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Home My WebLink AboutPermit Electrical 2007-5-24 s~aFl.-: iij '" l.D?,- lBt" .' INITIALS - I" I . \ . ~ DATE ';5- 0I4-u1 I'AJV SOURCE Nl S. Dale 5 ~ ';;) <-f - 2:.CJD 7 " 225 FIFTH STREET' SPRINGFIELD, OR 97477 , PH:(541).726-3753 'FAX: (541)726-3689 ELECTRIC4 PERMIT APPliCATION City Job Number tJ:J{r.t,C(1)5 - 0 I 4 L} 5 New Alteration or Extension Per Panel Jl:rr~qll'l'Ri:fI'.iDregon law requires you tv $ 43.00 . ' 'Ei'cllft.;dditisnal>G.iJ;9yitbewitli3gon IJ.II1IlY Q ......--: /.1/1 /J 10\lO~seWlce..frt.:e~~"'I'fennii rules ar" ,,<>lSfor' $ 3.00 ( Owners Name '- ) AI"'\. e.$ r ( et? &0 r \)otillcatl~~~t:l1~:OO1~~h;;U9P:o~~~~pr ' 'c' "....,,..,..- ;cr,~ Address A, C"/"z L .... .I~o' J -"'A' " /" o./) . ,n O'E'3 ~tiscenaIieoUs'I.(ser.\'iCe'feede!i~tiJichide~) -:,Each ,Installation',' t'i) r-rff::> ~ <"'"' "e ,.- aORQ y~ml>Y,lJUU:l,l."-lo'."Lv",-""~"""'- '..... --"'--' - ,. ,. " f' / II ,- '. "Ih.. ~p.nt!>r (Note: the telephone City "StO/'11u:: tI'(' dI Phone 5S13'- ~2<.. callpbm~ bt iirigi'tion"on Utility Nolifir.::Ilinn $ 50.00 , ./ ~um1-..,""I~r tt\B Jrp;.., . . ,. SlghlOutlme r:lgJitmg,~,,~ ".." A\ $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 . Minimnm Electric Permit Inspection Fee is $45.00 + Surcharges .-=._".y""-.:+"'.......o~,~, ..,..t,.-,'~,-,."(:;'"'.-.I\~r\-,- ,....;.---:c'J..,.......... ',..,....,. 7 .0<"71 ~.S'. UB"''''O''"u,O' 'E' 'AR' O'VE.:t"". ",. ;,,:. !.,,';;. " 2 u ~ 4. t::~_~.L.~~~,:t.~~~ .:f;.:~1;;';'i;/~t):.~.5>'t~.,<~~. .. 8% State Surcharge :5 . ft:, 0 10% Administrative Fee S. 7 " 5% Technology Fee 7. ;;) 0 it 'C6. $ ,~~'....'.t7.!'~:'O'~~.;.,1"''I"''. JI':';'.-r.- ~ ,::'ll'.~"'-""":::-";. .'1:,' . "',' ,- ~~~".., i~', '-:::,~; 1. M.qS1nQl~pg,~~.r~MnON:'fi~tir.~' 3. ,,7 '5f'Z. ? '-I- KSC;J/",u /~/P 5~(;....,r:;OI,tJ . LEGAL DESCRIPTION: G 'U'<l."l "'- JOB DESCRIPTION: I; D)~' 3 "") "'d"';)... () Zc;, 00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ,J,'-'.-:-' i'......~.~~...~c.":.~;r~~t!n~ ~~:?:rr",<" ":7i~.~ . : 'CONTRACTOR'INSTALLATIONONU,'!' 2. L.i':);....:'i:.~._,.:;..~~:~~-:~~....~~...:..:~~~..r.~.--i-i Electrical Contractor Addr~ / '. City Phone Expiration Date ~ "\ . Signature of Supervising Electrician OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~ Signature: {:/" u.-.u&///NL Inspection Request: 726-3769 ~.;o:~~'"t" W".,.!I;N,....1hl::.:;<"w.......f"'>.....~N'!~c2'P:-.~.1';""-.-tr~."".- ..~.~.,."f"...~..,-,-7' .. ~t.()M.~.gP}..l:f!::.E~!iE.P,~1!E.L.O,W{~~.Ei.c '_~ 'e~~1'...~rr.,,,..-".'.,'t "'~,.~f"-!";.r::::fJ:h'l-i~~v::;;.:~."<, ~...... ,,':;"C;;;i4"'T:'~~~ ~,~~.7 '''i~~ A. ~Jt~)y~,~~~'-~e~~!}~!S'~.~t~~~~ill.~ll~nl!~p~~s:~,~'~ ~~~g ~~i ,.,':"i~ . Service Included , 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manu fact" d Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 t,,~ ~,.;O-''t'lt:.~- n;I-t"1'''';'?-=-;;~:t').~~~..., ."1-,-'~'~~'" .' "X~a~"""''l;.'''''''~' ..-:-,,~,~,~t~t B. 'Sehices or.cFeeded'':'Installation,;Alterations'rii,Relocation: ,'.; ......~''-'-._':~,'"''',~....'. ~,;.:::~._.._,~.." "-''';;;'~1.-..'';~';',,:~''''''.i:.....:.!_....:.........;~J ~> / $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/V oilS Reconnect Only NOnCE: ro. $.]'" -:;-:..r;';::-::,"J":l-:',,'~l';-Y.,,,:-,," ';,,"":: _~':-;--"l"", .~i!'."l:"", ....-" ~,.' ;-,' -.:~~--;': T~I "J.' ora~' eIiYI~ ~e- cr ~.":;.~. ' ";"7'..~~'1.'::'.(.'",,;" ,"''''/ . ,."J"'1'!l"...,E~,,,U~~I~t:-1r-~HE>W8'RK- ---~_.