HomeMy WebLinkAboutPermit Electrical 2005-08-09Buildin g/Co mbination Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:126-3753 Phone
541-7263676Fax
541:7 2637 69 I nspection Line
PERMIT NO:
ISSUED-:'*
APPLIED:
E)PIRES:
VALUE:
coM2005-01079
08/09/200s
08/09/200s
04t04t2006
$ s00.00
SITE ADDRESS: 378 S 43RD ST Springfield TYPE OF Single Family Residence
ASSESSOR'S PARCEL NO.: 1702323403200
TYPE OF USE: Repair Residential
PROJECT DESCRIPTION: Replace wiring for 14 circuits in existing panel. Interior repairs of mechanical,
plumbing and structural for subfloor replacement.
Phone Number: 54l-736-9213Owner:
Address:
Contractor Type
General
Electrical
Mechanical
ROBERT MXON
378 S 43RD ST
SPRINGFIELD OR 97478
Contractor
OWNER
License Expiration Date Phone
rrill fi&f 10t04t200s s41-e1s-e828INC
CONTRACTOR INFORMA'II ON
# of Units:
Primary Occupancy Group:
Secondary Occupancy
" Primary Construction Type
Secondary Construction
# of Bedrooms:
Frontlard Setbaclc
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
- Special Instruction:
NIT tt0 0ril
R-3
ERMIl IS NOT
nla
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
to
OWNER
VN
Ileight of
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled
Overlay Dist:
# Street Trees
Paved Drive Rqd:
oh of Lot Coverage:
REQUIRED PARIflNG
Total:
Handicapped:
Compact:
DEVELOPMENT INFORMATION
Notes:
1of 3
m
EASTSIDE
OWNER
Oregon
CITY OF SPRIN
Building/Co mbination Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Rax
541:7 26-37 69 I nspection Line
PERMIT NO: COM2005-01079ISSUED: 08/09/2005APPLIED: 08/091200sE)PIRESz 0410412006VALUE: $ 500.00
Description
Estimate
Fee Description
+ l0%o Administrative Fee
+ 7o/o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
-Mechanical Issuance Fee-
+ l0o/o Administrative Fee
+ 7o/o State Surcharge
Building Permit
Dryer Vent
Exhaust Hoods
Fixture
Minimum/Adj ustment Mechanical
Vent Fan
Total Amount
Type of Construction
Estimate
$ Per Sq Ft Square Footage
or muhiplier or Bftl Amount
$1.00 s00.00
Total Value of Project
Amount Paid Date Paid
Value
$s00.00
$s00.00
Receipt Number
120050000000000r168
r200500000000001 168
1200500000000001 168
1200500000000001168
1200500000000001450
1200500000000001450
1200500000000001450
1200s000000000014s0
1200s000000000014s0
1200500000000001450
1200500000000001450
1200500000000001450
12005000000000014s0
Date Calculated
t0t04t200s
$8.20
$5.74
$43.00
$39.00
$10.00
$18.80
$13.r6
$45.00
$6.00
$9.00
$98.00
$24.00
$6.00
8t9t05
8/9/0s
8/9/05
8/9/0s
tot4t05
t0t4t0s
t0t4t0s
t0t4t05
t0t4t05
t0t4t05
tot4t05
tol4t05
tot4t0s
$325.90
Plan Reviews
To Request an inspection call the24 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.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to coYer.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
2of3
Reouired Insnections
rL
Valuation Description I
Ieelralq l
Status: Issued
225 Ftfth Street, Springfiel{ OR
541:72G3753 Phone
541-72G3676F2x
541:1 2G37 69 hs pe ction Line
CITY OF SPRINGFIELD
Buitdin g/Co mbin ation Permit
PERMIT NO: COM2005-01079ISSUED: 08/09/2005
APPLIED: 08/0912005E)PIRESz 0410412006VALUE: $ 500.00
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical 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 certiS that any and all work performed shall be done in accordance
with the Ordinances of the City of SpringfieH and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCT PANCY win be made of any structwe without permission of the Community Services Division,
Building Safety. I further certiff 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 card is located at the front of the property, and the approved set of plans will remain on the site
at all times
/o -c/-o f
Owner or Contractors Signature Date
3 of 3
Construction Contractors Board Permit *: LOI+tLc;.o to?,
Address: 37 Y S L/38 S+-
Issued by:C Date: lo l- 3 f
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed with 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 be filed with the permit-
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 38:
k,
ftz
tr 3A. My ge,neral contractor is
(Nane)(ccB #)
I
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-3784621
WebAddress:Erys1!q]4
Y
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.
I will instruct my general contractor that all subcontactors who work on the structure must be
licensed with the Constnrction Contractors Board.
OR
38. I will be my own general contractor.
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 fnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
applicant)
(White copy to issuing agency pennitfile, pink copy to applicant.)
