HomeMy WebLinkAboutPermit Electrical 2008-7-22
~..~ eu)' Of, "SP~lNGt['ELD, ORJ?GO}~ ;.
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S.J:GF:-~ ZON , \ A /
, INITIALS t.l '-'" ,/
:....,.- A!. DATE '-1 ~ 3do-O ~
-... 1OlII" SOURCE(Jn 0:S(>r.v
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726.3753 . FAX (';41)726-3689
ELECTRICAL PERMIT APPLICATION
CIty Job Number COM l!:.O or ~ C>O 7 I Z
Date
7/ rhJ../ 0 (7
1 LOCATION OF INSTALLATION:
..<.-f /,J> /7TH CfTAJE'n"'7
3 COMPLETE FEE SCHEDULE BELOW
LEGAL DESCRIPTION
17D~ ZS-Z,\
12000
A New Resldentlal- Smgle or MultI-FamIly per d,..lhng UDlI.
ServIce Included
JOB DESCRIPTION
S~v'L c....!.lnV{ e 8' Lf C~rL,^' fr
Permits are non-transferable an'exPlre If work IS
not started wlthm 180 days of ISsuance or If work IS
Suspended for 180 days
1000 sq ft or less
Each addItIOnal 500 sq ft or
portIOn thereof
Each Manufact'd Home or
Modular DwellIng ServIce or
Feeder
2
CONTRACTOR INSTALLATION ONLY
/
B
ServIces or Feeders - InstallatIOn, AlteratIOns or Relocatoon
ElectrIcal Contractor
200 Amps or less
20] Amps to 400 Amps
40] Amps to 600 Amps
60] Amps to 1000 Amps
Over 1000 AmpsNo]ts
Reconnect Only
UlfeS yOU to
. ore~ IlftlrL1&.wo'\ift)ll~'1 or Fceders
",11 \:1~1\~ \ dopted by th \ 5 are set lorth
IO\\OW r.U\~Sc~nter \ilRf.l1J~~~IlW~gr Relocatoon
~ NOlllI""' ~2'001-001Q,\\14.<L-mH\! fules 'J
~n O",R ~ou may obtar ~ Ilpnone n
~' n toe centel, ~~~ ~I~
\\ln9 the or~!lIl\OJ!l ,Amps
ellOl O'
nU ..:,....\81 IS lcWer 600 Amps or ] 000 Volts see "B" above
~ D Branch CIrcUits
Ad~
CIty ""
nature of Supervlsmg ElectrIcIan
Owners Name /)OA.lA- L/? /J, 'Y;;///I/C
New Alteratoon or ExtenSIOn Per Panel
One Crrcmt
Each AddltlOna] Crrcmt or WIth
ServIce or Feeder Penmt
L/
,
$]]700
$ 2100
$55 00
!
$ 70 00
$ 83 00
$]3800
$]8000
$413 00
$ 55 00
70
$ 55 00
$ 76 00
$] 10 00
$ 48 00
$ 400
/h
Address d J / f' /\/. / '7 I rl . <:"'/ E MIscellaneous (ServIce/feeder not mcluded) -Each InstallatIOn
CIty 0R//l/,;;;;::,.r:- L Il'hone 7 q 7.74'2-6 Pump or rrngatlOn $ 55 00
,
SIgn/OutlIne LIghtmg $ 55 00
OWNER INSTALLATION NOTICE~LImltll~WiaJHE WOR!'. $ 28 00
The mstallatlOn IS bemg made on property I own WhlclTHIS;lER I fRA~IliRMlT IS ,~U I $ 5000
IS not IOtended for sale, lease or rent AUT tfS' ~ePlNOO~mij,ee IS $50 00 + Surcharges
COMt:IIEN.C.~Q, (/ f
O)Y'"\rs Slgnatur~ / ~ ANY l'8o'Wff:vtlWDOF ABOVE D b
~'d/ ,12%StateSurcharge /O~L
......-i 10% AdmIDlstralIve Fee 8"'C:
C/ 5% Technology Fee Lf.To
/ D ? zz.
