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Home My WebLink AboutPermit Electrical 2008-3-14 ZON \ A J INITIALS - ~ f'-'" _ DATE ~-\\.f"'" U ( r SOURCI!'1\ 0-::"1 , / / I -, -"- Date '> / If.( Ie tf I ( /,io/Nf,{",,\t COMPLETE FEE SCHEDVLE BEWW tr"",,' ,', ^ f< &%JT'\tM~~ '" ' , 225 FIYfH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEl.,l KlCAL PERMIT APPLICATION City Job Number (:OVl/f e.~6 g - 0 0 :> S )"'" 1. LOCATION OF INSTATi:ATION:.~.., ' , ~".' ,"" <</Idlt' '"\ -..0&kh, /~ _ /' A 1)' e, (3 [;:J I\) :;-1 )/Y1/!~,! 71 (Jq.. ~ LEGAL DESCRIPTION J70~2.71(--s JOB DES~?UPTION Ad LAt-TEfl :;: ('"r7c..~,.-" Per~ts are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Of /0 G 2. CONTRACTOR INSTALLATlOllONLY > / ~ %", , ~ ^ "'; / Electrical Contractor Address City Phone Supervisor License Number ExpIration Da~e Constr Contr. Number EXIJI'ation Date Signature of Supervising ElectncIan 3. ~<"W"'l ", " 'f}"l'1Z! ~'f<, ~, yo >'>>>,>>)-:<<< '! "> "'i'iW <<'Ii > > >>> >~m(lMi"; ',y 11 " ~ " A. " New Residentiar;:Single or M'ulti-Famil:f'per dweUi~g unit" , (/ //~AA /)!/,y >>~~/ / -.. ';lllw~,,~,~>~l,n '" ' '/'lh~ Service Included 1000 sq. ft orIess Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $117.00 $ 2100 $55 00 /<v>> /"""'"'1'V"&::/i"<.wr;~ "" " l~ B. j Services or Feeders -lnstaIlation~ Alterations or Relocation: 'Db,/'\\ :'" ~t~>~ii~' ~ ~/ Over 600 Amps or 1000 Volts see "B" above. D. " Bra~ch Circ~i~' " '::'j:::~<::', , $ 70.00 $ 83.00 $138.00 $180 00 $413.00 $ 55 00 'L i > $ 55 00 $ 76 00 $110.00 , , ',i ,,,> '"", ",,> New Alteration or Extension Per Panel / One Circuit $ 48 00 Each AdditIonal Circuit or with 1_\. ~ -: I {S Service or Feeder Permit 7_ $ 4,00 Owners Name - j Cr' \Ill n 1 v \ ( ~ 1 D __ Address (;; I 3 [;0 r'>J :5 +- E. . ~iscellaneou~' (S~rvice/reede;:~~~ included)~E~~h"i~~tall~tion City~~prlj"0{;.f~(cl Phone !5L//-5t7-7701- Pump or rrrigation $55,00 I (j NOT'CE~ SignlOUtIinllLi '11\EWQt\\{ $55.00 OWNER INSTALLATION lHIS PERM\1-~\; ~~tl\S NOT $ 28 00 The mstaIlatIon is being made on property I own w"tfrHORIZEm.~~ . tLtfOR $ 5000 IS not mtended for sale, lease or ren~-.., COMMNWU{i).Qil~ttl ,er~,it I~~~~cti~~ Fee is $50.~0 + Surcharges O~ersSlgnature' 11' /' /~ AN,{1BQ.O~PFABOVE '''i''''', "" ~b ( _P (I j lr ) 1 '-/ I\.....(' t LCf- ";:'-:r--- 12% State Surcharge " / 10% AdmmistratIve Fee 5% Technology Fee 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts to Reco~e~ ~\feS )I~\\\\t'f ",. Ofegon a e oregon .-.h .",.-nE-til\Or'!, r'lted b:<J,,\\1 ese\to,u.,~"."" ,') ,... .. "u\eS ~~1':'i':f0lD1.V'IImt cesl""tAMeders tJ.\~\~ ntar. ",.,;:!r'dr;/~" ,','h' o\\ticat\on ce .Q.~"\ 0 thrOU.9 ~ the rules b't ~ OAR 952.-001 ~te.U\l(j€Ui~~r_~location 090. You ma)l~fuAtiPte~. Notif,cat\on o \\\og the c p~~~:>'d\~'ll.A4.\a C8 .Dat 10r \\'ilI) ,~~~ps ~" Qln\eJo\P ~ps to 600 Amps Inspection Request: 726-3769 l{B g TOTAL Shared Dnve(T )/BuIldmg Forms/ElectncaI Permit ApphcatIon 1-08 doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00355 ISSUED: 03/14/2008 APPLIED: 03/14/2008 EXPIRES: 09/14/2008 VALUE: $ 500.00 SITE ADDRESS: 613 W N ST ASSESSOR'S PARCEL NO.: 1703274301100 PROJECT DESCRIPTION: Add bath Owner: JOANN NICHOLS Address: 613 W N ST SPRINGFIELD OR 97477 Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VB Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer A vaiJable: Special Instruction: Notes: Springfield TYPE OF WORK: Bathroom TYPE OF USE: Alteration Residential Phone Number: 541-517-7704 I CONTRACTOR INFORMATION I ATTt=r~TiON: Oregon law reql!.iteeI\8lU to Expiration Date foiiow rules adopted by the Oregon Utility NotifIcatIon Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by ';'_"\";"'9 ~h" ^O"'~o. {"'"to' tho t,olorh"'QA nUlnBm)g)):m~l.tJl'll:lWKMWIIY~,-ncation \"~IIl~1 I~ l-OVU-""'-~". # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building Phone n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: # Street Trees Rqd: ~ Paved Drive Rqd: f ,\'\t. \NO~ tlot1~t COS\{j\t~ ~?'Rt. iRM\1 ,S ~Ol "n-\\S ?ER~(\~ \ \t\mER 1\'\~~l~nt\\tO fQR IPuImi~~~ w.r~,;\.. \.iU\~~ MW ~ 80 ut'\ Sidewalk Type: Downspouts/Drains: Total: Handicapped: Compact: Pa2e 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 Type of Construction Total Value of Project ~ Fee Description -Mechanical Issuance Fee- + 10% Admmistrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Amount Paid Date Paid $20.00 $15.60 $18.72 $7.80 $48.00 $8.00 $32.00 $43.00 $18.00 $98.95 $130.13 $11.45 $7.00 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 3/14/08 Total Amount Paid $458.65 I Plan Reviews I CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00355 ISSUED: 03/14/2008 APPLIED: 03/14/2008 EXPIRES: 09/14/2008 VALUE: $ 500.00 Value Date Calculated Receipt Number 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 2200800000000000326 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. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 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. Pa2e 2 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00355 ISSUED: 03/14/2008 APPLIED: 03/14/2008 EXPIRES: 09/14/2008 VALUE: $ 500.00 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. r;~~~ Owne~ or Contractors Signature Pa2e 3 of 3 3! Iii/Db Date 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 Address Penmt #: CO ~ Z-c-c::,- 8" _ 0 Q ~ S-.s- III s .1- Date: '$~~ / / b(3 [,,/ 'O~ Issued by: Statement: Info. mation Notice to Property Owners About Construction Responsibilities Note, Oregon Law, ORS 701.055(4) requzres residentzal construction permit applicants who are not , licensed wzth the Constructzon Contractors Board to sign the following statement before a budding permit can be issued. Thzs statement is requzred for residential building, electrical, mechanical and plumbing permits. Licensed archztect and engineer applicants, exempt from licenszng under ORS 701.010(7), need not submit this statement. This statement wzll be filed wzth the permzt, Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~f. ~. 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 will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. _- OR ~3B. I will be my own general contractor. In 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 immediafely 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 d~ understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /1 /1 ~/} , 0:(j--r;U&?i - IV t~ 3 / I t-( / Df) f/ - (Signature of permit applicant) (Date) (White copy to issuing agency permzt file, pink copy to applzcant) Property_owner doc 06-01-04 as Your INFORMATION NOTICE AB_OUT CONSTRUCTION Contractor? This Info/malion Notice to Property about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature, as can own contractor to construct a new home or a substantial Improvement to an eXIsting many problems by being aware of followmg responslbIhtles concerns. If you are You will, m most mstances, you use contractors not constructIOn or ruled to be an "employer" contractors you contract will be "employees" if wIth the Construction Contractors to do labor m constructmg or to aSsIst m the a reSIdentIal structure. you must comply with the following: As an you must Income taxes from employee wages at the tIme employees are You be lIable for the tax even you don't actually WIthhold the tax from your employees. For more mformatIOn, call the Department of Revenue at 503-378-4988. Tax: As an employer, you are reqmred to pay a tax for unemployment insurance purposes more informanon, calI Employment Department at 503-947-1488. Identification Number (BIN) is a for both Oregon Wlthholdmg and To file for a BIN. can 503-945-8091 or w\v\v,dor.state or us/fonnsnav.htmll for the Insurance: As an employer, you are compensatIOn .msurance for your subject to penaltIes hable call the Workers' to Oregon Workers' CompensatIOn Law, you fail to obtain workers' compensatIon costs If one of your employees IS mJured on the at the Department of Consumer and Busmess Workers' and must obtam Insurance, you could Job. more Services at 503-947-7815, Service: As an employer, you must tax payment even If you or VISIt their web Site at \"'\\'W.Irs,gQ~. federal mcome tax from employees' wages. " tax. For a Ern number, can the As for t111S that may be brought to your attentIOn you are for any faIlure to meet code Insurance: Contact your Insurance agent to see if you have adequate insurance such as over water damage pipe punctures, fire or Make sure you have su[ficaent tIme to your own to coordmate the work of rough-in can perform reqUIred mspectlOns, hmes so you Box 140, Salem, questions can the 97309-5052. (503-378-4621) or wnte the agency at PO Property- owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 COM2008-00355 Payments: Type of Payment Check cRecemtl RECEIPT #: 2200800000000000326 Date: 03/14/2008 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm AdmIn Ftxture MInimum/Adjustment PlumbIng Vent Fan MIntmum/ Adjustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend Ctrc Add, Alter, Extend Ctrc Ea Add + 5% Technology Fee + 12% State Surcharge + 10% AdmInlstrattve Fee Paid By JOANN NICHOLS Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received djb 309 In Person Payment Total: Page 1 of 1 11:47:56AM Amount Due 13013 9895 I I 45 3200 1800 700 4300 2000 4800 800 780 1872 15.60 $458.65 Amount Paid $45865 $458.65 3/14/2008