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Home My WebLink AboutPermit Electrical 2006-7-6 S,lI":-~ w, Un-. i INITIALS IV I-A.. ~-~, DATE\-\O-~\;., '~ ~,. SOURCE ,~ 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX, (541)126-3689 ELECTRICAL PERMIT APPLICATION City,1~g~~~.,,\~ ~~'~_'~~Q~"~~ '\ _<~ _~",; ".""~.~a:,"~~~,~:~~~"_,,._,,~_,, '," 1. :"tOt5i''1fr:)N'OF,INSTALIATION-,:t. '\;,S.:d 1, ~'COMPLETE FEE SCHEDULE BELOW"^ ,:..',;< :,~,,:t ~ t;....~. ..i,o,Z.-tt:.""':".... .~,... _~~""'.. ......'.....Ic,:......:..~"'~~~....-- .N __"-~ l~.~~1".~_....,}~\.7>..~'W~,:..:..:;~:.L.t.,....:::::s_... ~......:.;:\::r;,;.,.:t.,;. ..il:"....~L;!..,.:...:..::. '.:\J:.:...~ ~ '2 3 3' /11/)) Z1/,17n Pd Owners Name M/J;;r/clIP7e-x.J Address _/ Lj ;-/) \)."/1/} n--1J_~_tfk -4!C) ( City ~,9lAl/~Phone :5:S g- -97q LEGAL DESCRIPTION ~\.D Z, 30 ';~ JOB DESCRIPTION o b 500 t&CC~ICkL- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days, '_~~ ';'-""-:~"'('{I:<.""'..)_-""-',;.~,:,.-c""- .<:,..:"~ .::.'''',~7.:~~!'':'~:-:.;'-_' 2 ; CQN.TFACTORINST.-MMT!.O['fONLl:;.; . iJ:'\ "f_"'_~'~~;':":"~="';;~".;t'~('''1....t~__-,,,~~..';.~.):t,,,,~~~..J Electrical ContractorL) I i / /\//~ ~'<- ~/~~''<.~ ,Q~<<'<JJ;.,~ '<) ~v ~- _0-' ^' ~ Pnoti,j(- .$5 :--.."v' ~""? $:)' ~' ~~-::S\:)<i:-i? ~t:J ff j$ ~ <<,<0 Supervisor License NG'mbe? ,<J:; A ~ ~~ ~ ~ V ^' .;; -~ ~ Expiration Date ~ ",,,,,"'. ~ ' " ~' ~ Constr, Contr, Number Address City Expiration Date Signature of Supervising Elecnician OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: i~~ - ..... , Inspection Request: 726-3769 ~ A, rN~~;:K~~id:iITr~PSi;~~;;M'~W~F~;,ii~~~~(~~;~m;;r;;~i;;;,- ......._-___..,~ __~~.,~~.-.......-......._.J_..~.~._.... ----...1.___ .____ .~..: _..~_____~..;.,..:;J. Service Included 1000 sq, ft. or less Each additional 500 sq, ft, or portion thereof $106,00 $ 19,00 Each Manufact'd Home or Modular Dwelling Service or Feeder " ^ 00 $50,00 (j) ~ t.J'-... r I ~ ~~r."~5':\~t, .~'~v!"-~;7"7::.:L;;'- ~:~~:::... -~".' "'~~-;,.~:::~r.~" .....,..,(-:-...,.~-, B, ;:Services or, FeeMrs ~ Tnst:ill:ition~ Allerations or Relocation:' " ~:....;.tJ~:,,:-,<,:..,\-.:>.!.,:,.::s:;..;::.t~~"l:~,.~\.,Zi.. ...............j~.:.\:._~~- ~;o..'~;~..J..:_I:':""".....l'''~__':'''~ .,-' $ 63,00 $ 75,00 $125,00 $163,00 200 Amps or less 201 Amps to 400 ~ps 40 I Amps to 600,:Ainp~ is' ~v ~ 0-: " 60 I Amps to IJlOO,),:mps <:;,<:;, ,"" .~ f"" ,'C ~ v Over 1000Qb)np}hV~I~~ .,."IQ'" IQ $375,00 Reconnect,061y ,,'If.s;- ~ ",o~,,,~ $ 50,00 ,<Ii '$'''' S'" 0' '$'''' Q, e,,'I>" ~~-,~=-"-~~-,-,,IQ<<~..-~-~ ''''-,- ~ ..,.,., ",-..,',.;.,-.............N'7, AV.",,, '.""'qJ-~_ ~'. .',.r.~~~"; '" ~~.\;, f" "et ".., C, 1i,.Temp.orarv Sel'Vlccs;,or,Feroers, '. ,.'~" . , :.:. , .'" 'c ,VI' .;, ,', "'"f8"'It*ft:.""~~-!s~'''''<!'~''''''\'I....'':''-'''_--~''' ,- " - , ,:..~"~ o 0' '" <S' oQ..o' ,;P~~ O~Installa tion~ AlferatioJj)or,Reloca tion '>;: ,'t: ,~- <:;,'0 .ii ~ >:- r>Jv ~ ,~OO~mps orJess,. r:S] r;:;"J (j) ~ ..... ('o..