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Home My WebLink AboutPermit Building 2006-8-18 'sp. ~ELD ZON L'DL' '=--4 . INITIALS rJ,...; __ ,DATE ~!d.IJ~ . . c SOURCE~~\ v <J Date xIIX'I tH 3. t'"cd~jPiEiEFEirsciiEDuf:J[iiitiOlI~,~~!&J;'..' "-,,:,,,~~,'''~~.''''''~'lo'.~'>U~,;,.~llt.~~'~-L;:.,.....>:,...\..'-fN'~}:::J;='':f,~~ .. 225 FIFTH STREET. SPRINGFIELD, OR 91477 . PH:(541)126-3153 . FAX: (54])126-3689 ~::-:~~~.:!"I;!:-'1'*!'i'!:)'J,_';'.:,:;~,~,'':'"'''~<O;~ -re:t':,,::,~'1;'~;(:':.:L~..i;''''',~.'~::.;.':-it ~,-~?;;<,:".:,::u;",i{!;r."!?~~~t~~";'~~~;~~~:\~M:~~:J.;'}!~ir)~i:~l:~,; 'i,~~,,~~~r~~~~ 2 i; COIVTRACTOR INSTALIiATION ONLY,,: B.:.;;'Ser~icesor:l'eeilers'''-'.Insi:ill"ti()Ji;Alter:liiolis 'orR'eliH:a'tion:~' '1 ~lec::::;':::~::':'~','~"~;;;;;'>:~;i;e/iJe 2:'::::::t~~~:t:~;oU'~~I";~:"'M,n.",."".,:"""".;,,;::;;e,,"'-"b'''''''';'!-. L.. . ." ., ~r:on It Ity 20 I ,A:~]lS, t~11~g AWPaSet forth $ 75.00 '401 Amps to 600 Amps 001 $125.00 . .,l(jn.0l1!J11vt\n",,2- - r/n/~V(/{~.. L'jM) o~~li~'1JB~fSslQqM.Il)p..~as by $163.00 Phone 3 T~ - ~~a cen9,~~r(!gggJ!T'P"s~,Q.I~.10ne $375.00 Reconnect Only N 'f' t' $ 50 00 number for the ~,c"v" '-'''''', otllca Ion . Center is~,,ao~~~i:4~'c~""FIi~'~~" , ~~ C. +Temporarv<Ser;vlces;onFee(ters-. ".', c' ;'. . '..r.lf~ n..,~."'}I".:.o:at~\~:~.".~(lt,:.:.l...w.;;;,;,*,,i~~l:""l~o!... ~..... -' ~ t;!;;o"." ~" ,~~ ELECTRICAL PERMIT APPLICATION City Job Number OIM'ZOCb,. c:> IO'Z..~ l',', '("-'""~1"-':'~'~ "-,,. '~_~'J.d.<:.;.___; . " .:;:...\.........'~,'. ..)""'.'>(..-:....'q,~r,'.~~<'0: 1. :iLO, , GAn[:!JV,gF..!N.,STAI;P.l,rIONJi.i(il~~;':;:;i W'-g~.~:t'''''''''"'~C""--~1Ji~:r v, LEGAL DESCRIPTION 1'1031 $'Z- 'Z. If )00 JOB DESCRIPTION Tewt fJ ~L.Je-.L Permits are non.transferable and expire if work is not started within 180 days of issuance or if work is ' Suspended for 180 days. Address Po //93 RnX City C &.r1.JeJ I Supervisor License Number 2970-S /o~ t)J- L)? Constr. Contr. Number /5 9 ~ 3 7 '1- /.5 - tJ 8' Expiration Date Expiration Date Signature of Supervising Electrician (JLrP~P~ 1 Owners Name "':bON wAa.~ Address S.... \ w./I.4M.te#e:- 1': zfl( City l=-u.(,-e71If::.... Phone 7fY. S, b '7 OWNER INSTALLATION The installation is being made on properlY I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 "1,Lltfo ~~~,~~,~,,'.;~~:jt't.'.I;f.~~~r,,',fl~~l~;:<~-!~~..t>''I:'.~.;.:.!'''1.''~''N.-...~..~c:ll,i..,"'tt:r-;1f'i<,J.~~f. A. ';;.N: el;',~esid~n ti?l;': .~il:'gle.or. M ult~: Fa. mily ;Pe,:c~,vell !nii,urii t:',;{,,: ,..~<I:..__....;,~#..._~..~'IW:" .,__...<:;.14"1Kl'..'l,;.'.,r.....J~, looAo.............~.:......~...........':..'......,,,..<l(o'~ Service Included I 000 sq. ft. or less Each additional 500 sq. ft. or portion the'reof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 Installation, Alteration or Relocation 200 Amps or less I 20 I Amps to 400 Amps .401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 s-o Over 600 Amps or 1000 Volts see "BOO above. ;;' ~".'..n",',: '.;4',..~~-~~"'..;;.-:t;"""''"'';-J;!.;l>t'i!.~" ,)>;",>t'~(f,'-'l'!J!':ii:m D. i.";Bran, ch',Gir:cilits1J.,;; , ,~., ,~-t.~\~~~~~Il!r.ttffb;,:; -'-1 ",;~. ~~~~~~I~~~I(-.Alj~~?~~~~ ~....;I..:":'l~.~il;l..>~"" ..:v.',;.. '.'bi.'l.":'V'li~:';II::,:.t.....j.'=~\ll:JJo:l"~~'.~"~ " ~.\~~~ New Alteration or Extension Per Panel One Circuit _ . ..~n" $ 43.00 N01fifcK.Additional Circuirof.\wilii i\1!: "v"1 iH\s>qr'tLP.M;U~~~~~\f~\S peRMI\ IS:O $ 3.00 !