Inspechon Request 726-3769
TOTAL
Shared Dnve(T )/Bulldmg FormslElectncal Permit Appllcauon )-08 doc
--~.."~ 1iiii
~
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO' COM2008-007I2
ISSUED 06/17/2008
APPLIED: 05120/2008
EXPIRES' 01/22/2009
VALUE $ 47,250,00
225 F,fth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fdx
541-726-3769 InspectIOn LIDe
SITE ADDRESS 2318 17TH ST
ASSESSOR'S PARCEL NO 1703252112000
Spnngfield TYPE OF WORK FamIly Room
TYPE OF USE AddItIon
ReSIdentIal
PROJECT DESCRIPTION FamIly room and bath addIllOn
Owner DONALD A YOUNG REVOCABLE LIVING TRU
Address 2318 17TH ST
SPRINGFIELD OR 97477
Phone Nnmber 541-747-7826
I CONTRACTOR INFORMATION I
Contractor Type Contractor License ExpiratIOn Date Phone
General PRECISION REMODELING INC 11 1300 02102/2011 541-485-7480
Electncal OWNER
MechanIcal COMFORT FLOW 460 06127/2009 541-726-0100
PlnmbIDg JOE PISCOPO PLUMBING LLC 167915 01110/2012 541-510-0770
VB
I BUILDING INFORMATION I
# of Stones' .\aVllequlleS yo"I~~ Lot SIZe
Ei' ODSlllo98prl\11e OlegOfl7~~ortl\Sq Ft 1st Floor
p.,11 ~WlPM\[lli\\ed 8\'il'~ane~~C001J5q Ft 2nd Floor
10\\~~ le\~CJj~t l~hlOU9h O/l..R 95 I~S I:l q Ft Basement
NO~/I.. ll)ily~01~n COpIeS otth8l~ne ~q Ft Garage/Carport
In 90 ~!llIll'JlRPta ,~ote. the ~t!ffJ!cauonSq Ft Other
00 cali~~~!'8\~Wl~ ~~~\~~IC Occnpdnt Load
I DEWLo~ rN}.(f'RMATION I
15,682
450
# of Umts
Pnmdry Occnpdncy Group
Secondary Occupancy Group
Pnmary ConstructIOn Type
Secondary CoustructlOn Type
# of Bedrooms
R-3
REQUIRED PARKING
Frontyard Setback
S,de 1 Setback
SIde 2 Setback
Reary drd Setbdck
Solar Setbacks
10 00
Overlay DlSt
# Street Trees Rqd
Paved Dnve Rqd
% of Lot Coverage
Urban FrIDge
Total
HandIcapped
Compact
Street Improvements
Storm Sewer AvaIlable
SpecIal InstructIOn
I PUBLIC IMPROVEMENTS '. WO~\(.
NU "(,,. ~m~ ,nl\~
1HIS PERNI\'t"S"~Jb\I$"p"ERNI\1 IS MOl
AUTHORIII!!)l\l~IS ABAfIDUMED fOR
COMMENCED OR
ANY 180 DAY PERIOD.
