HomeMy WebLinkAboutPermit Miscellaneous 2009-2-11
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2211 DORNOCH ST ,
ASSESSOR'S PARCEL NO.: 1703272207502
CITY OF ~rK11'\j\.JFIELD-
Building/Combination Permit
PERMIT NO: COM2009-00198
ISSUED: 02/11/2009
APPLIED: 02111/2009
EXPIRES: 08/1112009
VALUE:
Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Reconnect electrical service'
TYPE OF USE: Alteration
Residential
~s;r
~'~~
Owner:
Address:
BROWN HAROLD L & PATTI K
2211 DORNOCH ST
SPRINGFIELD OR 97477
ContraCtor Type
Contractor
# of Units:
Primary Occupancy Gronp:
Secondary Occnpancy 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:
De~cription
Type of Construction
AT~nITION: Oreaon law reqUire,; YUtJ cu
I CONTRACTOR-INEORMAlH0N' Ilregol1 Uti!ily
Noiilicatl,>o~ll\er. 1 flU"",' ",,,s are set tor~h
in OAR 9b<.-v,' 001llJiceitse'l OA~i'iM1J'tiiin Date Phone
0090_ Vou may 'J 0;'1 copies of tile rUles oy
,. I_~_. ......~ f....I^nhnl"lo
BUlLDIl,iG:iNFORMATioN ("ility Notification
. Center IS l-bUv-vu- 2.344).
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
R~nge Type: , Sq Ft GaragelCarport
Energy Path: Sq Ft Other:
Sprinkled Building: nla Occnpant Load:
~J.~::~:::
I DE~E'f.9I\Mm)IT~MJ\Ijj'O!'llI'THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT REQUIRED PARKING
C~y.~r~~~~:()R IS ABANDONED FOR
A ~I/;Sfb'i'tt[J;';fell' ~\tD.
"PaveoDrive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
1.~UBLlC IMPROVEMENTS'
Sidewalk Type:
Downspouts/Drains:
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of 2
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO:COM2009-00I98
ISSUED: 02/1112009
APPLIED: 02/11/2009
. EXPIRES: 08/1l!2009
VALUE:
_&~~frI!!,~ImII1,!1RL
~,
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone .
541-726"3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid'
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
AmounfPaid
Date Paid
$7.56
$3.15
$63.00
2/11109
2/11109
2111/09
Total Amount Paid
$73.71
Plan Reviews I
Receipt Number
2200900000000000165
2200900000000000165
2200900000000000165
,. I
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
I". .
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
. I
work day. !
~eouired I~.sJleCtion~ ,
Electric Service: Approval reqnired prior to utility compan~ energizing service.
I
By signature, I state and agree, that (have carefully examined the bomPleted application and do hereby certify that all
information hereonis true and correct, and J further certify that a~y and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any strncture without permission of the Community Services Division, Building Safety.
J further certify that only contracto.rs and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree.to ensure tbat all required inspections are requested at the proper time, that each add'ress is readable from t~e
street, that the permit card is located at the front of the prop'erty, and the approved set of plans will remain on the site at all
times during construction.
~/~ d- ~Q.
{;) ,
Owner or Contractors Signature
---
02- //1/,) 'T
Date
Pa2e 2 of2
1:;i~~~_\h:'~''1>~tewMi+a$Of.~~~~,,"~>\XT~1;1
1~i;;~~1~el\5Jl~~~~~~.~"~iX~
I Permit no:Oc:; -I Y 6' I
I Date: 2/1 1 / if; I
1 I
This permit is issned under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is snspended for 180 days.
1l.\_ml!'QGAk'\{G.Q\tEB:NMENif"~RP.R0'Vfl.l!:~~~
1 Zoning approval verified? DYes D No
1~~C~mEGp,BYJi01i&tC,0NSmR.l!JCmI0N~1!;,~~I'
I ~esidential 1 D Govemment l D Commercial
1~0B~$lmE~INF;pBMA\i]j10Nifl.ND.!!&'QQ'~'li10N~.\1i
I Job site address: i-J-./ / ))0 nJ() C0- I
1 City: ('.o.a..! 1- State: tJy- 1 ZIP:,?; Y7' 1
I~=,:~~_ . . '.' ", "Ri- "" J Lot;;~~~""~,,~,,,;
1l;,;0"J9!R''''~'ilDES~RII''~ml~(Il;'LC:>FiftIW~RK~\.!ffii~c;i$",,'~1
1 1f}-f}(fJ 0el1J"~ Tktowtll~
1
1!~~r~J1iIlflRB:QaE8.T,y4[~WNERf;,~i\~1lfl'c4,'1t~
I Name: </.lorn I ^ I-- Kww A.)