\.;i ,v ~Q'J Q.i_<:'5 t:- ~ 20 I Amp's;to eOOt-mps ~ 0 ~"'V<r,v~""(,.... '" (!! ~401~Amps to 600'Amps ~ ~ $" .4.0'" ~ ~.... rt- ~o ~CZ!v~~~:~~~ 1000 V~ts,!~~~!~.~~~e" , __,_,___~ 'D ~B" ~""'-'~', 1i'""C' 'A~ '~t ""1,V':';i".~J'rif\;,';,"!' ~. ',: "'';','--..r,% '~~l'-t:;':t" 1(::"',-,\ , 'j, .11$'1 ra~c '..JrC~Il_S\~~~".,~.." l',','( ", ,. '('(,'."ll \'.".:...... ,"-'~.I'r,'" " ..........~-~......I ,_~.......~~... -~.-;.--..._-,......~:'----...- ~ , New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Pennit $ 50,00 $ 69,00 $100,00 $ 43,00 $ 3,00 .-'f~ ; _',," ",,,",,,:Y~.f,-~- ~'-_-"-::-:--,"t-:- '.........'. '-;:-:'::::"':~""-:~ ',,"~'- "~'-_... ...."..-.1 E. ,t\11~celi;iieolis.{Ser\'ice/f~ed'er .iot in'cluded'(-Each h.~iallaiion" ,~,.._.t..... ,,.. -,' '''.-'.,. "'.:.0._-:.1:._ __-'_~._,_..:::.._"';'.";:""._;...:.:__-;..~-,_... ....._-~~_.J, Pump or inigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fcc is $45,00 + Surcharges """~~~~I-"tr--~,-<{)---~~-..--. -:-..........,.~~. ".......--.~ 4, ~"srJBfOiAi'bFABOVE:>: 'r~';:_:,' :::; r~ W I.:t.;..::..~'.\.:,,-...;~~.~~. -=-.~ .:,~~~ .: .._'_ ' " ~ ...;.....( PI ()\.. \' "- 8% State Surcharge ~,OO 10% Administrative Fee 5. 00 "'5~ ,oB TOTAL Shared Drive(T:)/Building FonnslElectrical Pennit Application 1-Q6.doc I)'l \, .: ". ,,' ", .," . . Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web ,Address: www.ccb.state.or.us Permit #: CP~ As - () \ 0 IS Issued by: ~2-~'CJ -.A 'N\'? (N't:>()<;;ttz..l~L A"~. Date: 'l - (;, - O~ Address: 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 requiredfor 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 will reside in the completed structure, 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 will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board, ~ OR ~ 3B, I will be my own general contractor. IfI 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 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 oftbis form, f0/;~,dA/1/'- '(Slgnature..6f permit applicant) 1/ ~~t (White copy to issuing agency permit file, pink copy to applicant.) Property_owner,doc 06-01-04 . ,- . Adnnng ~~ fiUllll" OWlill Gelill(ell"~lC({J)nntll"~c~l!DIl"'l' INFORI\IiATIONNOTICE-TO PROPERTY OWNERS ABOUT CONSTRl!CrION 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, JEmplloyer 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 impr?vement 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.or.us/formsnav.htmll for the app.luj-Il;ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cvwp~..sation insurance for your employees, If you fail to obtain workers' compensation insuran~e, 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, OtllBer JRespoBlsfibmdes 2111ld Areas of iColllcems 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, "'. I Liability and Property Damage Insura'nce: 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 yoli have sufficient time to supervise your employees, Expertise: Make sure you have the skills to act