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Home My WebLink AboutPermit Electrical 2005-2-25 Status Issued 225 Fifth' Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line -e . CITY 01< ~rKlNuNJl.,L.1J Building/Combination Permit PERMIT NO: COM2005-00235 ISSUED: 02/25/2005 APPLIED: 02125/2005 EXPIRES: 08/25/2005 VALUE: * SITE ADDRESS: 967 LONG RIDGE DR ASSESSOR'S PARCEL NO.: 1802061411200 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Install service at shop TYPE OF USE: New Residential Owner: JAMES MANSON Address: 967 LONG RIDGE DR SPRINGFIELD OR 97478 Contractor Type Electrical I CONTRACTOR INFORMATION I Contractor OWNER License # of Units: Primary Occupancy Group: Secondary Occupancy Group: . Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description "'~":'I BUlI;DING1NFORi\,U.iioNiili~ - :'~'::~"":-;:I:1;';se rules are set forth ,-", L;(#ofStories: hOAR952-001- . "'2 OQ' Il"\~~(}f-'I--rnlln ,!, Sv - He ghl.o Structur~ the rules by '1',2'). You mc;l'yp'e1ofl}{\;li'eles 0 I hone VN m .,,= J~"te' the te ep .:alling the "..a,e.,:rype-: '.. N l lion number for RanglflI1)IjiFl Utllrly otllca Cen/9ltir;gy-lluih;332-2344) . Sprinkled Building: nla I DEVELOPMENT INFORMATION' Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: llnTII'!:. Phone Number: 541-741-3820 Expiration Date Phone Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: .1 PUBLI(NMPROY.EMENTSI:PIRE IF THE WORK AUTHORIZED UNDER THIS rSidIMJifk!:ry~:r COMMENCED OR IS ABANDBNFn FOR . ANY 180 DAY PERIOD. ownspoutsIDrams: I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Pa~e 1 of2 Value Date Calculated . . CITY OF ~rKlNljt<lJ!,LJJ Building/Combination Permit PERMIT NO: COM2005-00235 ISSUED: 02/2512005 APPLIED: 02/2512005 EXPIRES: 08/25/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project ~ Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $4.41 $63.00 2/25/05 2/25105 2/25/05 Receipt Number .1200500000000000257 1200500000000000257 1200500000000000257 Total Amount Paid $73.71 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. wiII be made the following work day. L.Renuir"tllnsn"diOl~ Electric Service: Approval required prior to utility company energizing service. 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 iuspections 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 Scringfil!ld, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-00235 COM2005-00235 COM2005-00235 Payments: Type or Payment Check 2/25/2005 . RECEIPT #: "'~RlNQI;IIILD 1Jii.-....."..-...-. . ...........-... .... ,!. . ", " I 'j -'-~' '. {, - ~ '" .., ,; ,,,t..~..,. . .. ---..'\. Jiil..ty of Springfield Official Receipt .velopment Services Department Public Works Department 1200500000000000257 Date: 02/2512005 Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Paid By JAMES MANSON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2425 In Person Payment Total: Page 1 of1 1:41:29PM Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 $73.71 . Pennit #: CoM z.' - Oc> Z ~ -) -. . . \" ../ ". ,,- - 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: Issued by: 767 Lo~<; 'J>6 12. -Lc;.e- / Date: 2-2.- J -0 )" Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constn./ction 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 1 and 2, and either box 3A or 3B: .@'l. ~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 ~B. 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. I bereby 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 oftbis form. \~JV\~ ;;>-~S-",,- \J (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 AdiilIDg a~ t1lllrr (())WIID G<eIID<errall <C!IID~rra(C~([Drr? INFORMATION 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 Legis/ature_ 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. JEmfilllloyer lRespoIIllsnlOmties 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.ofRevenue at.503-378-4988. . Unemploymeut Insurance Tax: A1; 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 W\v..v.dor.state.or.us/fonnsoav.htmll for the app~vt'.L~ate forms. Workers' Compeusation Insurance: A1; 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 W\vw.irS.QOV. Other RespollDslilblilllitlies amll A.R"eas oj[ COllDceR"IlDS Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremcnts 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 . , ., , ~ .' t' ," " ',':/ , . ~..,; ,........