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Home My WebLink AboutPermit Electrical 2008-6-13 225 FIFTII STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number eo","", Z~- Do 5" b b I LOCATION OF INSTALIATION: , tJ ,GJ3 o-z, r I o 7j'700 LEGAL DESCRIPTION 4~0~ 101 .'UyrH /r9U5t..JrAlOO,)) JOB DESCRIPTION (i;~( t'VlA'ST t [)ItGTE::nBA->E PermIts are non-transferable and expire If work IS not started wlthm 180 days of Issuance or If work .s Suspended for 180 days 2 "r,,"~- cONTRACTORINSTALIATION ONLY Electncal Contractor Address CIty Phone 1(-/ SupervIsor License Numbe\Jrfl ExprratlOn Date _ Constr Contr Number , ExprratIon Date SIgnature of Supervlsmg Electnctan Owners Name ~V lt0 6l6\2s;.{:::o~t-F Address toO \}J 'Z- -z.f-J V' AVI? City E?U 0c;?t0E Phone '"3,4 ( - e <;'-/'"3, OWNER INST ALLA TION The mstallatlOn IS bemg made on property I own whIch IS not mtended for sale, lease or rent O'f,ers SIgnature , 0N111.t7:.U-V7~J JcnA,Lli InspectIon Request 726-3769 Date r ~ ~= - 3 COMPLETE FEE SCHEDULE BEWW ,,__ _""--" ~_ J - --,. '" - A New R~sjdentJal- Smgle or Mult.:Famlly per dwellmg UUll. L __~~_ ~ M~ ~_--r~_~_ _~ _~~_~_ '--'- " __ ServIce Included 1000 sq It or less Each additIOnal 500 sq It or portIOn thereof Each Manufact'd Home or Modular Dwellmg ServICe or Feeder $11700 $2100 r/ ':))" $55 00 , , B ,Serv.ces or Feeders - InstallatIon, AlteratIons or RelocatIOn: . ,~ ~~~~_ _ _ ____ __ M TOTAL $ 70 00 $ 83 00 $13800 $18000 $4 I3 00 $ 55 00 $ 55 00 $ 76 00 $110 00 $ 48 00 $ 400 , ENJl'flle!~eous (Se~e/f~~der uot included) -E:ch Tnstlll'atIon_ IP)~fi.MlTtIWA~L EXPIRE IF THE WOfl~ 00 ~~rnll;R THIS PEI1IVlll I~ NPT500 I~f~~f~ I ~Mf\NDOt-ltU tUH $ 28 00 Imlte~ltnergy OIT QPItlal $ 50 00 Mmlmum ElectrIC Perm.t InspectIOn Fee .s $50 00 + Surcharges 4 r SUBTOTAL~OF~~~~~.~ ._.______ 5f" 12% State Surcharge b bO 10% Admmtstratlve Fee ~ S-O 5% Technology Fee 'Z.. 7r 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps A . Ov~rcJRP~hYi?t\IJ requires Yell :C , Recp.?"'1fiTS19!i'd by the Oregon Ulillt}. , -}")Jl CSI1t@I _Those rules are satfortll I 'C ',' '];cmpljlilfY! 6';1 ,,~,,~l!~llt.001.' 0,,[ J \'Oll in-ay obtain copies 01 the rufas by cd!IIIii'slt"atWlt\eAIt~iln \6,eRilil~ nUIIl'2'OI1IQUhe bf~.90n Utility Notification c;e1WBP flf f-mJO-332-2344). 20 I Amps to 400 Amps 40 I Amps to 600 Amps Over 600 Amps ~r 1000 Volts see "B" a,h,,::e _ D 'Branch C.rcUlts --'-- ~-,",-~~'-~-'---"'~- New Alterallon or ExtenSIOn Per Panel One CirCUIt Each AdditIOnal CirCUIt or With ServIce or Feeder Penrut Shared Dnve(f )/BUlldmg FonnslElectncal Penrut ApplicatIOn 1-08 doc b(sr Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00566 ISSUED' 05/09/2008 APPLIED' 04/23/2008 EXPIRES: ] 1/30/2008 VALUE' $ 13,00000 225 F.fth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fdx 541-726-3769 InspectIou Lme SITE ADDRESS 4363 E 20TH AVE ASSESSOR'S PARCEL NO 1803031102900 Eugene TYPE OF WORK Manufactured Home ou PrIvate Lot New ReSIdentIal PROJECT DESCRIPTION TYPE OF USE Manufactured Home to replace demolIshed reSidence Owner KEVIN BIERSDORFF Address 60 W 22ND AVE EUGENE OR 97405 Phoue Number 341-8513 I CONTRACTOR INFORMATION I Contractor Type General ElectrIcal Manuf Home Inst Contractor GEORGE J LEHMANN OWNER GEORGE LEHMANN License 81110 ExpiratIOn Date 03/20/2009 Phone 541-342-3201 81110 03120/2009 541-501-1699 3 BUILDING INFORNlATION I 9U\0 # of Stones etllllles ~,\l\\\\\ifot SIze HeIght ofStru~8l'1'la'tl \ Ole~Ol\ e\\O~Ft 1st Floor TYl\e \l!i'Ilelrl,e \bll~ilDh1.'f.itl~ff,El~o2..l)lIa"Ft 2nd Floor p..