Notes Stormwater to eXlstmg eaves
Paee 1 of 4
-~~
Status
Iss u ed
225 F,fth Street, Sprmgfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769InspectIon Lme
DeSCriptIOn
Tvpe of ConstructIOn
V Wood Frdme
Dwellmes
Fee DescriptIOn
Plan RevIew ReSidentIal
-Mechamcal Issuance Fee--
+ 10% AdmIDlstratlve Fee
+ 12% State Surcharge
+ 5% Technology Fee
AIr Handling Vmt Vp to 10,000
Hedt Pump
Mlmmum/Adjustment Mechamcal
Reversal - -Mechamcal Issuanc
Reversdl- + 10% AdmlmstratIv
Reversal - + 12% State Surchar
Reversal- + 5% Technology Fee
Reversdl - AIr Handling Vmt V
Reversal - Heat Pump
Reversal- MlmIDum/Adjustment
+ 10% AdmIDlstratlve Fee
+ 12% St..te Surcharge
+ 5% Technology Fee
I Bdth One & Two F dmIly
BUlldmg Permit
FIre SF Fee - ReSIdentIal
Plan ReVIeW MIDor - Plannmg
Samtary Sewer - Improvement
Samtary Sewer - Reimbursement
SDC Samtary/Storm Admm
Storm Dramage ImpervIOus Area
+ 10% AdmmlstI atIve Fee
+ 12% Stdte Surcharge
+ 5% Technology Fee
Add, Alter, Extend Orc Ea Add
Perm Serv/Fdr 200 amps or less
Total Amount PaId
I Valuation DescrilltlOn I
$ Per Sq Ft
or multIplier
$10500
Amount PaId
$257 05
$20 00
$700
$840
$350
$900
$1400
$2160
$-2000
$-700
$.840
$,350
$-900
$-1400
$-2160
$57 80
$66 66
$33 57
$16000
$395 46
$22 50
$1l600
$14283
$18783
$26 53
$200 00
$860
$1032
$430
$1600
$70 00
$1,77545
Square Footage
or B,d Amount
450 00
Total Value of Project
J{p~~, ~
Dale PaId
5/20/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
5/30/08
6/17/08
6/l7!08
6/17/08
6/17/08
6/17/08
6/17/08
6/17/08
6/17/08
6/17/08
6/17/08
6/17/08
7/22/08
7/22/08
7/22/08
7/22/08
7/22/08
Paee 2 of 4
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO' COM2008-00712
ISSUED: 06/1712008
APPLIED 05120/2008
EXPIRES 01122/2009
VALUE: $ 47,25000
Value
Date Calculated
$47,25000
$47,25000
OS/20/2008
ReCeipt Number
1200800000000000533
2200800000000000794
2200800000000000794
2200800000000000794
2200800000000000794
2200800000000000794
2200800000000000794
2200800000000000794
2200800000000000796
2200800000000000796
2200800000000000796
2200800000000000796
2200800000000000796
2200800000000000796
2200800000000000796
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
1200800000000000665
2200800000000001122
2200800000000001122
2200800000000001122
2200800000000001122
2200800000000001122
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO' COM2008-00712
ISSUED: 06/17/2008
APPLIED: 05120/2008
EXPIRES: 01/22/2009
VALUE $47,25000
225 F,lth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
I Plan Reviews I
InItIal RevIew 05/21/2008 05/21/2008 APP LLH
Public Works RevIew 05/21/2008 05/22/2008 APP TSS Storm water to eXlstmg eaves
Plan RevIew Comments 05/30/2008 05/30/2008 10 LLH Mechamcal permit Issed m error
and reversed
Structural RevIew 05/2112008 06/10/2008 APP RWC
Planmne: Review OS/21/2008 06113/2008 APP TAJ 10' IS mIDlmum street Side setback
To Request an mspectlOn call the 24 hour recordmg at 726-3769. All mspectlOns requested before 7:00
a m, will be made the same working day, inspectIOns requested after 7,00 a m Will be made the followmg
work day.
~Jr"r1I\l.''1~rt;omJ
Rough Mechamcal Pnor to Cover
Fmal Mechamcal When all mechdmcal work IS complete
Footmg Alter trenches are excavated
FoundatIOn Alter forms dre erected but pnor to concrete placement
Post and Beam Prior to floor msulatlOn or deckmg
Floor InsulatIOn Pnor to deckmg
Shedr Wall Ndlllng Before lavermg shedthlllg wIth fimsh matenals
Frammg InspectIon Prior to cover and after all rough In mspectlOns have been approved
WdlllnsulatlOn Pnor to cover
Cellmg InsulatIOn Pnor to cover
Fmal BUlldmg After all reqUIred mspectIons have been requested and approved and the buddmg IS complete
Penmeter FoundatIon Drams After gravel and filter cloth IS mstalled but pnor to backfill
Underfloor Plumbmg Pnor to msulatlOn or deckmg
U nderfloor Dram Pnor to cover or placement of concrete
Rough Plumbmg Pnor to cover and mcludmg requIred testmg
Shower Pan Pnor to covenng and mcludmg required testmg
Water Lllle Pnor to filling trench and mcludmg requIred testmg
Samtary Sewer Lme Pnor to filhng trench and mcludmg reqUIred testmg
Filial Plumbmg When all plumbmg work IS complete
Paee 3 of 4
-iIiF
CITY OF ~rKll~tJ1'lJ1.LD .