~ '- " ',:./_::" . ..' CITY Of S.~~tlNGFIELI?;' ORE.QO~>_. {j:-. ~;' SPRINQFIELD ~:-N 1. ',..~..",'.." . ";"'i" iii:: -. II '.' '~::.: ~ 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Caw... 'Zoo S- - n62 J \ Date 7- - z') - oS 3. IYcoMPuiitFEEiscii -'iJLE'BEt;OW.zrf'';;:;'~~>'~,~;~~~ ~ "",-'-"..".~..-.,-..,;'-"....--." "-,.,,,..,~.:..:;g;Nb.?b~~,,,,--;:,'-':,,r'-'~~':l.W.t;~~.~!.- ,~.-.j..,.. .-{ "._.,.,.f ~ ~-0 o~ :.01': ~ o~ A'S~~{~:~~I~!~~~~~~[Ji!i~~<<i~ ..,.~ ~ ""S"'6: 1000 sq. It or less &0' ~~ 9",~ "?-;., $106.00 Each additional 500 sq. w.~ ,. "'.0. '0'-1 portion thereof 'v~&' ;\ &~J~O Each Manufact'd Home or "" ~~~O'v~"'. Modular Dwelling Service or ~~ :~:& ~ Feeder . . ~ " . ~;"O'~>':l;~' > ""-;-'J';'''''/;'';li:;/ix~ '". "l..;#:""':t'<:"'.~"...r.-,,'. ;o;;;,;:;_~:.,,!,~J""-t';;...l:I'ir-"~'~.i~ B. : :~etYlc!t::?l:~~~~;~~,r~",~~~!~.I-!:t!!~!F:~ll~!,..,~~s.J~,~t:B~J~~~.tt~#ltffl~ outo I" < ciW~q~Y unity $ 63.00 b..> AliEN1\ur.: o~e~a<tlyAlttP~bE:WO"~~rtl\ $ 75.00 _talloW ru\es_a~t~r. lftb~~~ &;{)01. $125.00 )'fotiliC~~~~_~~1-001 ~\1~~f{W9 _bY $163.00 Phone/ i~ O{>. "~ay ObtOOlV&DR>~~\lI"e $375.00 / uu~uo.' the ce"te1R~IlI.~cf. nlllotilication $ 50.00 ./ canIng h ore~" Utili / number'!~~~e~ ~"refl9n~~~tl~~;s,~~OF€~d:~~ < "~~~1t 'i~:tl )\,~t ~~~ 1. (:;L6eAli(JN.OF;'i1isiAti:AfidN;;!,~,."'1<-J ~'w..;;;;;dZ~"U""-: .'k,",~,-"f. ,.~ ,r ',,.,... '_'>"'~"~"'-'-="-"" .~,~ ,..~ '(b 7 10lA..... r cL (~ btl 7 i LEGAL DESCRIPTION /8 C) 7_ ObfL{ 1/200 JOB DESCRIPTION /J1 e7EtL k c:.L--. ..-.(I Permits are non-tra~sferable and expire if lork is , not started within 180 days of issuance or if work is Suspended for 180 days. ~\::-.""'..-"-"~,..~.. "- .....- 'q .J.r'--,',. --. '"':~:-, ''-.u.-...~...::"f:'_.,; 1 ~CONFRACTOR\INSTALI!ATION:.O/llLY:; 2. ,. '~.A-'...\"" - -"" ".~..."....,,"~, "'LJ.~-,~". ~."'~ if._':",.-.-:'N:. . .....:.P<-,.,...-_ 't,"" ,,:"/"'--.:1 Electrical Contractor Address City Supervisor License N7b ' Expiration Date /' / Constr. con/umber Expiration Elate Signa~f Supervising Electrician Owners Name .....1 "tlMe.S E MA'vScJ;V Address Q/"7 J.oJt4r/dCf~ U, - - .. , City Sfr 11\ ~.\, t..w.. Phone 7 L{ ( - 3'3 2 0 OWNER lNST ALLA nON The installation is being made on property I own which is not intended for sale. lease or rent. Owners Signature: J AW\~ ection Request: 726-3769 Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps . $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. D t~B""~' "'h"'?e''?~''~'ts''~<'''''~_~~~W'''''~''~''''' .~., "'" '-F"~"" ' """""1 __ ranc ''''lrCUI ~":~"""'~''-'' i.. .'\81...1.:>:"(",..,..,,, ..'",~'''-l.'W-! "....:;,:'.'1~~"I-C,~.' 1'\..... . ~., ",.0 ",0'. o.'~" .w...,,"... ,....,0,." "0 \It!. , ...., h,"" "'-tN ' ." ~WJ1' '" ", ~ ..... .... iU\S O\Ne\V,\Aife~.&\o~ o~\Ext~nsiO'n~lTehanel " r "'" I \'\\.)t\"\ \ ,,- C\) FO\\ F\\.li\1c,QiIerOircuit Ie:. lI.BF\\'4\)Olk $ 43.00 O,,,rEacfi,\\'ddili;'nill Circuit or with . C \\I\\'il\~\.-" -0"\\' $ 3 00 Service'pI\'F.e'eder'Pennit . F\\'4'{ IOU. v' 0 Fi'~,<'\"."', '- ''',;::.--:;' -."'i:'S'''''',,''~ ,,.-,, .~i",,,,,,~""--:'f,~," "'.'-~~~':' ...('"-/':....,:'....~. '':..'T:~' '. '.l" ,:1 E. 1'.MI.sJ~II.a,,~!~!!~J~~mE~J~~,~,..:n:~tin~\i~~d);..;~.'i$lil~~I!!ti~~ Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45,00 + Surcharges 4. I'@UBTOTAEOEMOVE:;~,i{1~":;~2~.'~."W..':iI. F ~:7o'--:-iJ\"::t:II..'-'.;;'.'~F<""~'~.'1i:,7_\:"i~. >&~;"";"r'i~2':~;':'.f&:"',, --,'1 b) l{l{( b>O 73 ?!- '7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:YBuilding FonnslElectrical Pennit Application 1-D3.doc