\W~~J\~YP'e<\~~, "(\"lOse \l~~Vtc IU1eSIjl'Ft Basement \o\\~~,l!~W~~ .00\ 0 \\"110 ?\EIS'~~~e?\"Ic9lf Ft Garage/Carport 1'-I0En%~.it~ 9tl.\~\l\ ~\e \\"IIl \e o\\\\~\'ft Other \l\0[;;.~~,/~'f<<!Il \.1'-1 \}\\\\'ilI~Il', Occupant Load ....~~6 ..""Po C -...~{'on?t t)~. I DEVEL{irNi~FI'\lirr:i,MA9ioN I . , U~r'''?' 1,188 # of UOItS PrImary Occupancy Group Secondary Occupancy Group PrImary ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms I R-3 Frontyard Setback: S.de I Setback S.de 2 Setback Rearyard Setback Solar Setbacks 1600 11 00 500 4200 500 Overlay Dlst # Street Trees Rqd Paved DrIve Rqd % of Lot Coverage REQUIRED PARKING Total 2 Hand.capped Compact 2100 Street Improvements Storm Sewer AvaIlable Specl3l InstructIOn I PUBLIC IMPROVEMENTS I ",()'r.~ . \,,'t. 'i' Q\ Sidewalk Type tI-'?\'r.'t. \r ~\\ \S ~ \\01\C~w~~t!.\b~"t~~ '?~~~t;) ~()'r. \\\\S '?~~~~\) U~~~S t>.'Ot>.\\\)Q f>,U\'ni'J\O~c~\) t>t.'r.\Qt;). CQi'J\ CO\) \)~ p..W-t'l Notes No PublIc Works .ssues Pa2e I of 3 Status Iss u ed 225 F,fth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe DescriptIOn Tvpe of Construchon FoundatIOn Onlv Use B,d Amount Manuf Home Manufactured Home Fee DeSCrIptIOn Plan RevIew Resldeuhal + 10% AdmlDlstratIve Fee + 12% State Surcharge + 5% Technology Fee FoundatIOn PermIt Manuf Home State Issuance Mauufactured Home Conn - Plmb Manufactured Home Placement Plan ReVIew Mmor - Pldnmng + 10% Admmlstrdtlve Fee + 12% State Surcharge + 5% Technology Fee Manufactured Home Service Total Amount PaId CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00566 ISSUED 05/09/2008 APPLIED' 04/23/2008 EXPIRES 11/30/2008 VALUE. $ 13,000,00 I ValuatIOn DescrIntlOn I $ Per Sq Ft or mulhpher $100 $100 Square Footage or BId Amount 3,000 00 10,000 00 Value Date Calculated Total Value of ProJect $3,000 00 $10,00000 $13,00000 04/24/2008 04/24/2008 F PP\~ P1l,ljjJ Amount PaId Date PaId ReceIpt Number $38 08 $26 86 $32 23 $19 23 $58 58 $30 00 $50 00 $16000 $11600 $550 $660 $275 $55 00 4/23/08 5/9/08 5/9/08 5/9/08 5/9108 5/9108 5/9/08 5/9/08 5/9/08 6/13/08 6/13/08 6/13/08 6/13/08 1200800000000000391 1200800000000000450 1200800000000000450 1200800000000000450 1200800000000000450 1200800000000000450 1200800000000000450 1200800000000000450 1200800000000000450 2200800000000000893 2200800000000000893 2200800000000000893 2200800000000000893 $600 83 I Plan ReVIews I Imhal Revlfw 04/24/2008 04/24/2008 APP LLH Pubhc Works ReVIew 04/24/2008 04/24/2008 APP TSS No Pubhc Works Issues No uew Impervious area Planmne ReView 04/24/2008 05/01/2008 APP TAJ Need to provIde 32 sf of enclosed outdoor storage space Structural ReVIew 04/24/2008 05/07/2008 WE DLM Need Lane Co approval for reusmg the sephc system talked to owner, he WIll provIde prIor to obtalDmg 5/8/08dlm To Request an mspection call the 24 hour recordmg at 726-3769, All mspections requested before 7:00 a.m. wIll be made the same workmg day, mspectlOns requested after 7:00 a,m, wIll be made the followmg work day. Pa2e 2 of 3 CITY OF ~rKll"\iuFIELD . Status Issued Building/Combination Permit PERMIT NO: COM2008-00566 ISSUED' 05/09/2008 APPLIED: 04/23/2008 EXPIRES' 11/30/2008 VALUE. $ 13,000.00 225 F,fth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme I ReoUlred Insnechons I Ufer ElectrIcal Ground Install ground rod at footmg and call for mspectlOn m conjunctIOn wIth footmg andlor foundation