__. AUTHORIZFD lINDFR THIS OC:QWT IS NOT' COIJ1Stallatiojy Alteration or Reldtiition 'fo~~~~,or \~~s.IS ABANDONED FOR $ 50.00 ANy 10'1l [jIlY p'/'i;ilnn 20 I Amps to 4UO Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 VOIlS see "B" above. n-"".-~" ~'~~_'or.-.'-'.{:~""''''''''--''f'"'r'''.~''':Wi:'.,''tt. "','r'" .....--..-:-'~'T7''''7.,.~.:-, D. ~~!1clj'~ij..~~i~:::~~.:,' ;A<~:;;~?:.,.h...' ~;:;;:; j' '~.2.~~;:l~~~~.,:.:.....I~.'L> ~{>"~ TOTAL Shared Drive(T:)/Building Fonns/Electrical Permit Application 8-06.doc 225 Fifth Street Spfingfield, Oregon 97477 541-726-3759 Phone . ~;:~.~~ .. Ua.. ~ I caof Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2005-01445 COM2005-0 1445 COM2005-0 1445 COM2005-01445 COM2005-0 1445 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Date: OS/24/2007 2200700000000000828 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JAMES MEADOR Item Total: (;heck Number Authorization Received By Batch Number Number How Received njm 034312 In Person Payment Total: Page 1 of 1 9:33:55AM Amount Due 63.00 9.00 3.60 5.76 7.20 $88.56 Amount Paid $88.56 $88.56 5/24/2007 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2005-01445 ISSUED: 10/24/2005 APPLIED: 10/14/2005 EXPIRES: 09/20/2007 VALUE: $ 25,200.00 Status use initials 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 782 LAKSONEN LOOP ASSESSOR'S PARCEL NO.: 1702352202600 Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential PROJECT DESCRIPTION: Garage Owner: JIM MEADOR Address: 377 69TH PL SPRINGFIELD OR 97478 Phone Nnmber: 541-543-6207 Contractor Type General Electrical Plumbing Contractor OWNER OWNER OWNER I CONTRACTOR INFORMATION I License 8699 Expiration Date 12/18/2010 Phone 541-747-6638 BUILDING INFORMATION I # of Units: Primary Occnpancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: . # of Bedrooms: U # of Stories: 1 Lot Size: Height of Structure: 12.00 Sq Ft 1st Floor: Type,~fLH"~!iE: Sq Ft 2nd Floor: Wate~-Jr~'PERMIT SHALL EXPIRE 1~~~tB,l!,s~l'll\nt: Range Type: ~g F.t Q~t'l\elCarport EnergY,P'a'th'1RIZED UNDER THIS PE'sij1F\ bllieh I Sprin~I~~m,~!!~F9iD OR IS fDla\NDOrOcc.[p%'t Load: 1,008 VN I DEVELOPMENT INFORMATION I REQUIRED PARKING Street Improvements: Overlay Dist: Total: # Street Trees Rqd: Handicapped, Paved Drive Rqd: Compact: % of Lot Coverage: 25.00e5 yoU ,.... N 0 egon laW re41.J\' '\'t ..~TTENiIO :. r . _.. "'" the Oregon Uti.' Y .' I PUBLIC'IMPROYEM$:;'I~~_I' hose rules :~ ;;~-oo 'V"..-- Q010thrDU9hO" Fullv Improved ,1 O~R 952-001 ~btain c~~t'r,"~~ 'fiype:ules , Yes 0090. You may (NP'Q)Vo'spo\nfrD'Rli'JW callirl\l the center. 'Utility NotificatiOn number lor the o~e~?~ ~"'?_?2M). Storm drainage piped into 12' STM south property line per Greg Ferschweiler 10/19/2005 CAS 5.00 Frontyard Setback: Side I Setback, Side 2 Setback: Rearyard Setback: Solar Setbacks: 15.00 0.00 Storm Sewer Available: Special Instruction: Setback 5' To Storm Se",er Notes: Paee I 00 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2005-01445 ISSUED: 10/24/2005 APPLIED: 10/14/2005 EXPIRES: 09/20/2007 VALUE: $ 25,200.00 use initials 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Valuation Descriotion I Description Garilee Tvpe of Construction Garaee $ Per Sq Ft or multiplier $25.00 Square Footage or Bid Amount 1,008.00 Value Date Calculated Total Value of Project $25,200.00 $25,200.00 10/14/2005 '1 Fpp< P..irIJ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $149.66 10/14/05 1200500000000001524 + 10% Administrative Fee $27.53 10/24/05 1200500000000001591 + 7% State Surcharge $19.27 