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Home My WebLink AboutPermit Electrical 2004-12-01Status Issued 225 Fifth Street, Spring{ield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01469ISSUED: 1210112004APPLIED: 1210112004 EXPIRES: 08/0412005 VALUE: SITE ADDRESS: 13619TH ST Springfield TYPE OF WORK: Electrical Work Only ASSESSOR'S PARCEL NO.: 1703364200801 TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: 200amp service panel upgrade add 12 circuits Phone Number: S4l-554-7417Owner: Address: DIANE HUBEL 136 19TH ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor GROUNDED ELECTRIC License 158804 Expiration Date 02t24t2006 Phone s41 726-68s8 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: AUTHORIZED UND COM[4ENCED OR ANY 1BO DAY PER Sidewalk Type: Downspouts/Drains: REQUIRED PARJflNG Total: Handicapped: Compact: R-3 VN Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: $ Per Sq Ft or multiplier Square Footage or Bid AmountDescription Type of Construction Pase I of2 Value Date Calculated # of Stories: Height of Valuation Description I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line PERMIT NO: COM2004-01469ISSUED: 1210112004APPLIEDz 1210112004EXPIRES: 08/041200s VALUE: Fee Description + l0Yo Administrative Fee * 7o/o State Surcharge Perm Serv/Fdr 200 amps or less + l0Yo Administrative Fee + TVo State Surcharge Add, Alter, Extend Circ Ea Add Total Amount Paid Total Value of Project Date PaidAmount Paid $6.30 $4.41 $63.00 $3.60 s2.52 $36.00 $115.83 Receipt Number 120040000000000r679 1200400000000001679 1200400000000001679 2200s00000000000137 2200500000000000137 2200500000000000137 t2nt04 t2lu04 t2nt04 2t4t0s 2t4t05 2t4tos Plan Reviews To Request an inspection call the24 hour recording at 726-3769, AII 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. Electric service: Approval required prior to utility company energizing service. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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 inspections are requested at the proper time, that each address is readable from the streeto that the permit card is Iocated 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 Pase2 of2 Date Keourreo InsDecttons I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone r-ity of Springfield Official Receipt ,_ .lvelopment Services Department Public Works Department RECEIPT #: 2200500000000000137 Date: 0210412005 10:53:4eAM Job/Journal Number coM2004-01469 coM2004-01469 coM2004-01469 Description Add, Alter, Extend Circ Ea Add + 7o/o State Surcharge + l0% Administrative Fee Amount Due 36.00 2.52 3.60 s42.12Item Total: Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard HOLLYMAHAFFEY djb T89497 In Person $42.12 Payment totat: -$?77 2/4/200s Page I of I tlF*tfaHSs 1. r36 , 91't- bl LEGAL DESCRIPTION t7033 L\Z ooro ( JOB DESCRIPTION Zc>o A'"? SAvC Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contactor Address Supervisor License Number Expiration Date Constr. Cont. Number Expiration Date SignaXrre of Supervising Electrician ownersN"-. \ tknf,-j.^bo f 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only 225 FIFTH STREET . SPRINGFIELD,OR97477 o PH:(541)72G3753 oFAX: E I.E CTRI CAL P E RM IT APP LICATI O N City JobNumber (.Ort\ Za r:Ll - t..t61 Date / Z O ( oq gPrltnaoFrSlLt Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $s0.00 $ 63.00 $ 75.00 $125.00 $163.00 s37s.00 s s0.00 Installation, Alteratlon or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with Service or Feeder Permit $ 3'00 uires yeH to $ 50.00 $ 50.00 $ 25.00 $ 4s.00 84,5100 * Surcharges I otification qil L} TOTAL 7 37/ 3 A. B. "s L3 City c. D. Address t36 l?tL s+ E. City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease orrent. Signature: SPzi 5 phone 5q( sg \ -vfl7 Purnp or irrigation Lighting ln Utility N Inspection Request: 72G37 69 0090. Shared Drive(T:/Building Forms/Electrical Permit Application 1 -03.doc Building/Combination Permit Status Issued 225 Fifth Street, Springlield' OR 541-726-3753 Phone 541-726-3676Flx 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01469ISSUED: 1210112004 APPLIEDz 1210112004 EXPIRES: 06/0112005 VALUE: SITE ADDRESS: 13619TH ST ASSESSOR'S PARCEL NO.: 1703364200801 PROJECT DESCRIPTION: 200amp service panel upgrade Owner: DIANE HUBEL Address: 13619TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PhoneNumber: 541-554-7417 License Expiration Date PhoneContractor Type Blectrical Contractor OWI\IER CONTRACTOR