I Address: ;';L;;LL / j)tty- N c') C /.......
I City: S/,J Jti!d I State:Dr'
I Phone: S"='q -( J"t',f''-l7o/'~ Fax:
1 E-mail:
This installation is being made on residential or farm property
owned by me ora member ofiny immediate family, This
property is not intended for sale, exchange, lease; or rent. OAR
479.540(1) and 4]9, ,560(1),
Signaturor/4'A-?/ :z _~ . ,,--=-
1"-~~c:>NmMCmPR'iiINSmAI!E~TiI0N~~f41J[,1.1
I Business name: .f)vJ If 0L- 1
I Address: I I Each branch circuit
I City; State: I ZIP: I I b. Ree for branch circuits without purchase of a serviCe or feeder fee:
1 Phone: 1 Fax: 1 I First branch circuit (2) $ 55,00 $
I E-mail: 1 ,I Each additional branch circuit $ 6.00 $
I CCB license no.: I BCD licen;e no.: I I Miscellaneous fees: service qrfeeder not included
I Signing supervisor's license no.: I I Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor:- 1 I Each sign or outline lighting (2) $ 63.00
Signat~re of signing supervisor: I I Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2) .
Electrical Permit AplPlication
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753.FAX(541)726-3689
1 ZIP:Cj)i/7 )
44O-2584-J (9/08/COM)
I Residential, per unit, service included: I
11,000 sq, ft, or less (4) $134,00' $ 1
I Each additional 500 sq. ft. or portion $ I
thereof $ 25.00
1 Limited energy (2) $ 32,00 $ 1
I Each manufactured home or modular I
dwelling service orfeeder (2) $ 63,00 $
I Services or feeders: installation, alteration, relocation I
I 200 amps or less (2) $ 81,00 $ 1
I 201 to 400 amps (2) $ 95,00 $ I
I 401 to 600 amps (2) $158,00 $ I
I 60 I to 1,000 amps (2) $205,00 $ I
Over 1,000 amps or volts (2) $469.00 $ I
Reconnect only (2) 1 n. $ 63,00 $ 03~
I Temporary services or feeders: installation, alteration, relocation I
1 200 amps or less (2) $ 63.00 $ I
1 20] to 400 amps (2) $ 87,00 $ I
1 40 I to 600 amps (2) $126,00 $ 1
lOver 600 amps or 1,000 volts, see services or fe~ders section above \
1
1
/'
I
1
I
I
I
]
I
Branch circuits: new, alteration, extension per panel
. a. Fee for branch circuits with purchase of a,service or feeder fee:
I $ 6;00 / $
$
$
additional inspection: (I)
$58,00 $
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
1 (B) Enter 12% surcharge (.12 x [A])
I (C) Technology Fee (5% of[A])
I TOTAL fees and surcharges (A through C):
$ .?
(p'?
$ /I~
$ :K!5--
$ '13 '!..!-
Construction Contractors 'Board
-700 Summer St ~ SI!Jte 300 -"
PO Box-141'10 ' .. '
Salem O~ 97309-5052 .', : _ .-
Phone: 503-378-4621 ,
Web Address: wwW.ccb.state,or.ns
Permit#: ~'~5-:nr) (,7 F
-
Address:' ;2.;).--1 ( bo;!..../V~'
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Is;ued by:' (]~
',- Date:
2/11/1)7
.,
.
, .
State~ent: Information Notice to Property Owners
AboutConstruction Responsibilities" .
'j' .
Note: Oregon Law. ORS 701.055(4) requires residential construct~on permit applicants who are not "
licensed with the Construction'Contractors Board to sign' the following statement before'a b~ilding
permit can be issued.' This'statement is requiredfor residential'building, electrical. mech~nicaland
, plumbing permits. Licensed architect and engineerappliccmts. exemptfroinlicensing under -','
ORS 701.010(7). need not submitthis statement. This statement will be/zled with the permit.
