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HomeMy WebLinkAboutPermit Electrical 2004-10-21 225 FiFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-368~ _ ~ ELECTRICAL PERMIT APPUCATION -5 <>'" '" <>' <0 . C1.i~ ;;;;~:;;~~:i;~:~~. . ~_~~le_,._.~L~,~./.~~~\.\.~?:\::_ ~~d.7,_~~~~ _,"~f~ 3. .COMPI:,E71EEEEiSqmD' '0 L~~~~C~~~~ 12.0 ~ m~~~~~~:-: l ~ o"Z r-", c,... I'?". 0 '1ID f Service Included JOB DESCRIPTION ~I fl. ~ p~ 1000 sq. ft. or less Each additional 500 sq. ft..or +DD _ C I f'CU+-O:;; portion thereof' ,"" Pennlts are non-transferable and expire ifwork'b Each Manufacl'd Home or ;. not started within .180 days of issuance or If work is Modular Dwelling Service or S50 00 Suspended for 180 days. - / ~ . ~~J~O~~~~~ _AfS'p,j '" ~ ~ 0 (I. .Jor~~~!9'4OO Amps S 75.00 Address ~'(.c:1'-' h~ ,^.:,<:$ ~ 0 4Iil~~ 10 600 Amps S125.oo ~v..~' A' ~'\:J~ ~~\:~~\~sto 1000 Amps S163.00 Ci~ t~~~ P~'~J:',-<b<' ~o~ \)~9~~OOO AmpsIVolts S375.00 tf.~ C!l':l'lt'~-s\ ~e~,e~#'!l'?iteconnect Only . S 50.00 SupervisorLicenseNwn.~/ ~~~~<;:~~~~~,''!l,. C. ~1IDl~~~~K4.~~\&~ /' Q" ~' ~ "tA<' ,/ . ~<" V" Expiration Date ~ Constt. Contt: umber / / Expirati ./. Date lUre of Supervising Electrician Owners Name Lu iLD ::To l-i ~ 50",,", Address 7,,'11 ? .::JW;p~ 12o . Ci~ ~p Q. Phone -tJ 51'1 -tn,'{( C>/J-. OWNER INSTALLATION The installation is being made on property I own which is nol intended for sale, lease or rent. . .' o.,ets SigI!8?2~~ /K ________ /' - v Inspection Request: 726-3769 \ Installation, Alteration or Relocation 200 Amps or less S 50.00 201 Amps to 400 Amps S 69.00 40 I Amps to 600 Amps .. S 1,RQ-00 .. ' .~<:::,'0~ ~~~..~~~_.I.~.:.~::;~~~b~.e,\'~~'...,.~~~ D..~Il~~~.r.~g.l.~~~?~~~~~' . ", l~~ " . E . Re~<l..'<:. ~_?:-~ " " New.Alterationor xtenslon #'l'~"'" ~<.c.,v One Circuit . ~'v <<;. '\~S ,(;\'\5 S 43.00' Each Additional CircuiH>!'~th(- ~- " 0... Service or Feed'ej.P~I'~~'V'" f.> ~ S 3.00 V E ~. ~~:.~_~.~Lt"'il'I"'1i'!F.i')'o/~~Ii"'TJ!:P.tiill"'.~. . J.msceuan,~~,~,'." ~~-k;~.~",Ll!E~~>;J:~,~~~!.~A . .""~ *~'<;n.<;:''\) . S5000 Pump or 1I1'Jga~'l9'. ""OJ . Sign/Outline Lighp) . S 50.00 Limited EnergylResidential S 25.00 Limited Energy/Commercial S 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~':;~;;;TAL"'OF14BOVE""~ '~;<' c i' '..:>.o._.-...~.".,...."".._.,-;;:;-mlt.o..i!ii.'il"_"""~"'~"'~~ ... "b ~~=ot: ;:.o.,-"~~.;i;'"''Ii'-,=='~~1''''''' .,..., '" -. ~.. 7% State Surcharge 10% Administrative Fee Sbf '6/0 9Lf?2. TOTAL Shared Drive(T:YBuildinJf: Forms/Electrical Permit Applicntion 1~3.doc . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01312 ISSUED: 10/22/2004 APPLIED: 10/22/2004 EXPIRES: 04/22/2005 VALUE: $ 2,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3773 JASPER RD ASSESSOR'S PARCEL NO.: 1802061309701 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Alterations to existing SFR . Owner: Address: Contractor Type General Electrical Plumbing LUKE JOHNSON 3773 JASPER RD SPRINGFIELD OR 97478 '10~ \~.... _ .\teS , \\\\\" 'ft~ ,,,-3. ,,"o.u' t.,,\ \O\!F 1-r<ooTI"~6R\fNl;:"eRM'ATION I ~. . 1 ~., J , ,,~. 0 ~eu' e \J. Op..f\ - ~e':> ~. . A\'t\'v 60~ -.0'" :l\ e t\) . cOiemr~~ ~ ~et. \" :r.tO~c;;, 0\ \'r' :l\O~lcense o DoJ4 ~ CJ3~ ",\0'11 <\\eS \e\09. 2>,\\0(\ I>r.A\O(\ r;::,,\J::j'v .~ CO.. . \~e ~\,\c OW \r:p.~n.';,?J:J~ o'O\?J. ~~o\e. '\'~" ~o , o J>,.Q... 1" \,}\\\., jl,1ll)' \~\'l!"".~t\\ ~ _ftC\\e :_f~ _ :.".,?_'!J oO~\\,,~ ~\ir ~bIiiN~.rIf.ijiORMA nON" ~"06 r;o.(I'I'P' ~ "'- # of Stories: R-3 Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Phone Number: 541-514-0341 Expiration Date Phone # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENTINFORMATIoN I ~'NOW(\ "I'\ct. \..\.t'i-?I?'t. If 'Il!~PARKING "0' . Ii Sl-ll\ " ?t.B Overlay Dist:.,. Ie; ?'t.?NI \'ID't.? il-ll., J;ptJ'iOR # Street Trees ~1'r1a?lltD \} a? IS l\'OI\\'IDamndicapped: Paved Drive R4~l\t\Nlt.