\I1it.\QRI1f.R;.,.......o:.\~1l:p"!rt\I'"~N\i<QJ~~:,,,.i',..~"',..,,~..., ...,ii',~'>':""i~' ct~;~~i~~fR{;e~'~~~~~'~J~~,2~Ili~I!,;~~c.t!!ls~.:~~g~"~ I\Npump or irrigation $ 50.00 ' Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges !.:: ~,~.\I:.;.~~:..;;;t,-r.~{~j'iri'c;.'7~'.:\~.'{~.Il.J'S.:;b:~'$'{'J ;.:~~~~:~V. ;~:'l~"~ 4. ",SUBTOTALOFABOVE..~: ~i~,,,,~,,,,;>;d.~'i--:";:' ,1:i~.~_~!.r.;t-F~-:\'..;;;;.~JJal~:~;'~f';'.; ~'.:~t~.:l :~~ N~l~.~ :':: {.;'t:.:.'t so LIDO .500 Z'SO b'se . '.--- Shared Drive(T:)lBuilding Forms/Electrical Permit Application 1-G6.doc 8% State Surcharge 10% Administrative Fee Z " "Te-Cl~ ':eE TOTAL . . CITY v.. ~rI<J1~t.."It<,LD Building/Combination Permit PERMIT NO: COM2006-01025 ISSUED: 08/10/2006 APPLIED: 08/10/2006 EXPIRES: 02/17/2007 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 857 KELLY BLVD ASSESSOR'S PARCEL NO.: 1703352211500 Springfield TYPE OF WORK: Dryrot TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Dryrot repair Owner: DON WARD Address: 541 WILLAMETTE ST 214 EUGENE OR 97401 Phone Number: 541-954-5169 I CONTRACTOR INFORMATION I Contractor Type General Electrical Contractor OWNER C PERKINS ELECTRIC INC License Expiration Date Phone 159537 04/15/2008 541-895-4466 I BUILDING INFORMATION' . :,...-e5 You t ,1"__',.., 0 # of Stories:' I _, rU' ;<to(Sjz~:'ility Heigiti~of~iruct~r~r 0(,: :C. "lrGughOS?{I'!;rstt~!?,~r: Type of'Hea!j tile Ce lam COpies of ~....rFt'2i)(!tf,l~or: Watet'Type:r for lh nter. (Note: th S.q':FtIB'!.5!:,'Vent: Range Type:~enter e Oregon Uti/it e 1rSii!F.tlG.'!!age/Carport Energy Path: IS 1'800'3:12. Y N(sqlF.!JPJ,~er: Sprinkled Building: n/a 2344pccupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 VN I DEVELOPMENT INFORMATION I REQUIRED PARKING Fronlyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROY~MENTS I ..... . ..., !lV1I1 uHAL' r.VD'''''C 'r- T' AUTHORIZED UNO SiiIewalli.llype:iE WORK ER THIS PFR~~IT Ie: NOT COMMENCED OR ISDownspouts/Drains: ANY 180 DAY PERIO;.t1!\I~UUNED FOR Notes: Paee I of 3 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-0t025 ISSUED: 08/10/2006 APPLIED: 08/10/2006 EXPIRES: 02/17/2007 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuatioo Descrintion I Estimate $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 5,000.00 Value Date Calculated Description Estimate Tvpe of Construction Total Value of Project $5,000.00 $5,000.00 08/10/2006 F....., PIii,I Fee Description + 10% Administrative Fee + 8% State Surcharge Building Permit + 10% Administrative Fee + 50/0 Technology Fee + 8% State Surcharge Temp Power 200 amps or less Amount Paid Date Paid $6.84 $5.47 $68.40 $5.00 $2.50 $4.00 $50.00 8/10/06 8/10/06 8/10/06 8/18/06 8/18/06 8/18/06 8/t8/06 Receipt Number 1200600000000001238 1200600000000001238 1200600000000001238 1200600000000001295 1200600000000001295 1200600000000001295 1200600000000001295 Total Amount Paid $t42.2t 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. ~~,.,p,.tion~J Framing Inspection: Prior to cover and after aU rough in inspections have been approved. WaUlnsulation: Prior to cover. Final Building: After aU required inspections have been requested and approved and the building is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Pa2e 2 of 3 . . CITY OF ~rKll-.JGFIELD Building/Combination Permit PERMIT NO: COM2006-01025 ISSUED: 08/]0/2006 APPLIED: 08/10/2006 EXPIRES: 02/17/2007 VALUE: $ 5,000.00 225 Fifth Street, Springfield, OR 