INFORMATI( # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Vo ofLot Coverage: ATIENflO}t Oregon law requlres you to bltov rules adopted by the Oregon Utility Notification Centee Those rules are set forth ln OAR 952-001-0010throrgh OAR 952-001- calling number TICE: Lot Size: Sq Ft lst Floor:OT Sq Ft ONED FOR R-3 VN ANY ,I80 DA' nh Sq Ft Other: Occupant Load: g Sidewalk Type: Downspouts/Drains: REQUIRED PARJ(NG Total: Handicapped: Compact: cenffi"[f, tQ-332'231?hare FootageTvpe of construction or multiplier or Bid Amount PUBLIC IMPROVEMENTS Description Total Value of Project Value Date Calculated CON{IilENCE Building/Combination Permit Status Issued 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676Fax S4l-7 26-37 69 Inspection Line PERMIT NO: COM2004-01469ISSUED: 1210112004 APPLIEDT 1210112004 EXPIRES: 06/0112005 VALUE: Fees Paid Fee Description + l0o/" Administrative Fee + 77o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Date Paid t2nt04 t2lu04 tznt04 Receipt Number 1200400000000001679 1200400000000001679 1200400000000001679 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. witl be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street that the permit card at the front ofthe property, and the set of plans will remain on the site at all times Lflr?uL Owner or Contractors construction. Date Pase2 of2 trLi Keourreo lnsDecuons I Construction Contractors Board 700 Summer St lttE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: !gryg[,$e!gg,5 permit #: COurtZoCtc( - Olq67 Address: / 3 elL + Issued by:\(Date ()(l Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requtres residential construction permit applicants who are not licensedwith the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiledwith thepermit. Fill in the appropriate blanks and initial boxes I and 2, md either box 3A or 38: kr ftz 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. 3,A.. My general conhactor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the shucture must be licensed with the Construction Contractors Board. OR K ,r. I will be my own general confiactor. If I 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 notiff 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 Responsibilities on the reverse side of this form. (Signature of permit applicant)(Date) (White copy to issuing agenq) pennitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 t Acting as Your Own General'Contraetoy?,,,,, : i. INFOfr,MATION NOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RE$PONSIBILITIES I L If you are acting as your own contractcr to consfruct a new home or make a substantiatr structure, you can prevent many problans by being aware of the following responsibilities E rnployer Responsibilities You will, in most i*stanees, be ruled to be a:r ooernptroyer" and the contractors you sontract wi& will be *'employers" if yogr use contra{Jt$r$ n*t triaensed with the Constructi*n Contraclors Board tu d* iabor in constructing or ?u assist in thc consfruetion or impr*vement of a residentiatr stmctr:rs. As tke employer* y*x ra*st comply witk tke followiug; Oregox,s Withhsldi$g ?ax X-aw: r\s an ernployer, yorl rnust vrithh*ld ineome taxes fr*n'e enrptr*yee wsges at the time employecs ar* paid" Y*u ra,ilX be liable fclr thc taN p*pments ev*n if y*u don't a*tually withhcld t?re t*x fi*:m y*ur enrpl*yee*" F*r n:*re inf?:Tmation, *all the Departrner:t of Reve*ue at 5S3-3784988. I]n*mpleyrxlsre? Xmsxlr*ri*e Txxl ,&s ax *mpl*yer, ys* are required t* pay a tax for utrernployr:u:ent in$matlce purpsses - *n tl:c wage$ *f a1l mrpl*yees. For cnor* i?rfu?:rati*n, *atri ihe {}reg*n Hrlrp**Saxext S*partrce*t at 5$3-94?-1488" The {}reg** Silsilll*ss ldentrflcatl*n }iiurnber {SlN} is a **mbi*sd nrunfoer {br boch Oregon Witi:holding ;rnd Ur:enrpioy-n*rt Xnsxratr** ?ax. Tc fil* f*r a $1lS- eail 5*3-945-S0$t iir X.g]?.{1*f,-q{A1q*-{,},1$lt$Ilfi$pa}.lX83l".L f*r the appr*priat* f*rsr:x" to and c*n*er::s Wcrkers' Cornpensati*n Insarance: As an employer, you are subject to the Oregon Vforkers' Cornpensation Law, and must obtsin workers' compe4sation insurance for yoer ercpioyees.. If you fail to obtain workers' compeirsation insurance, you could be subjeci to$enaities andbe liable for all claim costs if one of your ernployees'iS irijured on the iob. For more infcrmatir:n, catrl the Workers' Compensation Division at the Department of ConsBrnief and Busir:ess Services at 503-947-7Etr 5. Li.S. {raterm*X }&evcxtr*c $ervie*t As *n emp}oyer, y*u m*st withhold federal inc*rne tax from *mployees' wage$."' Y*u vrill }:e lixb}* J*r rhr tax $e),'fi1enr e,aen if yr:u didri"t a*txatrly yrithhc)ld th* t::x" Fr:r a Federxi StrN ttutxber, eatrX the IX$ at l-80S-82!)