\'ICtD \lIIOD. Compact: % of Lot Cove,lOge:-: ,\8\) DI\"i ?E 1\\'I"i . I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: Pal!e 1 00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Bid Amount Use Bid Amount Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Building Permit Fixture Minimum/Adjustment Plumbing Perm ServlFdr 200 amps or less Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Total Amount Paid . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01312 ISSUED: 10/22/2004 APPLIED: 10/22/2004 EXPIRES: 04/22/2005 VALUE: $ 2,000.00 I Valuation Oescrintion I I IIIII $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 2,000.00 Value Date Calculated Total Value of Project $2,000.00 $2,000.00 10/22/2004 ~ Amount Paid Date Paid Receipt Number 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 1200400000000001502 $17.10 $11.97 $18.00 $45.00 $28.00 $17.00 $63.00 $18.28 $24.04 $2.12 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 10/22/04 $244.51 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. ~rptlT~ Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Pal!e 2 013 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: COM2004-01312 ISSUED: 10/22/2004 APPLIED: 10/22/2004 EXPIRES: 04/22/2005 VALUE: $ 2,000.00 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 reDiain on the site at all times during constru ion. .JJ Owner;': Contrictors Signature Paee 3 00 /0/ Z- 2- /l'i <f ( , Date I;, .' .225 FIfth Street Springfield; Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-01312 COM2004-0 1312 COM2004-01312 COM2004-0 1312 COM2004-01312 COM2004-01312 COM2004-0 1312 COM2004-01312 COM2004-0 1312 "fOM2004-01312 . ~. JiIilY of Springfield Official Receipt. .elopment Services Department Public Works Departmeut RECEIPT #: 1200400000000001502 Date: 10/22/2004 Description Building Permit Fixture Minimum! Adjustment Plumbing Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Payments: Type of Payment Paid By Check TERRY JOHNSON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 4839 In Person Payment Total: I ',.} 1) . , \',; ,,", . , 10/22/2004 Page I of I 3:02:50PM Amount Due 45.00 28.00 17.00 63.00 18.00 11.97 17.10 24.04 18.28 2.12 $244.5] Amount Paid $244.51 $244.5 ] e. . . ...... ../ ". .' . . . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Weh Address: www.cch.state.or.us permit#~-~5'Z 'R-D Date: 10/2 V<tXf " , Address: '377 S 66 ~ ""b~ Issued by: 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 the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 181 1. fS:iJ 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 ~ 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I 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. L , I hereby certify that the above information is correct and that I have read and do understand the Inf'tifD,Iation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~ L /' ~V ( {} - ""2.. C - 0 L! 'lgnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 Aclfl~~C~.~ ,Ln-~wnn G~nn~Ir~ll CC~nntIrIDd((J)Ir? INFORMATION NOYICE YO PROPERTY OWNERS V~ $\0 I ABO~ glNSTRUCTION RESPONSIBILITIES . .. NOTE: This Information Notice to Properly 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. JEmlPBoyell" ReslPoJrnsibiBities 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/formsDav.htmll for the appropriate 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 I{able 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.<!ov. OtllneJr Re!>j[Don1lslilbililllitlies 21mll AJr'e21S OJ[ COn1lCeJr'n1l!> 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. Liability and Property Damage JInsurance: 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. 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 "pp.up.;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. Property _ owner. doc 06-01-04 (:) -.i N 3J73 :J~ ?2D ~~(uJj) . ~1h'#rGG1rJ- Garage 16.0' c~r<) .-.------.~--.-----l i i ! ! ~ Covered : N Patio I I ! ! ; i ! , i (, Utility '0 l"\ , Dining ~ i C' ~ I , 13.0' CD E~~'fItJ~ c-o 00 -.J 'f.o p1c-tv12c W/l-\DOvJ -b te. @ F,LU'i/ ItJ1 f2epIAc"'u WIt!