Building/Combination Permit
Status
Issued
PERMIT NO
ISSUED'
APPLIED,
EXPIRES:
VALUE'
COM2008-00712
06/1712008
OS/2012008
0112212009
$ 47,250,00
225 FIfth SII eet, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
Underlloor MechaDlcal Pnor to msulatlOn or deckmg aud mcludmg reqUIred testmg
Rough Gas After hne IS mstalled and reqUIred testmg and capped If not attached to an apphance
Rough MechaDlcal Pnor to Cover
Fmal MechaDlcal When all mechanICal work IS complete
Rough Electnc Pnor to Cover
Electnc ServIce Approval reqUIred pnor to ullhty company energlzmg servIce
Fmal Electnc When all electncal work IS complete
By SIgnature, I state and agree, that I have carefully exammed the completed apphcallon and do hereby cerllfy that all
mformatlOn hereon IS true and correct, and I further cerllfy that any and all work pertormed shall be done 10 accordance with
the Ordmances of the CIty of Spnngfield and the Laws of the State of Oregon pertammg to the work descnbed herem, and
that NO OCCUPANCY WIll be made 01 any structure wIthout permISsIOn of the CommuDlty ServIces DIVIsIOn, BUlldmg Safety
I further cerllfy that only contractors aud employees who are 10 comphance wIth ORS 701 005 WIll be used on thIS proJect.
I turther agree to ensure that all reqUIred mspectlOns are requested at the proper lime, 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 remam on the SIte at all
tImes durmg constructIOn
{Q~t!)~~
1',/ {7'
Owner or Contractors Slgndture V
7/.;z~9
I
Date
Page 4 of 4
~
'Construction Contractors Board
700 Summer St NE SUIte 300
PO Box 14140
Salem OR 97309-5052
Phone, 503-378-4621
Web Address' www ccb state or us
Perrmt # COIM z..C 0 c- () () 7/ Z
Address Z 5/ t' 171-L... $)--
Issued by i::>{s Date ~/zr~ g-
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note Oregon Law, ORS 701 055(4) requires resldentzal constructzon permit applicants who are not
lzcensed with the Constructzon Contractors Board to sign the followzng statement before a bUIldzng
permit can be Issued This statement IS reqUired for resldentzal bUIldzng, electrzcal, mechanzcal and
plumbzng permits Licensed architect and engzneer applzcants, exempt from lzcenszng under
ORS 701 010(7), need not submit thiS statement This statement will be filed with the permit
FIll m the app.vpuate blanks and mltIal boxes 1 and 2, and either box 3A or 3B
ifl
~2
,
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
o 3A My general contractor IS
(Name)
(CCB #)
I will mstruct my general contractor that all subcontractors who work on the structure must be
lIcensed with the ConstructIOn Contractors Board
OR
~B I will be my own general contractor
If! hire subcontractors, I will lure only subcontractors lIcensed with the ConstructIOn Contractors
Board If! change my mmd and rure a general contractor, I wIll contract with a contractor who IS
lIcensed with the CCB and will l1nmedlately notIfY the office IssUIng thiS bUlldmg permit of the
name of the contractor
I bereby certify that the above mformatlOn 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,
~Cl,tL~
(Signature ofpe~;lIc~'
?/ ~/r7K""
, (Datej -
(WhIte copy to Issuzng agency permit file, pznk copy to applicant)
Property_owner doc 06-01-04
" ~ r -
A-ttirl~) as' Your-Own General Contractor?