Property_owner. doc 06-0 I -04
ra /ot/or' '(oate;
Actimg as "r-our Own Generafl Contractor?
INFORMATION ttOTlCE TO PROPERTY OWNERS
ABQUJ CONSTRUCTTON RESpONStBtLtTtES
NOTE: This lnformation Notice lo Propeiy Awners abou! Construction Responsibdrliis Lvas devetoped by the
Construction Contractors Board in accordance with ORS 701.055(5J, passed by the 1g8g Oregon L,egislature.
If you are acting as your cwn contractor to construet a new home or make a substantial improvement tp an existing
structure, you can prevent nrany problems by being aware of the following responsibilities aRd concerns.
Employer Responsibilities
You will,.in.most instanees, be ruled ta be an "errryloyer" and &e contractor-s you conkact with will be "employees" if
you us€ contactors not licensed with the Conskuction Contractors Board to do iabor in constructing or to assist in the
construction or improvement of a residential structure. As the employer, you must comply with ti-e foltowing:
Oregon's \trithholding Tax Law: As an employer, you must withhold income taxes from employee rvages at the trme
employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from yqur
employees. For more information, call the Department of Revenue at 503-3784988. ::r r: j i
Unemployment Insuranee Tax: As an employer, you are requked t<rpay a t*x for uneinployment insurance purposes--
on the wages of all employees. For rnore informatlon, call the Oregon Employrnent Department at 503-947-1488.
-\-
The Oregon Business Identification Number (BIhI) is a combined nurnber fsr tro&:Oregon \{itbholding and
Unemploymant lnsurance Tax. To file for a BlN, call 503-945-8091 or r.v.yu,.dor,Qlate.or.qslfqrmspay.htmll for the
appropriate forms.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' compensation insurance for yow empioyees. If you fail to obtain workers' compensation
insurance, you could be subject to penalties and bd'Iiable for all claim costs if onr of your employees is injuied on the
job. For more information, call the '$lorkers' Compensation Division at the Departmant of Consumer and Business
Services at 503-947 -7 81 5.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' *ag"i)-
You will be liable for the tax payment €ven if you didn't actually withhold the tax. For a Federal EIN number, cali the
IRS at 1-800-8294933 or visit their web site at lvlt'w-irs.gov.
Other Responsibilities and Areas of Concerns
Code Compli*nce: As the permit hoider for this project, you are responsibie for resolving any failure to meet code
requirements that may be brought to your attention through inspections.
Liability and Property llamage Insurance: Contact your insurance agent to see i'f you have adequate insrnafcg
coverage for accidents and omissions such as falling tools, paint or/er spray, water damage &om pipe punctures, fire or
work that must be redone.
Time:Makesureyouhavesufficienttimetosuperviseyouremployees.!;l
Expertise: Make sure you have ihe skilis to act'as your own general contractor, to coordinate the work of rough-in
and finish trades, and to notify building officials as the appropriate times so they can perform the required inspechons.
(t
If you have additional questions call the Construction Contractors Board (503-3784621) ar write the agency at PO
Box 14140, Salem, OR 97309-5052.
Property*owner.doc 06-01-0 4 ;'u : )
225 Fifth Street
Springfii:id, Oregon 97 47 7
541-726-3759 Phone
City of Springfield Official Receipt
velopment Services Department
Public Works Department
RECEIPT#: 1200500000000001450 Date: 1010412005 11:15:2eAM
Job/Journal Number
coM2005-01079
coM2005-01079
coM2005-01079
coM200s-01079
coM2005-01079
coM2005-01079
coM2005-01079
coM2005-01079
coM2005-01079
Description
Building Permit
Fixture
Vent Fan
Exhaust Hoods
Dryer Vent
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
+ 7o/o State Surcharge
+ l0o/o Administrative Fee
Amount Due
45.00
98.00
6.00
9.00
6.00
24.00
10.00
13.16
18.80
Item Total:s229.96
Payments:
Type of Paynent Paid By Received By
ChEkNumber
Bdch Number
Authorization
Number How Received Amount Paid
ROBERTNIXON djb 01741A In Person $229.96
PaymentTotal: m
tl
'i
{
(
I
10/4/200s
1of1
aetsalli'!
CreditCard
225FIFTHSTREET . SPRINGtr'IELD, OR97477 o PH:(541)726-3753 oF
E IE,CTP.I CAL P ERMIT AP P LI CATT ON
JobNumber CS,t Dbf - O t O-? 1 Date
1.3.
32 g > Ll3I
LEGAL DESCRIPTION)7oZ3Z31 oizeo
-o
A.
JOB DESCRIPTION
W.yAE l( c(rc$.i
Permits are non-transferable and expire if work is
"- not started within 180 days of issuance or if work is
Suspended for 180 days.