- f', ?to\>0 1\ 3l/ . /f3JADD lw,..{ .;.~ . DooTZ IrJ (hI'.:> \.Y~IoJI"lV-,{oti Ollevt.v...d. f'etv.k... LoCA.-tro"-' C'IoIH 4'toe,',,,lt/I'f ro~u,'" 6l "-,, r 6.5' ...; e' St"" ) cO 2 I tle~~I-Io 'te -" ' -- - - r 3.0 , .,,,, ,'" "'" . ~ "''''''1 ~ · "" (:) 11 I . Bath ~.;2 IJew ~ _-.i ()5,? /l,.iCl.hT FI~Il-e.,:> . " - _ _,... -kl~- IlI.s-ltl.l/cD Bath ro I ~ ::---- - - . t I '- ~ \/Jet \3hl< [ ~~. . -.. Q ~/ r ;: \i I B~droom ~.... > tJew _,,-,l (~itv \ 1 SIL)~ PrlJO .' \..:.' ~.ijo/fl) lofle. w'-teV" -t, I - k 11\~~/Il!'D to . ..1" ..... 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JOURNAL OR JOB NUMBER: 0 NAME OR COMPANY: 0 LOCATION: 0 TAX LOT NUMBER: 0 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF: 0 LOT SIZE (SF): 1 STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 0.00 I SO.31O '1 = I $0.00 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I ! I 0.00 I SO.31O I I 50% I ~ I ITEM I TOTAL - STORM DRAINAGE SDC So.OO 2. SANITARY SEWER - CITY DISCOUNT $0.00 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I I S18.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC COST PER DFU S24.04 ~ I =1 $42.32 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRJP RATE 1 x I NUMBER OF UNITS I x I COST PER TRIP x (NEW TRIP F ACTORI I 9.57 I 0 I S18.30 i 100 I B. IMPROVEMENT COST: I ADT TRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x !NEW TRIP FACTORI I 9.57 I 0 I S80.72 I 1.00 ITEM 3 TOTAL - TRANSPORTATION SDC =1 SO.OO 4. SANITARY SEWER - MWMC Igj 10 10 O~~ I~ SO.OO 1070 S24.04 11091 I 518.28 11092 _I 50.00 11093 I SO.OO ! 1094 A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I S82.03 = 50.00 11054 B. IMPROVEMENT COST: I INUMBER OF FEU's I x ICOST PER FEU I I 0 I S865.31 = 50.00 I 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) So.OO I 1054 MWMC ADMINISTRATIVE FEE SO.OO I 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = 1 SO.OO J1 SUBTOTAL (ADD ITEMS I, 2, 3, & 4) ~ 1 $42.32 ~. ADMINISTI{ATIVE FEE: I I SUBTOTAL I ADM. FEE RATE 1= CHARGE x I S42.32 I 5% I S2.12 TOTAL SANITARY ADMINISTRATION FEE: 2.12 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: SO.OO .r78 Cheryl Slaymaker 10/20/2004 TOTAL SDC CHARGES = , $44.44 PREPARED BY DATE I . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS I (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTIJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS - - BATHTUB 0 0 3 = 0 DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER / MOP SINK 0 0 3 = 0 ICLOTHESWASHER - 3 OR MORE (EAt 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRIG / WATER STATION / ETe. 0 0 1 = 0 IRECEPTOR FOR COM. SINK / DISHWASHER / ETe. 0 0 3 = 0 ISHOWER. SINGLE STALL 0 0 2 = 0 I I SHOWER. GANG (NUMBER OF HEADS\. 0 0 2 = 0 I I SINK: COMMERClAURESIDENTIAL KITCHEN 0 0 3 = 0 II I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 I SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 URINAL. STALL / WALL 0 0 5 = 0 TOILET. PUBLIC INSTALLATION 0 0 6 = 0 TOILET. PRIVATE INSTALLATION 0 0 3 = 0 ,I MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS .EDU (Equivalent Dwellinp: Unit) is a discharge equivalent to a single family dwelling unit (20 DFlfs) set at 167 gallons per day - MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE L YEAR CREDIT RATE/$I,OOO I ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 0 BEFORE 1979 $5.29 (Enter I for Yes, 2 for No) 1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 0 1980 $5.19 (Enter I for Yes, 2 for No) 1981 $5.12 BASE YEAR 1979 1982 $4.98 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) 1984 $4.63 VALUE /1000 CREDIT RATE I 1985 $4.40 $0.00 x $5.29 ~ , $0.00 I 1986 $4.07 I 1987 $3.67 CREDIT FOR IMPROVEMENT (IF AITER ANNEXATION) 1988 $3.22 VALUE/1000 CREDIT RATE 1989 $2.73 $0.00 x $5.29 0 I 1990 $2.25 I 1991 $1.80 1992 $1.59 TOTAL MWMC CREDIT = $0.00 I 1993 $1.45 1994 $1.25 1995 $1.09 1996 $0.92 1997 $0.72 1998 $0.48 1999 $0.28 2000 $0.09 2001 $0.05