HomeMy WebLinkAboutPermit Electrical 1995-09-05CITY OF OREGON
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COHPLETE FEE SCMDULE BELOV
225 FIFTE STREET
SPRINGFIELD, OREGON 97 477 De*e-
INSPECTION REQUEST: 726
OFFICE: 726-3759
L
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COI\ITRACTOR INSTALI,ATTON ONLY
Electrical Contractor
Address
City- Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Exoiration Date
Signature of Supervising Electrician
Ovners Name
Address 0
Ci ty Phone
OVNER TNSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Ovners Signa
DATE:
EI.,ESTRICAL PERHIT APPLICATION
Ci ty Job Nurnber q aqg
&,
fi
8S str
nof
.-.*3=-"
B
A. Nev Residential-Single or
Multi-FamilY per dvelling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular Dvelling
Service or Feeder
D. Branch Circuits
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
-401- amps to 600 amps _
601 amps to 1000 amps-
Over 1000 amps/vo1ts
Reconnect 0n1y
Temporary Services or Feeders
Instal-Iation, Alteration or Relocation
Items Cost Sum
$ 8s.00
$ 1s.00
B" aSoiE-
$ s0.00
s 60.00
s1oo.0o
$130. 00
s300.00
s 40.00
00
00
00
$ 40.
$ ss.
$ Bo.
see It
c.
200 amps''or less
201 amps to 400 amps
0r'er 401 to 500 amps
0ver 600 amps or 1000-lrolTs
rhn
J
Nev, Alteration or Extension Per Paneln --
one circuit / $ 3s.oo C5
Each Additional
Circuit or vith Service
or Feeder Permit ? $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/Out1ine Lighting_
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
52 State Surcharge
32 Administrative Fee
TOTAL
s
$
s
s
40
40
.00
.00
.00
.00
20
36
RECEIVED B
ture:
5
BFSIBENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WOFK:
ASSESSOHS MAP:
LOT:5? oo
SPR!l\lGFIELO 50/n
Zfr,
JOB NUMBER
225 Fif th Street
Sprlngf leld, Oregon 97477
BLOCKT
TAX LOT:
SUBDIVISION . Aayn t-/
a q7 4tt3PHONE:
STATE:7r
4
CITY:
'
"x*' i'(',l\(j ZIP:77'{ 7},
-7
ADDRESS|
DEMOLISH OTHER
DESCRIBE WO
"rLotirvNEW
-
REMODEL ADDITION
NAME ADDRESS EXPIBES PHONE
c7
.t
CONTBACTOB
MECHANICAL:
ELECTBICAL:
PLUMBING:
GENERAL:
CONST,
CONTBACTOR ,|
q3 \
\
- OFFICE USE -
Y OF BDRMS:
BANGE:
4vt\il\\: U(Jutr:
FLOOD PLAIN:
SECONDAHY HEAT:
SOUARE FOOTAGE:
OUAD AREA:
r OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
LAND USE:
# OF UNITS
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recor<llng. All lnspectlons requested before 7:00 a.m, wlll bemade the same worklng day, lnspectlons requested after 7:OO a.m. wlll be made the followlng work day.
REOUIRED INSPECTIONS
[--l Temporary Eloctrlc
Slte lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Underslab Plumblng/ Electrlcal /
Mechanlcat - Prlor to cover.
fffiough Mechanlcal - Prlor to.J cover.
fl,.dough Electrlcal - Prlor to|J cover.
Electrlcal Servlce - Must be
approved to obtaln pormanent
electrlcal power.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
ffframlng - Prlor to cover.
fl)zfralltCelllng lnsulatlon - Prlor tol...g cover.
| - Prlor to taplng
Wood Stovo - After lnstallatlon.
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prlor to
placement of concrete.
Sidewalk & Drlvewav - A(ter
excavatlon ls complete, forms
and sub-base materlal ln place.
Fence - When completed,
ffi Flnat Plumbing - When ailf plumblng work ls complete.
ffi ftnat Electrlcat - When ail\J electrlcal work ls complete.
ffi flnat Mechanlcal - When all'fC mechanical work ls complete.
ffi flnal Building - When ail
f requlred lnspectlons have been
approved and bullding is
completed.
| ,zf Foundallon - After forms areH erected but prlor to concrete
placem6nt.
[-l UnUerground Plumblng - Prior.J to fllllng trench.
f/Unaertloor Plumblng / Mechanicalr-r - Prlor to lnsulatlon or decklng.
ffi Footlng - After trenches arel...N excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Post and Beam - Prlor to lloor
lnsulatlon or decklng.