as y~ur o~ general contractor, to coordinate'the work of rough-in and finish trades, and to notifY building officials as the app' VI" ;ate 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_owneLdoc 06-01-04 . . CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2005-0I015 ISSUED: 07/06/2006 APPLIED: 07/28/2005 EXPIRES: 01106/2007 VALUE: $ 14,250,00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3238 INDUSTRIAL AVE ASSESSOR'S PARCEL NO,: 1702303406500 Springfield TYPE OF WORK: Manufactured Home ou Private Lot New Residential PROJECT DESCRIPTION: TYPE OF USE: Replace Manufactured home on private lot Owner: LARELLE GRANT Address: 455 ALEXANDER LOOP APT 149 EUGENE OR 97401 Phone Numher: 541-485-1998 \ .~" '~.... r CONTRA0TOR INFORMA nON I ""'~ ~\,). ,-f.<... -'<; Contractor ,(,. ,\":,,\ ~ y... DON FAIRCHILD GONCREl'&INC OWNER v{3.<<-~~0~,,-'V' RONALD N ~I,..OE!.HN~<;)~ 94324 ,-0 10/13/2007 OWNER c...y:-'?' ~<.:~ ...''(y ,~,:v~,;,~-'l, is' ~'''~:~'* \:; .::::,""~,<- '(.) l"'BUILDlNG INFORMATION I J'Q,~<::- -"'Q,....-;<;)<;) '-0-\ ~~ ~'<; ~1f. <v<;) ~"-~' ~ \'li O\'li ~Q,o- OJ") ~Q,'" Q, # of Units, '\ '\'\~~"0{S "",'<i:<-r::.J I::' ' # of Stories, ,'Ii "$'Q, ~I? O~(;ot'Sizef', 0<::- Primary Occupancy Group::' _,,~ ,.,<R\'j Height of Structure ....0<::-,'<:)-\ n\-S~ .sirF61'~t'Floor: ... <",,-~'\J- (JVJ r."lo S'{,J ~ O. ,.,., .....,"" Secondary Occupancy Groupy- ~ '\ Type of Heat: ~rs'ed ~1,\E!lectric, Q,'" ~9'FtJnd Floor: Primary Construction Type <f" VN Water Type: 0:<1-' Oo"<n\' Eh;~ricQ' ".:Sq.Ft'Basement: ~ 'li ~'(J ",v ~I ~'(J .~,"'I 0-"" Secondary Construction Type: Range Type:~ nC:- n<::- rlElectric,,-O"q,F.tGarage/Carport -'" ~..... (;VJ ,iv ~V' ~ '-':1' I # of Bedrooms: , 3 Euergy ~~th:.,\-S ~ <J() & 0\' q?<::- ~9'Ft Other: Sprinkled l!und!it~:0'l: ",,1>-\ Q,iilitJ'li <o\30ccupant Load: '\.0 ....,V: _~ .,' G '" ,,~ I DEVELOPMENT,;iNFORMA:iioN:iio\? '" ~- ~..... ~. lOr IS O'li ~ CJ Overlay Dist: ~~ # Street Trees Rqd: Paved Drive Rqd: , % of Lot Coverage: License 24425 Expiration Date 04/29/2010 Phone 541-747-8381 Contractor Type General Electrical Manuf Home Inst Plumbing 541-343-5966 1,536 Fronlyard Sethack: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 24,00 8,00 28,00 15,00 5,00 2 Yes 23.90 REQUIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Availahle: Special Instruction: ACMat Yes Sidewalk Type: DownspoutslDrains: To Storm Sewer Notes: Storm drainage piped to storm system 7/29/2005 CAS Paee I of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line, Description Tvpe of Construction Foundation Onlv Use Bid Amount Manuf Home Manufactured Home Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Foundation Permit Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Placement Manufactured Home Service Plan Review Major - Planning Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin' Storm Drainage Impervious Area + 10% Administrative Fee + 8% State Surcharge Manufactured Home Service Total Amount Paid I nitial