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Home My WebLink AboutPermit Electrical 2008-5-12 i ZON \M INITIALS N 1\-^- DATE _~- \ i--Og:- _ SOURCE~ Q3'~?) Date ~ S /:1,/ fJ F? 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number CoM ~ 8 - 0 06b ( 1. WCATION OF INSTALLATION: 3. COMPLETE FEE SCHEDULE BELOW ~ 0 7 7 'f ~_<;t 5/JA11JJQHtG./d oll..Cj )t!~ - - v LEGAL DESCRIPTION P ~sJA e/Jl1iAl/7DZ3.5Lf L JOB DESCRIPTION ('. el\/fl(ft L lleAf- / M J;~allf/J Permits are non-transferable and expire If work IS not started W1thm 180 days ofIssuance or If work IS Suspended for 180 days. A. New ResldentIal- Smgle or Multi-Family pel dwellmg umt. o 0 Ill( Semce Included 1000 sq ft orless Each additIOnal 500 sq ft or portIOn thereof $117 00 $ 21 00 Address NOTICE: 2 CONTRACTORINSTALLATIONT~RMIT SkAEt~M~E~rfm-InstallatIOn, AlteratIOns or Relocation: AUTHOR/ZED U~~~ WORK Electncal Contractor COMMENCED 0 t't>!l~MIT /S NOT $ 70 00 ANY 180 DAY PE 4W~~R $ 83 00 ps to 600 Amps $138 00 60 I Amps to 1000 Amps $180 00 Over 1000 AmpsN olts $413 00 Reconnect Only $ 55 00 Each Manufact'd Home or Modular Dwelling Service or Feeder $55 00 City Phone OWNER INSTALLATION InstallatIon, AlteratIon or Relocation 200 Amps or less $ 55 00 201 Amps to 400 Amps $ 76 00 401 Amps to 6-00 Amps $110 00 A~~~IbdmV\r~eSJYf)hbm-e fcOoWBW8snaQ~ by the Oregon Utility Notlflv5ltlon Center. Those rules are set forth In OAlr~~.temti891W~()M Biietl01. 009c1?Itfdilwm\, obtain copies of the rul,s by $ 48 00 ca_ 3I8IU'~hUICI(lMUtet tflCh telepn9.ne D hy Ll. J , n alJ /"' J. 1el / nu~ItJl~tDt.~""llJl1Utllrty Notlflc~tlon $ 4 00 Owners Name Dfr:..._ D^ Q-.L...L (Y vv Center IS 1-800-332-2344). Address J 0 7 7'-/ 1l.. 5"/: E. Miscellaneous (Service/feeder not mcluded) -Each Installation City 5.j2fJIXSSFI t:. kJ Phone .<"'1 / 6~ J - .8".:(06 Pump or ImgatIOn $ 55 00 Sign/Outline Lighting $ 55 00 LImited EnergylResldentIal $ 28 00 LimIted Energy/Commercial $ 50 00 MIDlmum Electnc Permit Inspection Fee IS $50.00 + Surcharges 4. SUBTOTAL OF ABOVE 52 12% State Surcharge f:> e.Cf 10% AdmmlstratlVe Fee 5'Z 0 5% Technology Fee Z6c: b6~ ~<' Supervisor License Number \ ~ r .} 1) Constr Contr Number c. Temporary Services or Feeders ExpiratIOn Date ExpIratIOn Date Signature of Supervlsmg ElectrIcian L(*O ~ 0 AtvtfJ '-\40 It mfJ The mstallatlOn IS bemg made on property I own which IS not mtended for sale, lease or rent Owners Slgljl..ature fi~ ^ _ r::~71--P~i Inspection Request. 726-3769 TOTAL Shared Dnve(T )/Bulldmg FormslElectncaJ Permit ApphcatIon 1-08 doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00661 ISSUED: 05/09/2008 APPLIED: 05/09/2008 EXPIRES: 11/12/2008 VALUE: 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 207 74TH ST ASSESSOR'S PARCEL NO. 1702354200114 Spnngfield TYPE OF WORK Heatmg System TYPE OF USE. New Residential PROJECT DESCRIPTION Heat pump & air handler Owner BADGWELL BRIAN E & ANNE M Address 207 74TH ST SPRINGFIELD OR 97478 Phone Number 541-653-8506 I CONTRACTOR INFORMATION I Contractor Type Electncal Mechamcal Contractor OWNER MARSHALLS INC License Expiration Date Phone 25790 BUILDING INFORMATION' 12/23/2009 541-747-7445 # of Stones. Height of Structure Type of Heat Water Type' Range Type Energy Path Spn~ded BUlldmg -~ fj.?\y,f:. fE ENT INFORMATION' ~O"t\ct~ ~ $\\"'\.\.. 1\\\S \' y\\'4D rO~ Frontyard ~q.t.~~ U~\)t.~ l\~\)O~t: Overlay Dlst. Side 1 SetbaR-\1\\O~\1.t.~\') O~ \S l\\) # Street Trees Rqd Side 2 Setbac~Vt'\t-..~l-J\t.~Ct: " ~t.~\O~. Paved Dnve Rqd Rearyard set&.