Floor lnsulatlon - Prlor to
decklng,
Sanltary Sewer - Prlor to f llllng
trench.
Storm Sewer - Prlor to fllllng
trench.
Water Llne - Prlor to filllng
trench,
Other
MOBILE HOME INSPE TIONS
Blocking and Set.Up - When att
blocklng ls complete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Electrlcal Connection - When
blocklng, set.up, and plumbing
lnspectlons have been approved
and the home ls connected to
the servlce panel,
Flnal - After all required
lnspectlons are approved andporches, sklrtlng, decks, and
ventlng have been lnstalled.
Zhougn Plumblng - Prior tolJ cover.
L/
OWNER:
It\ \
WATER HEATEFI:
CPE[,tnrz,
.38+
OCCY GROUP:
C OF STORIES:
fj E
E
tl tl
Streel Trees - When all requlred
trees are planted.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typr
-''
-.
lnterior P.L.HSE GAR ACC
N
S
E
-
Corner
__ Panhandle
-
Cul-de-sac
THE PROPOSED WORK IN HE..-sroRtcAL OtSTRtCr, oR oN
THE HISTOBICAL REGISTER?
-
lf yes, thls appllcailon must be slgnedand approved by the Hlstorlcal
Coordinator prlor to permlt issuance.
IS
HI
APPROVED:
3s(- -S/a?o Zpea
BUILDING PERMIT
VALUE
-I.Ag+ sb
(A)t 6r{.-lt
SQ, FT. X $/SQ. FT.ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Ar*5go
__15q.5:
t e..L\
P!r.[D_tNG VALUE, PLAN CHECKAND BUILDING PENMiT
. of Sprlngfleld, lncludlng thelating the construction and use of
ewed By DIG-PI ans
/3
v
reg u
css
Recei pt Numbe
Beceived By:
7
Thls permit is granted on the express condlilon that the saldconstructlon shall, ln all res pects, conform to the Ordlnanceadopted by the Cit
Development Code,
and may be s uspended or revoked at any tlmetlon of any p rovislons of sald ordlnan
k Fee:
sICqs
bulldings,
upon vlola
Plan Checl
Date Pald:
DEVELOPMENT CHARGE (SDC)
f 4az 2j(B)
SYSTEMS Systems Development Charge ls dus on all undevelopedproperties wlthln the City llmits whlch are belng lmproved,
ITEM
Flxtures
Resldentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
PLUMBTNG PERMIT
ZZ* /g
FT.
FT.
(c)
FT.15a &Z
4r,o
b
4o
FEE
ooPlumblng permlt
State Surcharge
Total Charge
ADDITTONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
E}ryer-tlcnt
I rl,
MECHANICAL PERMIT
3.esc
,7fr,{f
(D)
'f
tg
?
N0
Mechanical permlt
lssuance
State Surcharge
Total Permlt
.6Q
zo
Furnace
Exhaust Hooc,
Vent Fan
By slgnature, I state and agree, that I have carefully examlnedthe completed appllcailon and do hereby cerilfy that alllnformatlon hereon ls true and correct, an j I turther certlfythat any and all work performed shall be done ln accordancewlth the Ordlnances of the Clty of Sprlngfleld, and the Lawsof the Stale of Oregon pertalnlng to tho work descrlbedhereln, and that NO OCCUPANCy wlll be made of anystructure wlthout permission of the Bulldlng Safety Dlvlslon.I further certlfy that only contractors anOimptoyees whoare ln compllance wtth ORS 7Ol.O5S wlll be used on thlsprolect.
I further agree to ensuro that all requlred lnsrequested at the proper tlme, that eachfrom the street, that the permlt card lsof the property, and the approved set
pectlons are
address ls readable
located at the front
of plans wlll remalnon the slte at I ti du ructlon.Y/ Slgnatu
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
--
ft
Curbcut tt
Demolitlon
State Surcharge
Total Miscellaneous permlts (E)
VALIDATION:
HECEIPT NUMBEH
DATE PAID
AMOUNT R
RECEIVED
ECEIVTOTAL AMOUNT DUE (excludtng electrtcat)(A, B, C, D, and'E Combtned)
BY \
N0
-
-
-
-
-
6
Permit #:
Address:
Issued by:Date:
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered 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 registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38:
1. I own, reside in, or will reside in the completed structure
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A,. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notiff the office issuing this building permit of the
name of the contractor.
I hereby certify thatthe above is correct and thatl have read and do understand thelnformation
Responsibilities on the reverse side of this form.