541- 726-3 753 Phone 541-726-3676 Fax 54 I -726-3769 I nspection Line By signature, I state and agree, that I bave 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 eacb 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 3 225 Fifth ~treet Springfield, Oregon 97477 541-7-26-3759 Phone · ii:~ <Aof Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2006-0 I 025 COM2006-0 I 025 COM2006-0 I 025 COM2006-0 I 025 Payments: Type of Payment CreditCard cRcceinl1 RECEIPT #: 1200600000000001295 Date: 08/18/2006 Description Temp Power 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By C PERKINS Item Total: Check Number Authorization . Received By Batch Number Number How Received djb 036903 In Person Payment Total: Page I of I 3:38:43PM Amount Due 50.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 8/1812006 . . , , I" :' . , , '~Ykr / ~ 8:/ 10;.0 I I - . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01025 ISSUED: 08/10/2006 APPLIED: 08/10/2006 EXPIRES: 02/10/2007 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 857 KELLY BLVD ASSESSOR'S PARCEL NO.: 1703352211500 Springfield TYPE OF WORK: Dryrot TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Dryrot repair Owner: DON WARD Address: 541 WILLAMETTE ST 214 EUGENE OR 97401 Phone Number: 541-954-5169 I CONTRACTOR INFORMA nON I Contractor Type General Contractor OWNER License Expiration Date Phone BUILDING INFORMA nON I .....(", ' # of Units: - '~,I'! ~01~~ \S ~C5\ Primary Occupancy Group: R-3 t.i-WRt!W~\I"!~re Secondary Occupancy GrouIMC~, "\ S\\\>.\.\. \\,1\~\ 'Offi&'aliv' Primary Construction T)Iji_L)\ \ 't.\\"'\\N \J~'V't.\\ ~iit\+\lfy-pe: ".... .. Secondary Construction T~e<;1 '? 'V\\\1't.'V r;:J~ \S ~ange Type: ' ~., # of Bedrooms: I>-\J\~ ~'t.~,,'t.\:> '?'t.\\\r;:J\Energy Path: ' "r;:J~ \ 'QlJ \:>I>-i Sprinkled Building: n/a 1"" 'I'DEVELOPMENTINFORMATION I . Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garoge/Carport Sq Ft Other: Occupont Load: REQUIRED PARKING Frontyord Setback: Side 1 Setback: Side 2 Setback: Rearyord Setback: Solar Setbocks: , OverIoy Dist: 10 # Street Tree~,'Rqll:10U.1'''' '~I '''~'_ \JII h, . OI€.~aveh~::;i.x'L~\\:)l\ rth p;rtl'J-.\\ION. dop"{~'Of.lIot CoYeJ~ge:Sel 10 O~- ol\OW lules a leI. \\,\ose tU'" 01\1'\ 952-0 \ ..~~ "en _ ,'-,~\Iah _..\00, '0'1 NOo\l\;~R95'I'PUBLic,i~I!ROV{~i~:rS1Jll\e m ",~.. l\ \J I"~-J NU\.V' . ',' Cd\\O 0090. '{O \,\e cel\lel. \,\ \Jlili\\} Noll I Sidewalk Type: a\l\n9 I 0le90n 23/1/1). c (11'oel 101 \\,\e. ~_800-332- Downspouts/Droins: nU cen\el IS Totol: Handicopped: Compoct: Street Improvements: Storm Sewer Available: SpecioI Instruction: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount VoIue Date Calculated Poee 1 of 2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01025 ISSUED: 08/10/2006 APPLIED: 08/10/2006 EXPIRES: 02/10/2007 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Estimate Estimate $1.00 5,000.00 $5,000.00 $5,000.00 08/10/2006 Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 8% State Surcharge Building Permit Amount Paid Date Paid $6.84 $5.47 $68.40 8/1 0/06 8/10/06 8/10/06 Receipt Number 1200600000000001238 1200600000000001238 1200600000000001238 Total Amount Paid $80.71 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. L-Reoui~el'tio'U . Framing Inspection: Prior to cover and after all rongh in inspections have been approved. Wall Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. 