~~ "\~O \')1\\ % of Lot Coverage Solar Setbacksl\~ # ofUmts Pnmary Occupancy Group Secondary Occupancy Group Pnmary Construction Type Secondary ConstructIOn Type # of Bedrooms VB Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Garage/Carport Sq Ft Other Occupant Load R-3 n/a REQUIRED PARKING Total Handicapped Compact. Street Improvements. Storm Sewer Avadable Special InstructIOn. I PUBLIC IMPROVEMENTS I Sidewalk Type AI I ClffiQN: Oregon law requires you to follow rul~oatMpftYds~nmeSOregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copIes of the rules by calling the center. (Note: the telephone number for the Oregon Utility NotifIcation Center is 1-800-332-2344). Notes Pal!e 1 of 3 Status Issued 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme I Valuation Descrmtion I DescrIPtIOn Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project ~ Fee DescnptIon -Mechamcal Issuance Fee- + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Air Handling Umt Up to 10,000 Heat Pump Mlmmum/ Adjustment Mechamcal + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Orc Add, Alter, Extend Clrc Ea Add Amount Paid Date Paid $20 00 $500 $6.00 $250 $9.00 $1400 $27 00 $520 $624 $260 $48 00 $400 5/9/08 5/9/08 5/9/08 5/9/08 5/9/08 5/9/08 5/9/08 5/12/08 5/12/08 5/12/08 5/12/08 5/12/08 Total Amount Paid $149 54 I Plan RevIews I CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00661 ISSUED: 05/09/2008 APPLIED: 05/09/2008 EXPIRES: 11/12/2008 VALUE: Value Date Calculated Receipt Number 2200800000000000639 2200800000000000639 2200800000000000639 2200800000000000639 2200800000000000639 2200800000000000639 2200800000000000639 2200800000000000643 2200800000000000643 2200800000000000643 2200800000000000643 2200800000000000643 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. ~eouiredJnsDections I Rough Mechamcal Pnor to Cover Fmal Mechamcal. When all mechamcal work IS complete Rough Electnc. PrIOr to Cover Fmal Electnc When all electncal work IS complete Pal!:e 2 of 3 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2008-00661 ISSUED: 05/09/2008 APPLIED: 05/09/2008 EXPIRES: 11/12/2008 VALUE: 225 FIfth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIon Lme By sIgnature, I state and agree, that I have carefully exammed the completed applIcatIon and do hereby certIfy that all mformatIon hereon IS true and correct, and I further certIfy that any and all work performed shall be done m accordance wIth the Ordmances of the CIty of SprIngfield and the Laws of the State of Oregon pertammg to the work descrIbed herem, and that NO OCCUPANCY wIll be made of any structure wIthout permIssIon of the CommuDlty ServIces DIVIsIOn, BuIldmg Safety I further certIfy that only contractors and employees who are m comphance wIth ORS 701 005 wIll be used on thIs project I further agree to ensure that all reqUIred mspectlOns are requested at the proper tIme, that each address IS readable from the street, hat the permIt card IS located at the front of the property, and the approved set of plans wIll remam on the sIte at all tIm d'urmg constructIOn ~I ~ i-?ahhA./d $--/.;;- 00' Owner or Contractors SIgnature U ( Date Pal!:e 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 Pernnt# COvvt L:--COt?- oab b f Address Z 0 7; 7 Lf +-L- j j- :-:D~ Date :S/~/09 I / Issued by , \ I \ Statement: Information Notice to Prpperty Owners About Construction Responsibilities I Note Oregon Law, ORS 701 055(4) requzres reszdentzal construc~lOn permzt applzcants who are not lzcensed wzth the ConstructlOn Contractors Board to szgn the followzng statement before a buzldzng permzt can be zssued Thzs statement zs requzred for reszdentzal bti;zldzng, electrzcal, mechamcal and plumbzng permzts Lzcensed archztect and engzneer applzcants, exempt from lzcenszng under ORS 701 010(7), need not submzt thzs statement Thzs statement wzll be filed wzth the permzt I FIll m the appropnate blanks and ImtIal boxes 1 and 2, and either box 3A lor 3B. ~1 ~ I own, reside m, or will reside m 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 mstruct my general contractor that all subcontractors who: work on the structure must be lIcensed with the ConstructIOn Contractors Board OR ?B I Wlll be my own general contractor If I lure subcontractors, I will hire only subcontractors lIcensed with the ConstructIon Contractors Board If I change my mmd and lure a general contractor, I will contract with a