,,
Service Included
1000 sq. ft. or less
Each additional500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
o
$106.00
$ 19.00
$s0.00
B.
Electrical Contractor
Address I S 05C G€
City SPFcD i7Y78 Phone
law
€L€C,ENTI Wl$e
ow Iu\
tort!
R952 -001-
." b:[-tol\on
onngs
nu
You lpoo
D.
E.
N
,z-?34 4)
$ 63.00
s 75.00
sl2s.00
$163.00
$375.00
$ s0.00
s 43.00
s 3.00
tu'000 ru\
,2
Supervisor License Number \ 7) 7s
Expiration Date ,0-0 l- h7
Constr. Contr. Number lt177O
Expiration Date 10.'01- os
Signature of Supervising Electrician
Owners Name I"d t
Address s78
OWNER INSTALLATION
The insallation is being made on proPerty I owu which
is not intended for sale, lease or rent.
Owners Signature:
Installation, Alteration or Relocation
200 Amps or less $ 50'00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps 5100.00
Over 600 or 1000 Volts see "B" above.
New Alteration or Extension Per Panel .
One Circuit /
Each Additional Circuit or with , ?
Service or Feeder Permit ' J
cl3
37
City SP phone 736 - 1Zt 3 pumporirrigation
Sign/Outline Lighting
$ s0.00
s 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45'00
Minimum Electric Permit Inspection Fee is $45'00 * Surcharges
gZ
,7r'|Yo State Surcharge
l0% Administrative Fee
TOTAL
gLo
?t ?a
Inspection Request: 726'3769
4.
Shared Driv(T: /Building Forms/Electrical Permit Appl ication 1 -03'doc
City g-
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Fax
541:7 2637 69 Ins pe ction Line
CITY O
Buitding/Co mbination Permit
PERMIT NO: COM2005-01079ISSUED: 08/09/2005APPLIED: 08/0912005E)PIRES: 0210912006
VALUE:
SITE ADDRESS: 378 S 43RD ST Springfield TYPE OF
ASSESSOR'S PARCEL NO.: 1702323403200
TYPE OF USE:
PROJECT DESCRIPTION: Replace wiring for 14 circuits in existing panel
Electrical Work Only
Repair Residential
Owner:
Address:
ROBERT NIXON
378 S 43RD ST
SPRINGFIELD OR 97478
Phone Number: 541-736-9213
Contractor Type
Electrical
Contractor
EASTSIDE ELECTRIC INC
License
117770
Expiration Date
r0t04t200s
Phone
541-915-9828
,. # of Units:
Primary Occupancy
Secondary
Plimary
Secondary
# of Bedrooms:
Frontlard Setback
Side l Sefrack:
Side 2 Seback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
esb{
Overlay Dist:
# Street Trees
Paved Drive Rqd:
Yo ofLot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:nla
Sidewalk Type:
Downspouts/Drains
REQUIRED PARIilNG
Total:
Handicapped:
Compact:
$ Per Sq Ft
or multipfier
Square Footage
or Bkl Amount
DEVELOPMENT INFORMATI(
PUBLIC IMPROVEMENTS
Description Tvpe of Construction
lof2
Value Date Calculated
r\lL
theb.j
0
Valuation Description I
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Fax
541 :7 26-37 69 Inspection Line
Buildin g/Co mbination Permit
PERMITNO: COM2005-01079ISSUED: 08/09/2005APPLIED: 08/0912005E)3IRESz 0210912006
VALUE:
' Fee Description
+ l0%o Administrative Fee
+ 7%o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Total Amount
Amount Paid
$8.20
$s.74
$43.00
$39.00
$95.94
Total Value of Project
Date Paid
8t9t05
8/9/05
8t9t05
8t9t05
Receipt Number
1200500000000001168
r200s00000000001168
1200500000000001168
1200500000000001168
Fees Paid
Plan Reviews
To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Reouired fnsnecfions
By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certiff that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCUPANCY will be made of any structure without permission of the Community ServicesDivision,
Building Safety. I further certi$ 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
Owner or Contractors Signature
2of2
Date
L LL
Job/Journal Number
coM2005-01079
coM200s-01079
coM2005-01079
coM2005-01079
225Fitth Street
Springfieldn Oregon 97 477
541-726-3759 Phone
.'ity gf Springfield Official Receipt
-_ evelopment Services Department
Public Works Department
RECEIPT #:1200s00000000001168 Date:08/09/2005 t:54:47pM
Descripfion
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7o/o State Surcharge
+ l0% Administrative Fee
Amount Due
43.00
39.00
5.74
8.20
Item Total:
Payments:
Tlpe of Payment
$95.94
Paid By Received By Batch Number Number How Received Amount PaidCreditCardEASTSIDE ELECTRIC djb 035493 In Person
Payment Total:$9s.94
t,
81912005 lofl
l-r