. -.. . . .- - . '.~
. . . . ,
. "
Fill ~n the app>vpriate blimks and initial bo~es I and 2, and dthe~ box 3A,or 3B,: ,
.~. .
~,.
,
,~
..1. ,I own, reside in, or will residdn,the completed structure.
2. 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 #~
.,' .
.... ' "',' ,',
twill instruct my general contractor that all subcontractors who work onthe structure must be
, licensed with the Construction C:6ntractors Board: ' .' -
OR
~, ,3B. I will be my own genl'ral cop.tractor.
. if I hire-subcontractors, I will hire only subcontractors licensed with the Construction', Contractors
Board. If! change my mirid'.and hire a general. contractor, I will contract with a contractor'who is
'licensed with the CCB and will immedjately notifYtheoffice issuing this building permit ofthe '
'name of the contractor.., , .'
. ;: hereby certify that ,the above information is correct and that I have read and do unde;staJd the Inforu;atlon
N'.)tice ,to Property Owners abo~tConstrnction Responsibilities on' the reverse side of this fJrm. '
, :', '". '.., J " .'
i/~7-'~ ~//I/(/r'
(Signature ofpel1llit applicant) . (Date),
(White copy to issuing agency p(!rmitfile. pink copy to applicant.)'
,
Property _ owner. doc 06-01-04
.,
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ActiIfg:as ''Yioilt-'Own 'Genera:l'~C~~tractor?--:;. ;'.
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.'~ . - '.-INFORMATION NOTICE TO ,PROPERTY OWNERS -'.t; . .p' ,<
. '1 " '.-
~,\\,\\:';.. :-.,~. -ABOUT~I'!~T!,U'C,tIQN:RESPONSIBILITIES.."" "'.'
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NOTE: This Information Notice to Property Owners about Construction R~sponsibi1itJes was developed by th';
Constructiori. Contractors Board in accordance witli ORB 701.055(5), passed by the 1989 Oregon Legislature. -
.' . ~;",;~~,::...:.:~:~~,,", ~~,'-'_~'~'~ '.'r... .....~ .','" .....r.ot'~;/,',~.if . ~- ......." ."
If you are acting as YOll!' own 'c,?ntra~!or to construct a ncw home or make a subs!anti,al impro::ement to' an existing
structure;you can prevent'.many prolilems,by beirig aware of the folloWing responsibilities and<concems.
. . ~ ~
Employer Responsibilities
" . ~. ", . t" ,.r.I". ,",;"" '"j" ... ,\ ".:. ,". . ,'\. ;, ," . L~' '.-. . 0 I
You'J"Ul,\jn'!ll<isrj!}!'ta.n!?es,;~erul~4to.!!e,!\n,','emp,\oyer",an(tth~ ~.ontraC!9!'~'.Yo.u,c<?ntI:a~t'vo.:it~ will b.e "~m.ployees" if .
you u~e c.ont.ra~tQrs;!Iot licensed .yitJ:t the.Qo!1stru~tio!! Contractors Board,to ,doJabOl,-.in con.s~cting or to assist in the
~ ....., ."' .',' ""~'" ._..,;1 .... .~...~".~.. J'. ,.\., 4 I.~ _I" ..... '....,,'-" ". '. ~
construction.o.r\4mpro~ement flf a.resid,ep.tial structure. As .the ~mployet:;yol-1 i:nu.s~ 'cill~j:ily with- t\l.e foq~wi\lg: . .
. <-:~:-.~"~._~'~~;~..."~.L~:"};':\" .' vl~,.~,r:,^~ ~"_:~.~:.' " -~,:..:.. '.' .:, .~~..~.. :~F ,.":",,,~ ..,...., .~\.~.
Oregon's Withholdhig 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 payment~ even if you don't actually wit!1holdthe tax from your
e1!lployees. For more inforrmition;:b'all'tlfe Dep3:rihiiint o{Re'/e~ue at 503,378--4988. ,.:.;",: ,,:Ct " ;" r', '.