-4933 *r rrisit tlreir w*b site et XXIYJIs.SqY. ffther Kexpomribilitics end Areas of C*neerxl$ C*d* C*rnplixal**:: ;\x ti:.* j:ermit h*lqX*:: f*r thir pr*jeet, ysre ilr* r*sp*nsibl* f*r resq:lrri*g einy failur* to ffie*t ceic$e requiremct;rs that inay h* brought to y$ur att*fillotl through lnipl"f,ti*n$" Lixhility axcd Fr*xp*r*y &*rc*g* I&sca*"x&**: C*ntact y*r:r insuran** ag*nt fi: s*e if ynu }:av* adequate insur*nee i;$lr*r*#* for ae*ici*ni* ;;;.i *ffili*$i*ns sli*i: ;rs ktSLing 1**?s, paint *1'*r iil:lfiiy. o,vat*r d*n:iag* &*:x pip* pun*tLlres" fir* *r w*rk li:rat rnusi h* r*rtr:*r:. Tix'rl*r Make s*r* y*u have *u{ficies? tis:r:* t* supervise y*r'r *mp}*y*cs" ! HxBer{ise: hX;rkc.1,,.: Irrir havf flrc rkrl}s io ari fir yfiur (ti\rr gft,!fra} cofltract{.if, lt'l *n*rdinalc thc work cj ifiir*.h'in *od tir-i*tr* tra**s, n:r*1 t* rx:lify b*i[*i*g q:l{i*i*]s as thr api}r*prial* t'iin*s s* t}r*y *a* p*rf*r::: th* r*quir*d i*:;p*eti*ns. 1f y6u have actrqiiti*;;1ai q**sti*:ls eatri {ir* C*nstrx*li** il*nka*t*rs S#ar{i {5$3-3?S-{'6?1} *r rarire th* xge:"rev a1 PL} S*x 1414*, $aierx, *:{ q?3*9-5S5?. Froperty*4v",.**r"ek:c $&-* t -l'.ld' NOIE: This lnfarmatian Notice to Praperty Awners aiout Construction Responsi5ilifies il/as developed by the Consfruc#on Contractars Saard in accordance with ORS 701-055{5j, passed by the 1989 Aregon Lagislature. 225 Fifth Street Springfi-eld, Oregon 97 47 7 541-726-3759 Phone :ty of Springfield Official Receipt -l)evelopment Services Department Public Works Department RECEIPT #: 1200400000000001679 Date: 1210112004 3:08:31PM Job/Journal Number coM2004-01469 coM2004-01469 coM2004-01469 Description Perm Serv/Fdr 200 amps or less + lYo State Surcharge + l0Yo Administrative Fee Amount Due 63.00 4.41 6.30 Item Total:$73.71 Payments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard DIANE HUBEL djb 548470 In Person $73.71 Payment Total: -$ETI t2/t/2004 Page I of I *Ptlt{ttFrlLt City of Springlield 225 Fifth Street, Springlield, OR97471' 54]-726-3759 Phone 541-72G3676Fax August 03,2005 HUBEL DIANE 136 19TH ST SPRINGFIELD OR 97477 Job Number: Location: coM2004-01469 136 19TH ST Project:200amp service panel upgrade add12 circuits Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the pennit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 136 19TH ST which is set to expire on 8l4l2OO5. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notiff you that your permit(s) will be expiring shortly. If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at 541-726-3790. Sincerely, Lisa Hopper Buiiding Safety Supervisor CIT'Y OF'RINGFIE[-D. OREGONI 225 FIFTTI STREET . sPRrNGFrEl,D, oRfltn o PHz(s1t)72G3713 o FAX- E L E CT RTCAL P E RMI T APPLTCATION $ze City JobNrmrber (otyLOOLl - C2 tq (>c( I. LOCAIIIONOI'INS:TALI-ATION 3. COMPLETE FEE A. New Residential - Single o Servicc Included l(X}0 sq. ft- or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Pump or irrigation Sign/Outline Lighting Limited Enerry/Residential Limited Eneqry/Commercial 7o/o Stale Surcharge 1 0olo Administrative Fee TOTAL 136 t?t^ a+ LEGAL DESCRIPTION t7o3 3 6qZ ootrD( JOB DESCRIPTION + /Z LtQ-cvtTl s (,= A"'f 9-<t-g,1*-bn' r unit. s50.00 rations or Relocation: $ Permits arc non-transferable and expire if work is not started within lE{l days of issuance or if work is Suspended for lE{l days 2. ooNTRACTOR TNSTALT-ATTON ONLY B. Services or Electrical Contractor ,qJ J Supervisor License Number 7;{ ExpirationDd, {0' I - 07 Constr. Contr. Number E690q Expiration Date L zl- a6 of Supervising Electrician \il,^u-f $ 63.00 $ 75.00 $r25.00 $163.00 $375.00 $ 50.00 C. Tem or Feeders Instelletion, Alteretion or Relocation 2fi) Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 4Ol Amps to 600 Amps $100.00 Over 600 Amps or 1000 Vola see "B" above. D. Branch Circuits $cg't 5. fr LS 3b $ s0.00 $ s0.00 $ 25.00 $ 45.00 (r73 y*+ ?e, P //tqs-7H City A Phone OwnersName t,,^\ ,/\ e Address Address City 726 6 y' t3G I ?+L >,|-- =Prt\Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Minimum Electric Permit Inspcction Fee is $45.1D + Surcharges 4. SUBTOTALOFABOVE 71 Inspection Request 72G3769 Shared Drive(t:/Building FormJElectrical Permit Applicdion l43.doc J 5 New Alteration or Extension Per Panel rt lHE WO $ 3.00 not included) -Each Installation 1 OR ISED ANY