--I '") .JlT',- \ '" ,<.- <- I ,
...... <' '\ .., ~ '-~
INFORMATION NOTICE TO PROPERTY OWNERS
" r \', "\,' AB.Q.ULCONSTRUCTION RESPONSIBILlTIES-
\ \
NOTE This Information Notice to Property Owners about Construction Responslbilllles was developed by the
ConstructIon Contractors Board In accordance wllh ORS 701 055(5), passed by the 1989 Oregon Legislature
If you are actmg as your own contractor to construct a new home or make i substantlallmpro~ement to an eXlstmg
structure, you can prevent many problems by bemg aware of the followmg responsIbilItIes and concerns
Employer Responsibilities
You WIll, m most mstan{.es, be ruled to be an "employer" and the contractors you contract WIth wIll be "employees" If
you u~ contractors not hcensed WIth the Consln+ctlo!\ Contractors Board to do labor m constructmg or to assIst m the
constructlOn or Improvement of a resIdentIal structure A~ the employer, you must comply WIth the followmg:
. - ,
. ~ ,'>'" .. ,
Oregon'. Withholdmg Tax Law: As an employer, you must WIthhold meome taxes'from employee wages'at the time
employees are paId You will be I;able for the tax payments ~"en If you don't actually wIthhold the tax from your
employees For morc mformatlon, call the Department of Revenue at 503-378-4988 "
Unemployment Insurance Tax: As an employer; you are reqUIred to pay a tax for unemployment msurance purpos~
on the wages of all employees For more mformatlOn, call the Oregon Employment Department at 503-947-1488
, ..........
The Oregon Busmess IdentIficatIOn Number (BIN) IS a coml;nned number for both Oregon Wlthholdmg and
Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dOl state 01 usfformsnav htmll for the
ap'p.l.Vf"~Aate forms
"
Workers' Compensation Insurance. As an employer, you arc subject to the Oregon Worker,,' CompensatIon Law,
and must obtam workers' compensal1on msurance for your employees If you fjlll to obtam workers' cOfl1pensatlon
msurance, you could be subject to penall1es and be hable for all claIm costs If one ofyo,!r employees IS mJured on the
Job For more mformatlOn, call the Workers' CompensatlOn DlvlSlon at the Department of Consumer and Busmess
Servrces at 503-947-7815
U,S, Internal Revenue Service' As an employer, you must wlthhold federal Income tax from 'employees' wag;;S~
You WIll be hable for the tax payment even If you dIdn't actually \VJthhold the tax For a Federal EIN number, call the
IRS all-800'829-4933'6r VISIt theIr web SIte a(owww IlS l!OV
; ~ - ' .
, Other Responsibilities and! Areas of Concerins
Code ComplIance As the penmt holder for thIS prOject, you are responSIble for resolVIng lmy fallure to meet code
reqUirements that may be brought to your attentiOn through mspectlons
s ,
LIability and Property Damage Insurance' Contact your Insurance agent to s~e If you have' adequate msurance
covel age for accldcnts and orrusslons such as fallmg tools, pamt over spray, water damage from pIpe punctures, fIre or
work that mU,~t ~e r~d~e~ \ (' r ~ _" \ '::\ "'-,: . ~ '" _ ~ r.) ,
,)
TIme: Make sure you have suffiuent time to supervIse your employees ,
"
'~
, ,
.. ... .
ExpertIse Make sure you have the skIlls to act as your own general contractor, to coordimite the work of rough-m
and fill1~h trades, and to DOtlfy bUlldmg offiCials as the appropnate times so they can perform the reqUIred mspectlons
If you have addlhonal quesnons call the Constructron Contractors Board (503-378-4621) or wnte the agency at PO
Box 14140, Salem. OR 97309-5052
,
Property_owner doc 06,01-04
225 FIfth Street
SpnAgfield, Oregon 97477
541-726-3759 Phone
~~~
CIty of Sprmgfield OfficIal ReceIpt
Development ServIces Department
PublIc Works Department
Job/Journal Number
COM2008-007] 2
COM2008-007]2
COM2008,00712
COM2008-00712
COM2008-007]2
Payments
Type of Payment
Check
cRecemtl
RECEIPT #:
2200800000000001122
Date. 07/22/2008
DescriptIOn
Penn Serv/Fdr 200 amps or less
Add, Alter, Extend Clrc Ea Add
+ 5% Technology Fee
+ ] 2% State Surcharge
+ 10% AdmInistrative Fee
PaId By
LOUIS YOUNG
Item Total
l.:heck Number Authonzatlon
Received By Batch Number Number How Received
dJb 7421 In Person
Payment Total
Page 1 of I
104434AM
Amount Due
7000
1600
430
]032
860
$10922
Amount Paid
$10922
$10922
7/22/2008