IDspectlOn. FoundatIOn After forms are erected but prIor to concrete placement Manuf Home Set Up When mstallatlOn of all pIers or stands IS complete Fmal Manuf Home Set Up After all reqUIred mspechons are requested and approved and porches, skIrtmg, decks, ventlOg, street address numbers, trees, dnveway, efe have been Installed Fmal BUlldmg After all reqUIred mspechons have been requested and approved and the bUlldmg IS complete Manuf Home Plumbmg After home has been counected to water and sewer MH ServIce Approval requIred prIor to uhhty company energlzmg ServIce MH Electnc When blockmg, setup and plumbmg mspectlOns have beeu approved and the home IS connected to the panel By sIgnature, I state and agree, that I have carefully exammed the completed JpphcatlOn and do hereby cerhfy that all mformahon hereon IS true and correct, and I further cerhfy that any and all work performed shall be done 10 accordance WIth the Ordmances of the CIty of Sprmgfield and the Laws of the State of Oregon pertammg to the work deSCrIbed herem, and that NO OCCUPANCY will be made of auy structure Without permIssIOn of the Commumty Services DIVISIOU, Bulldmg Safety I further cerhfy that only contractors and employees who are 10 comphauce WIth ORS 701 005 WIll be used on thIS project I further agree to ensure that all reqUIred mspechons are requested at the proper tIme, that each address IS readahle from the stI eet, that the permIt card IS located at the front of the property, and the approved set of plans will remam on the sIte at all times dunng constructIOn wJ~A;t v Owner or Contractors Signature I~ r 1-;/0 rt> Date Paee 3 of 3 - 'Construction Contractors Board 700 Summer St NE Smte 300 PO Box 14140 Salem OR 97309-5052 Phone 503-378-4621 Web Address www cch state.or.us Penmt# COlN(Z:OC~- 6 056 (, Address L(j b -:> 1=- 20 +r...... Issued by Df1 A-V b/ J/oY I ' Date 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 followmg statement before a buildmg pemllt can be Issued TIllS statement IS reqUired for resldentw1 buildmg, electrical, mechamcal and plumbmg permits Licensed architect and engmeer applicants, exempt from licensmg under ORS 701 010(7), need not submit this statement This statement will be filed with the permit FIll m the appropnate blanks and IllitIal boxes I and 2, and either box 3A or 3B ifl ~ 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 ~ 3A My general contractor IS {;' CO"--<; c:- L (:- ivv.. ,A-", "'- (Name) <6/ /fO- (CCB #) I wIll mstruct my general contractor that all subcontractors who work on lhe structure must be lIcensed with the ConstructIon Contractors Board OR o 3B I Will be my own general contractor If I hrre subcontractors, I wIll lure only subcontractors lIcensed with the ConstrucllOn Contractors Board Ifl change my mmd and lure a general contractor, I WIll contract with a contractor who IS lIcensed wllh the CCB and wIll IITnnedlately notIfy the office Issumg tlus bmldmg permit of the name of the contractor I hereby certify that the above mformatIon 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. r (Slgnaru~~:l~~ ~~l1.7---o~ (Date) (WhIte copy to Issumg agency permit file, pmk copy to applicant) r.~t'~';LoWDer doc 06-01.04 Actirita~ Your awn General Contractor? \ [\ ...).