10/24/05 1200500000000001591 Encroachment Permit $130.00 10/24/05' 1200500000000001591 Garage/Carport $230.25 10/24/05 1200500000000001591 Plan Review Minor - Planning $85.00 10/24/05 1200500000000001591 SDC Sanitary/Storm Admin $16.28 10/24/05 1200500000000001591 Storm Drainage Impervious Area $325.58 10/24/05 1200500000000001591 Storm Sewer - 1 st SO Feet $45.00 10/24/05 1200500000000001591 + 10% Administrative Fee $7.20 5/24/07 2200700000000000828 + 5% Technology Fee $3.60 5/24/07 2200700000000000828 + 8% State Surcharge $5.76 5/24/07 2200700000000000828 Add, Alter, Extend Circ Ea Add $9.00 5/24/07 2200700000000000828 Perm Serv/Fdr 200 amps or less $63.00 5/24/07 2200700000000000828 Total Amount Paid $1,117.13 Initial Review Plan nine Review Pnblic Works Review I Plan Reviews I 10/18/2005 10/18/2005 APP SKG 10/18/2005 10/21/2005 APP TAJ 10/18/2005 10/19/2005 APP CAS Storm drainage piped to 12' STM south property line; Encroachment permit required included form in permit packet 10/19/2005 CAS 10/18/2005 10/24/2005 APP RJB Structural Review 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. I RpnnirptjJ nsnections I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Encroachment: After item(s) have been removed to inspect condition of public right of way. Paee 2 00 . _ CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2005-0I445 ISSUED: 10/24/2005 APPLIED: 10/14/2005 EXPIRES: 09/20/2007 VALUE: $ 25,200.00 Status use initials 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. - Footing: After trenches are excavated. Slab: To be made after all inslab building service equipment, conduit piping a~d other equipment items are in place but prior to concrete. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work 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 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 ofthe 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. Owner or Contractors Signature Date Paee 3 of 3 -. . . . . . . '. .' . . . 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 Pennit #: C5 - _, 4 Lf5 U:A..,/0So s-J G1:) Lp rY"--- Date: 5 - 24..(57 Issued by. Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constroction permit applicants who.are not licensed with the Constroction 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 1 and 2, and either box 3A or 3B: ~ 1. I own, reside in, or wiIl reside in the completed structure. D 2. 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 wiIl instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR . 6 3B. I will be my own general contractor. IfI hire subcontractors, I wiIl hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I wiIl 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. .~L/ ~~.P (Signature of;lrmit applicant) (Date) } (White copy to issuing agency permit file, pink copy to applicant.) Propeny _ owner. doc 06-01-04 A(C~nIDl~' m~ 111lR~. (Q)WIDl G~IDl~IrmR C!tIrtdl(Ct@r? INFOR'MATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES 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. JEmlPRoyer Re~IPOIIl~ilOmtie~ You wi\1, 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.oLus/formsoav.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 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. On:llnelT' ResJ!lloImsnbJillnanes 2Im~ A.IT'e2S olT COIm<eell'ims 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 Insurance: 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 appropriate 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