Value) X $ (Rate X Assessed Value) Improvement (if after annexation date) = = Rate per $1,000 Assessed Value $2.46 2.14 1.77 1.37 0.97 0.61 0.44 0.15 CREDIT TOTAL = $