Review 07/29/2005 Plannine Review 07/29/2005 Plan nine Review 08/0212005 . I Valuation Descriotion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 1,300,00 12,950,00 Total Value of Project Fpp<. PIUU Amount Paid Date Paid $29,25 $30,00 $21.00 $45,00 $30,00 $45,00 $160,00 $50,00 $150,00 $57.21 $75,21 $18,83 $244,19 $5,00 $4,00 $50,00 7/28/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 8/5/05 7/6/06 7/6/06 7/6/06 $1,014,69 I Plan Reviews I 07/29/2005 APP LLH 08/0212005 WE ' T AJ 08/0212005 APP TAJ Paee 2 of3 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01015 ISSUED: 07/06/2006 APPLIED: 07/28/2005 EXPIRES: 01106/2007 VALUE: $ 14,250.00 Value Date Calculated , $1,300,00 $12,950,00 $14.250,00 07/28/2005 07/29/2005 Receipt Number 1200500000000001110 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200500000000001054 2200600000000000935 2200600000000000935 2200600000000000935 WiIlamalane SDC & Addressing fee not charged, This, is a replacement home Site plan not to scale and no setbacks shown, Called Don Fairchild Contractor and left a message 8/2, I can't process the permit without this information, 1. This is Lot 3 of MS-134, 2, Provide)2 sf of storage area, 3, Provide 2 off street parking spaces, ,the first 18' needs to be paved unless Industrial is not a curb and gutter street. . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01015 ISSUED: 07/06/2006 APPLIED: 07/28/2005 EXPIRES: 01/06/2007 VALUE: $ 14,250.00 Status Issued 225 Fifth Street, Springfield. OR 541-726.3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Public Works Review 07/29/2005 07/2912005 APP CAS Storm drainage piped to storm system 7/29/2005 CAS Standard M,H, Only comments, Structural Review 07/29/2005 08/02/2005 APP DLM 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 Rel1uired Insnec~ Foundation: After forms are erected but prior to concrete placement, Manuf Home Set Up: When installation of all piers or stands is complete, Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks. venting, street address numbers, trees. driveway, etc, have been installed, Manuf Home Plumbing: After home has been connected to water and sewer, By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 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 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, ~JJ/;1I!tt/),A / Owner or Contractors Signature 1/ 11/ ! 6 0 / I ~/ ' Date ' Paee 3 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone .iiL~ <aof Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2005-0 I 0 15 COM2005-01015 COM2005-0 I 0 15 Payments: Type of Payment Check cReceintl RECEIPT #: Description Manufactured Home Service + 8% State Surcharge + 10% Administrative Fee Paid By BOOKEEPERS UNLIMITED 2200600000000000935 Date: 07/06/2006 Item Total, Check Number Authorization Received By Batch Number Number How Received jmp 5433 In Person Payment Tolal: Page I of I 3: II: 14PM Amount Due 50,00 4,00 5,00 $59,00 Amount Paid $59,00 $59,00 7/6/2006