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Home My WebLink AboutPermit Electrical 2003-10-7 ," .C", C',' '" ',", ~ ,nxTGEIE['''''''~'' 12.0N',"''': oj <.: <,i! ,.. ~;'t ~<:., 0 {.,',,';'J ,,' ~ ,~;.L-.1'-ll~ .LI u,.. 0'~ ~r~ ~ i!"~~,,~~, ",,',,tjf!.~ :."~~4'-I'1'.,, r.,.-:" !""""~J I -'. ,~.r,~ '.~;' ,~,l' ~~.l ;J,,' .\~~ ... _,{,t. . ...~ :~,;-:,,-'l~t ~'~'lGI~/;~Jl.:.,';.~M. \,'~""""" "",, .... ...''1'< ; ", '.'''' , ,- .-\-.... ,,'~""" ~'. ""'~ ....."'...--~."'...'"' . .: ubmitted has the following ':g~t~, an oas quire. specific land use 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 .1~.;{S41)726-3689 Lbt'2- ELECTRICAL PERMIT APPLICATION Zoning' " ~:~~ir~;ir~;iF :o~:~~~~ LEGAL DESCRIPTION A. '[~~~,!!>.'!~iil$s,,~gl~!}V,g}.\!;~p~r'lI~~~!!,~f}Jt~li!~il 1703ZS'tZ 200 Amps or less $ 63,00 20 I Amps to 400 Amps $ 75,00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163,00 Over 1000 AmpsNolts ~~ $375,00 Reconnect Only y..~ 't$;) '(:j\. $ 50.00 C !1"T"""~x.-~~~ ~~\~~~,; ~'d" , "'i' 1"-'"'' ~*'."""'~" ,,;,,,a,~~~ . ,,'~ ellll OY. l!;.""-,\!!,,:!:ee erS~,,1!i'it".4 ",~,,'~:f%' -Wi' . ~'C'f.;\~S"'(' ~~V'~"'-~_'~--'A "'~- -'" ' ,~"\\~'fc:,~~~ 'O~~~~eration or Relocation " y,,\'O 'i'~ ~\1.~$ "t~\'R~ilJ'! less \. #"y,,(;) &..~"~~.9~~'t;s to 400 Amps ,,\J~~ 'O~ \)~ I Amps to 600 Amps ~\'{ '\ F. 0/ SesO JOB DESCRIPTION , I r b ftD 0 'Z c., /Z.u.,~ :k {1.. T ' PermitS are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. IbcomRXCrOR'rNSiA1;/J'ATJONONf'jy'] 2. ~~r~...,""k1j;l>}Fo;i-'''t~~..:.I;:u',7''<>'JO''' .....(< Electrical Contractor Address City Phone Supervisor License Number ~ey o!/ Expiration Date Constr, Contr. Number Expiration Date Signature of Supervising Electrician Owners Name ~IL ,^\Qlkur Address ::z..01L\ I_OM ,,.,,.., d AA.J-' City ~:v..i~lp,\p( Phone '74\-1,,"73 Co i -,~. " OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: --aid. /'J~iX~ InLction Request: 726-3769 I Service Included 1000 sq. ft. or less Each additional 500 sq. ft, or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106,00 $ 19.00 $50,00 !,.,....:'t',ru..;..r,_;..1:_ ,.t.'\""',;':{<:.fi"'Ii-+'~~:'i::V':')I'K.#:"\.\'~""'-'J-"~'(~"_~-~'c0..,j~s.-' ::>::-1 B. ~~tr[~~t~_9~~~~,~.lti"j'Yi!n~!.\~-!I.,!Jg&t~~t.!!~f>,,~g[~~?ti1i~~~?-;~.~ $ 50,00 $ 69,00 $100.00 Over 600 Amps or 1000 Volts see "B" above. ty;~.nr~_r;,:,l'-'t;.~;t".""'P,,4-. ~~ t~\>'tr~""~~;:~'" "" Y>r'J;,,",,,..~J1!?-'-"2Y1~,,~;:Vdi~~ D. MBliancli'Clrcults~~''''!F'c7;~.':,'!rVI1~ -tt~\fW:kiR'-''}~;~;m,~~ ",":~';;>:-ct:.~'\" * t~ 1kir~~~.- ~ ",,~ " . A"'~ '\O~" ;;;;1(\t'" .,~,:,'~ "''''."H New Alteration or Extension~tjll~o.el,r , , o.l.l\' \)\11'\', I J :> One Circuit '\a.'l'I Ie teQpfl . .p,f\ $ 43,00 ., Each Ad.'ffiQJ11iP~irsu..~~6rq)I~le S"~ n~f ' 'S :\I~~at~chi~~~jl\l.l\e Op,~.Q~~~~ ,$ 3,00 P, .~e~---<" '~'rr""'\~~;:\~""ma~~'--"' ',,,,~~,.,,,,-"""""'''j.,1l ",,'''' "'A'I"-I:n,'I."~-'.'(1i; ,'l'!~lf,,"'~!l""~' [re=, )"E"'h'I'''t.'U'''''''' '-." , ~,,,,,j'" 'ce aneou.."" ""1 ~""uen\1 ,~ac 'ns a atton" ~~\\{\C~\~~;~Q~",\j~\9.i~~e', \~e~~\<<e'3\\ =':!.a--",,^' ,.-, ->..=71 \ O~.'1'.I?&~\iftikRIR\!.I' \..~O \)\\\\\'1 .y. A\, $ 50.00 QQ9<Sigh1'0u..\llile;~~l!.,~OflQ ~?,'2..'l. $ 50.00 ~\\\~ ,,,6 0.(\' t~ Eilergy~sidential $ 25,00 ""~ (I\'e 'L'lmited f&rgy/Commercial $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.' ~~:~tq:1:~gf'6J!q:~:~~J?iljttf~ lfr;OO 7% State Surcharge -S~ Z. 10% Administrative Fee l../ou 53 crz TOTAL Shared Drive(T:YBuilding Forms/Electrical Permit Application 1..()3.doc . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01019 ISSUED: 10/07i2003 APPLIED: 10/07/2003 EXPIRES: 04/07/2004 , VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2034 LOMOND AVE ASSESSOR'S PARCEL NO.: 1703251201500 Springfield TYPE OF WORK: Heating System PROJECT DESCRIPTION: Install heat pump TYPE OF USE: Residential REQUIRED PARKING Total: 0 Handi<B~ped: c. 'i"'-.~ "''' , o.\}\€om~~ . \O~ \'3-\!l ~0 0~0~~~ 'Oe~J:}O 0(\ ~0 'i>~ 9~" \ . ,.0\0QJ_n '0'1.0 ~\}\e ('\~ . (\}W'i> I PUBLIC IMPROVEME~i\V~ g.OOV~~ .-((\t~o\}~~~ 0' \~"e~~O~~o(\ 1'" >11\;>\0 rso/f ^('o~O f'Q9~. \~0" o~,\c 'O\~~\eg.