OR
.7'15^95
(Signature of permit applicant)
(White copy to issuing agency pennitfile,
pink copy to applicant)
Notice to
(Date)
t"
Information Notice to Property Owners
, About Construction Responsibilities
Noti: this lnfonrtctrion Notice to Property Owners abotil Consrruction Responsibilities ,.
' vie.t tlevelaper! bv the ('orr.ttruciitt'n Contractors Boartl in ctccorclance with ORS 70t.055(5),
II'yuu arc acting ar your olvn f,ofilraotor t$ constmct a nt: w home or maks a suhstantial improvemcnt to an existing structure,
you can prevent maury problems by.being aware of the following responsibilities and areas of-ooncert. . ,
EMPLOYEH RESPONSI BI LITIES:
If you hire persons. not legistered with the Construction Contractorq Board to do.labor in constr,ucting or assisting in the
construction or improvement of a residential structurg, you will, in most instanqes, be ruled to be an employer and the people
you hire will be employees. 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 OregiSn Ddpf. of Revenue at 945-8091 . ' '= "'
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For rnore information, call the Oregon Emplayment Division at tlrc Deprtrrent.af Hurnan Resourres
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and rnust
obtain workers'compensation insurance for your employees. If you fail to obtain workers'compensation insurance, yourmty
be subject to penalties and will be liable for all claim costs if one of your employees is injured on thejob. Fo{fore informatien,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'ivages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
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.
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 overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertisc: Make sure you have the expertise to act as your own general conlractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can.perform the required inspections.
If you have additional questions, write or call the Construction Contractors Boar<I (PO Box l4l4{*,Salem,.& g73W-5O52,
5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
lt94
ATTACHHENT 81 r0B N0. 7s-atrz
CITY OF SPRINGFIELD SYSTEMS DEVELOPMEM CHARGE
WORKSHEET
(COHHERCIAL & RESiDENTIAL)
NME OR COMPAJ,{Y:
LOCATION:
DEVELOPMENT TYPE:
BUILDING SIZE:
1. mBqeTM
IMPERVIOUS SQ. FT.
2. SANTTARY SEWER-CTTY
X $0.209 PER SQ. FT
X S43.26 PER PFU
2
SIZ . Ft.
3Ff
v
3
NO. OF PFU'S
(See Reverse)
TRANSPORTATION
NO OF UNiTS X TRiP RATE X COST PER TRIP
x
-
x $436.19
x
-
x $436.i9 $
s
SUBTOTAL (A.DD ITEHS i,2. & 3)S 7 F3,oF
4. SANITARY SFl^lFR-Mhil'4C
N0. 0F PFU'S x $17.i9 PER PFU + $10 Ml,ll',lc pOMiN.FEE s
(Use PFU Totai From Item 2 Above)
HI^Il',lC CREDIT IF APPLICABLE (SEE REVERSE)
.J=:.
TOTAL.}4I.IMC SDC
SUBTOTAL (AOD ITEMS 1.2.3 & 4)s t72,of
5. ANHTNISTATTVF FFFS
BASE (ABOVE) X .05
2 -2s- 2 5-
ig, P.E.
i nator
2C
82. SDC
Date:
TOTAI SDC $ 40 2,2 3
{-;af>
--__-_-----
FIXTURE UNIT CALCULpTION TABLE: Number or New Fiv
{i.iOTE: For remodels, calculate onll _ : NET additional lixturesl
NUMBER OF
FIXTURE TYPE NEW FIXTUBES
Bathtub.....
Drinking Fountain...........
Floor Drain
lnterceptors For Grease/Oil/Solids/Etc.
lnterceptors For Sand/Auto Wash/Etc.
Laundry Tub/Clotheswasher....
Clotheswasher - 3 Or More....
Mobile Home Park Trap (1 Per Trailer)
Receptor For Ref rigerator/lvater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.
Shower, Gang........
Sink: Bar, Commercial, Residential Kitchen..
Urinal, Stall/1vall..:...............
Wash Basin/Lavatory, Single.
Toilet, Public lnstallation
Toilet , Private....
Miscellaneous: tlrtlt pPj gAt
TOTAL FIXTURE UNITS
:s X Unit Equivalent = Fixture Units
UNIT
EOUIVALENT
FIXTURE
ut.,ltTS
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
I
I
.a
d/Hea
4
I
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits sdparates.
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
1 980
1 981
1 982
1 983
1 984
1 985
s3.46
3.38
3.32
3.21
3.O6
2.92
2.73
1 985
1 986
1 987
1 988
1 989
1 990
1 991
1 993
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
xs
(Rate X Assessed Value)x$
(Rate X Assessed Value)
CREDIT TOT.A,L - $
t'
2
I