contractor who IS lIcensed with the CCB and wIllnnmedlately notify the office Issumg this bUIldmg 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. ()Auw~n)h,~Jl~ S--//-O? (Slgnature-o(pf'rmlt applIcant) (Date) (Whzte copy to zssuzng agency permzt file, pznk copy to applzcant) Property_owner doc 06-01-04 > ~ eneral Contractor? PROPERTY OWNERS RESPONSIBILITIES -Acting a's' Your INFORMATION NOTICE A~OUT NOTE ThiS Information Notice to Property Owners Constructlon Contractors Board In accordance With ConstructIOn Responsibilities was developed by the 701055(5), passed by the 1989 Oregon Legislature If you are actmg as your own contractor to construct a new or make a substantIal Improvement to an eXIstmg structure, you can many problems by bemg aware cfthe fol1owmg responslbIhbes and concerns Employer You WIll, m most mstances, be ruled to be an "employer" and the contractors you contract W1th WIll be "employees" If you use contractors not hcensed wlth the ConstructIOn to do labor m constructmg or to aSSIst m the constructIOn or improvement of a reSIdential structure As you must comply 'With the followiug: Oregou'!' Tax Law: As an employer, you empl.oyees are You w1l1 be habie for the tax employees For more mfonnatIOn, call the Department Withhold mcome taxes from employee wages at the time even 11 you don't actually wnhhold the tax from your at 503-378-4988 Unemployment Tax: As an employer, you are on the wages of aU employees For more mformatlon, 1 to pay a tax for unemployment msufance purposes ~ Employment Department at 503-947-1488 The Oregon Busmess IdentIficatIon Number (BIN) IS .1 Unemployment Insurance Tax To file for a BIN, can appropnate forms numb~r for_ both Oregon WIthholdmg and or WV./w dor state 01 us/fonnspav htmil for the '." '. Workers' Compensation Insurance: As an employer, are to the Oregon Workers' CompensatIOn Law, and must obtaIn workers' compensatIOn msurance for you t If you fall to obtam workers - compensatIOn mburance, you could be subject to penaltles and be hable fmf clmm costs If one of your employees IS Injured on the Job For more mfonnatIOn, can the Workers' CompensatJt)n DiVISIOn at the Department Consumer and Busmess SerVices at 503-947-7815 U.S. Internal SCJrvice: As an employer, you IT ust You will be hable the tax payment even If you dIdn't ac .uaJ1y IRS at 1-800-829-4933 or Vl'nt theIr web 1'nte at \'\<\\'\11 1J~ 20/ federal Income tax from employees' wages "'- the tax For a EIN number, call the ~ Respon~ibiiities Code Comphance: A<, the pennlt holder for thIS project, you dre respom;]ble for resolVing any faIlure to meet code reqmrements that may be brought to your attentIOn through Liabihty and Property Damage Insurance: Contact coverage for aCCIdent,> and omiSSIons such as tools, work that must be Insurance to see If you have adequate msurancc over spray. water damage from pIpe punctures, fire or " Make sure you have .;;ufficIcnt tlme to supervIse yom Expertise: Make sure you slans to act as your C'wn contractor, to coordmate the work of rough-m and fimsh trades, to notify bmldmg offiCIals as the appropnate times so they can perform reqUIred mspectIOns If you have additional que:o.t1ons call the Construction Box 14140, Salem. 97309-5052 (503-378-4621) or wnte the agency at PO Property_owner doc 06-01-04 225 Fifth Street Sprmgfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department PublIc Works Department Job/Journal Number COM2008-00661 COM2008-00661 COM2008-00661 COM2008-00661 COM2008-00661 Payments Type of Payment CredltCard cRecemtl RECEIPT #: 2200800000000000643 Date: 05/12/2008 DescriptIOn Add, Alter, Extend Clrc Add, Alter, Extend CITC Ea Add + 5% Technology Fee + 12% State Surcharge + 10% AdmlDlstratlve Fee PaId By ANNE BADGWELL Item Total Check Number AuthorizatIOn ReceIved By Batch Number Number How ReceIved dJb 031176 In Person Payment Total Page I of 1 10 40 OOAM Amount Due 4800 400 260 624 520 $66 04 Amount PaId $66 04 $66 04 51! 2/2008