~O~~J:)\, ~~~'O\J,'Yf~o\~\\~\~ ~b.b.,\. ~o\\ ~ 9~" . I?,l!!\'nsR~,qlsmtajmr::?l'2:'2: , 01'1 -{OV 0 e0 0~0QJ ",r:/?; (\ eO. \~ ~0 .~\J 00 e'f1:.X$\~ ~ ,o~ ~ ,i\'i> '\ ,...'00 "'e(\\ (\u v Owner: MARK WALKER Address: 2034 LOMOND AVE SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER I CONTRACTOR INFORMATION I License # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATIO~ ~~ f,;)'\ # of Stories: I( '\~\ ,S ~ Height of S~~.~ ~$~ Type of~~a~ ~~~~\) VN ~~~~~ ~\)(S ~~. ~~~:ls~ ~ \~;~~~~\) ~~$, ~irD&Vil\Oi>];l"" 1 mrORMATION I '~'?-~..... ' Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: R-3 SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Pa~elof2 New Phone Number: 541-741-6736 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: Vatue Date Calculated . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01019 ISSUED: 10/07/2003 APPLIED: 10/07/2003 EXPIRES: 04/07/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~ Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $4.60 $3.22 $43.00 $3.00 10/7/03 '10/7/03 10/7/03 10/7/03 1200200000000002284 1200200000000002284 1200200000000002284 1200200000000002284 Totat Amount Paid $53.82 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. I Rl'/luirl'd Insnl'ctionsJ 1 Rough Electric: Prior to Cover 2 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 correcl, and I furlher 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. Owner or Contractors Signature Date Paee 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-01019 COM2003-01019 COM2003-01019 COM2003-01019 Payments: Type or Payment Check Wir~~.'..""~-'~''''.....'.i. ,: . , 10' \ , I -'"."",' .,;;: 1 ~' " i ..~. ,"",e' Receipt #: 1200200000000002284 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By MARK WALKER Received By djb Check Number Batch Number Authorization Number Ciiy of Springfield Official Receipt Development Services Department Public Works Departmept Date: 10/07/2003 2:20:S4PM Amount Paid Item Total: 43,00 3,00 3,22 4,60 $53.82 How Received Amount Paid In Person Payment Total: $53.82 $53.82 . . I), , , \, ,/ " " " " . 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#:COJ'l.1A-OIO\ I Address: 2 0 3 Lf LoVV'-o~ J Ave- Issued by: ~Ii: Date: 10 --07 -0..3 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 be filed with the permit. Fill in the c.yy.vy.;ate blanks and initial boxes 1 and 2, and either box' 3A or 3B: ~1. ~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 al1 subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I wil1 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 tbat I bave read and do understand tbe Information Notice to Property Owners about Construction Responsibilities on tbe reverse side of this form. --yv1w.L(/~~ t IO-?-O :.c; (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 03/1 I/03 . J, . . Acttnrrng 3l~ Y mUlIr ~wrrn Gerrnelt"31ll COlillttlt"31CttOlt"? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITiES f . . .. 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, lEmployer Responsibilities 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 !:Tom employee wages at the time employees are paid. You will be Ifable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ID number, call the Business In, formation Center at 503-986-2200. , . . .., . 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. 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 a,11 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 503-947-7~15. " U.S. Internal Revenue Service: As an employer, you must withhold federal inc~me 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 866-816-2065 or fax them at 801-620-7115. Other R~sponsibili~ies ,and Are~s of Concer~s , - Code Compliance: As the permit hold~r 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 y~l!'have sufficient time :o~upervise your employees, .__J.'"' " , Expertise: Make sure you have the skills to act as your own generaI'contractor, to coordinate the work of rough-in and finish trades, and to notifY building officials as the appropriate times so they can peiform 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 03/11/03