Unemployment Insurance' Tax: As an einplj)yeti-)'Qu'fan!"f€qU:iredtopayl~tax 'for unemployment insurance purpQs~~'>
on the wages,of all employees; For more information, can the Oregon EmplQyment Department at 503-947- 1488.
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t. . 'J'" ,,' ',;{ -. i!~J- .':-:f-:) ,)ff. :J h.t~,-'''''' ,~!,-,}.....' i"!,):;.'llit.* . t.... .j ': : ~.{'(' -:,-.1 .-'. ~ .:~; .,~ . .::~.~ -ol' ~L: ". ' 1.. I. . . ;' 1.. '
The' Oregon Business Identification Number (BIN) is a combi1).ed :,n.i1JnbeL fQr ;1>pt):1. Oregq~ Withholding and: "~I
Unemployment Insurance Tax. To file for a BIN; call 503-945-8091 or www.nor.state.or.us/formsnav.htmll for the
appropriate forms. . _ .." .
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Workers' Compensation Insurance: As an employer;, you ire subject to the Oregon 'Workers' Compensation Law,
and must ,obtain workers' compensatiQn insurance for your employees. If you fail to obtain workers' compensation
insuninc~; Yo~~o'JldBis1ibji:c\fop~alties"arid be:'liaiiJ'~ for all' cjlliin(io~rs if on6 'bf your'irtipioyees"iS" lA]u~ed on the
job. f'6r' rilQieinfQimation;' call the WQrkers' Conip~Iis~tiori Divlsi6n'l'it the'Depai-Werit of Consumer' and Business
Services at503-947-7815.
U.S. Int~rnal Revemie'S'ervice: "As 'an employer; you must withhold' federariIicofue' tax .from 'ern'ployees';wages"",'
You will be liable for the tax payment even if you didn't actually withhold the.tax: For a Federal EIN number"call the
IRS ai:.1c800!8294933lor'vislt--their web site at www.irs:!lov. ,ffc' . i:'", ",;._ ..,,' "', E
.... ..":.--'fj(.l:: : ~ ~...... '~(l-"... p! ' Jot....:::,:..: ,j.:,,"r..r .... _ :,J:.~ J..~' . p'. 'of 8:\:
.,:: .' ,::."Othe.l"'-~esp()nsibilities a~d.Ar.~asof C<>n<;erns,
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Code Compliance: i\s the permit holder feir this"project, you are respqnsible for iesoiv'iiigany"failure'to meet code
requiremerits t)1a.t !Day be brought to your ?ttention through inspections. _ .
. :;i.---.tJ'~:l'.:",;,,"".'-\."'~",:," .~1' .....'-.:j'~-.:..'"'_:. "'. ....._,;....:.._..-.~~.'~ .,.. ~.~"., ~", ,~~"':.:::...:..~...
'Liability and Prope* Da~'age' i'Dsiir'ance:-'~Cohtait~btir 'itikurdnce hgent'to' ~~e if you 'have' adequate insuraric-e'
coverage for accidents and omissions such as falling tools, painlover spray, water damage from pipe pynctures" fire or
wQrk that must be redone. ~ . . ,_.', '- .
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Time: Make sur~ you':na..).e,sufficient time to supervise youi- emp]oyees~' ". -. . ",' ....: - ,-" '"
'Expertise: Make sure' ydu: ha~e\ii'e' skiiis"to ~ct as Y6u}' ~~ \en~rarcorifraCfor,' to" ~o~i-ii;~~(e the work of rough-in
and finish trades, and to notify building officials as the appropriate times so they can perform the required inspe,ctions,
If you have additional questions call the ConstrUctiQn Contractors Board (503-378-4621) or write the agency !'It PO
fl.'lx 14 ]40, Salem, OR 97309-5052.
.. .
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,
PrQPl'l1y _ owner. doc 06-01-04
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00198
COM2009-00198
COM2009-00198
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Description
Service Reconnect
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
HAROLD BROWN
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000165
Date: ,02/11/2009
Item Total:
t.:heck Number Authorization
Received By Batch Number Number How Received
CJC
322495 In Person
Payment Total:
Page I of 1
II :33: I2AM
Amount Due
63.00
7,56
3.15
$73.71
Amount Paid
$73,71
$73.71
2/11/2009