\- ..J- -\ ~ -- , , \ \ -INFORMATlON'NOTICE TO PROPERTY OWNERS '-\CJ\, , \ ABOUiI..c,ONSTRUCTIO!'l RESPONSIBILITIES \ NOTE This InformatIon Notice to Property Owners about Construction ResponslbllJtles was developed by the ConstructIOn Contractors Board In accordance wJth ORS 701 055(5), passed by the 1989 Oregon LegIslature I If you are actmg as your own contractor to construct a new home or make a substantIal Improvement to an eXlstmg structure, you can prevent many problems by bemg aware oflthe followmg responslbllIhes and concerns Employer Re~ponsibmties ,- , '. You WIll, m most mstances, 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 m constructmg or to asSISt m the construchon or Improvement of a resldenhal su;ucture As the eml!~oyer, you must comply with the following: , Oregon's Withholding Tax Law' As an employer. you mmt 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 YOUT employees For more mformatlOn, call the Department of Revenue at 503-378-4988' . Unemployment Insurance Tax- As an employer, you are reqUIred to pay a tax for unemploymenl msurance purpo~~s- on the wages of all employees For more mformatJon, call the Oregon Employment Department at 503-947-1488 _ , " ". J.. ... ~ ..... The Oregon Busmess IdentJficatlon Number (BIN) IS a combmed nwnber fqr- both Oregon Wlthholdmg and Unemplqyment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state 01 us/fonnsnav htmll for the I ~ \ ~ ... applVpU.ate,lonns...: ./ t", ..J J ........, .., Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtam workers' cqmpensatlOn msurance for YOUT employees If you faIl to obtam workers' compensatIOn I ' , . msurance, you could be subject to penalties and be liable for all chum cOots If one of your employees IS Injured on the Job For more mfomlatJon, call the Workers' CompensatIOn DIVISion at the Department of Consumer and Busmess Servrccs at 503-947-7815 U S Internal Revenue Service. As an employer, you must WIthhold federal mcome tax from einployees' wager You WIll be lIable for the tax payment even If you dIdn't actually Withhold the tax For a Federal EIN number, can the IRS at 1-800-829-4933 or vmt therr web site at WW\'\ liS aov . . .. . ~ Other Respolllsdnlnties and Areas of Concerns Code ComplIance' As the permIt holder for thIs proJcct, you are responSIble for re.olvIng any faIlure to meet code reqUIrements that may be ,brought to your attentIOn through InspectJons , '~ . '; l -. LIability and Property Damage Insurance' Contact your Insurance agcnt to see If you have adequafe'lnsurancc coverage for aCCIdents and omiSSIons such as fallmg tools, pamt over spray, water damage from pipe punctures, fire or work that must be redone ' ~., \ \ ~"::vl I J Time Make sure you have suffiCient tIme to supervIse YOUT employees , - ~ ~ . ... , \ Expertise: Make sure you have the skills-to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to nohfy bUlldmg offiCIals as the appropnate 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 06-01-04 225 FIfth Street Spnngfield, Oregon 97477 541-726-3759 Phone Job/Journdl Number COM2008-00566 COM2008-00566 COM2008-00566 COM2008-00566 Payments Type of Paymeot CredttCard cRecemtl RECEIPT #: Description Manufactured Home Service + 5% Technology Fee + 12% State Surcharge + 10% AdmInIstrative Fee Paid By KEVIN BIERSDORFF *~ CIty of Sprmgfield OffiCIal ReceIpt Development ServIces Department Pubhc Works Department 2200800000000000893 Date' 06/13/2008 Item Total Check Number Authorization Received By Batch Number Number How Received dJb 982742 In Person Payment Total Page 1 of 1 8 05 HAM Amount Due 5500 275 660 550 $69 85 Amount Paid $69 85 $69 85 6/13/2008