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 furtber certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be mode ohny 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 cord is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. own~t:~'l~g~aJ 8/(0/010 Dote Paee 2 of 2 225 Fifth Street Springr..ld, Oregon 97477 541'-726-3759 Phone Job/Journal Number COM2006-0 I 025 COM2006-0 I 025 COM2006-0 I 025 Payments: Type of Payment Check cReceinl1 . RECEIPT #: Description Building Permit + 8% State Surcharge + 10% Administrative Fee Paid By ADW LLC .~ Wir. . <A of Springfield Official Receipt .Iopment Services Department Public Works Department 1200600000000001238 Date: 08/10/2006 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1033 In Person Payment Total: Pa~e I of I 8:48:29AM Amount Due 68.40 5.47 6.84 S80.71 Amount Paid $80.71 S80.71 8/1 On006 -. . . \. ./ ", .' ," ,.' . 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 penmt#:QQM700h-O~ Address: 857 Kelly Boulevard Issued by: D. Bowlsbv Date: 08/10/2006 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrnction permit applicants who are not licensed With the Constrnction 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 at't',ut',;ate blanks and initial boxes I and 2, and either box 3A or 3B: jZLl. D 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. 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 IZl 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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 tbat tbe above information is correct and that I have read and do understand tbe Information Notice to Property Owners about Construction Responsibilities on tbe reverse side oftbls form. /1//;'jJJ:m,f:/.d ~ /17 /017 (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 06-0 1-04 Adnrrng ~~ INFORMATION NOTICE TO 'PROPERTY OWNERS ABOUT CONSTRUCTION 'RESPONSIBILITIES t;~Ir Owvrrn GerrneIr~n <C'rrntl:Ir~Ctl:~Ir?' NOTE: This Infonnation Notice to Property Owner.s about Construction ResponsibiHties 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. lEmpBoyer .!Respolllsibilities You will, in most instances, be ruled to be. an "employer" and the c~ntractors' you contract with will be "employees" if you use contractors not li~ensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential struCl1.!re. As the employer, you' must c!>mply with the following: .- . . . Oregon's Withholding Tax Law: As an empioyer; 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;y'ou 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 boll} Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate fonns. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cv,...,,~..sation insurance for your employees. If you fail to obtain workers' cv",,,~..sation insurance, you could be'subje'ct to penalties and'be liable for all c1a'im costs if one ofyouf employees is injured on the job. For more information, call the Workers' Cv",,,v..sation 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. lResponsibfilities allD.dI Areas of COHllCerllD.S Code Compliance: As the permit holder for this project, you are responsible for resolving any failure'to meet code requirements that may b~ brought to your attention through inspections. Liability and Property Damage Insurailce: Contact your 'insui-a~ce agent to 'see i'f 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 a"",vl',;ate times so they can perform the required inspections.