HomeMy WebLinkAboutPermit Electrical 2009-2-13
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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I Date"~p ~J {) 1 I
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are uontrausferable. Permits expire if work is uot started within 180
days of issuauce or if work is suspended for 180 days.
1F"'.;:1'z'~o.'n."lmnlgill!a.p{p;l!r.<:)o'v:eaAl'v~e. ~n:Gfil.e<:)dJ?".;E~NIIII.EDNitY~eAs'e;e;R~:VAD'L~N.O 'J.91.:~~ _~~IiEE~S:C8ED.UI!!E~;~~mti[l
~N'lfi;tf,1~~l"p~i~p~1~"(li~)' .':~llliQ~~y,iIFl.G9~ ~'t~ral~
- , i&JLY\J;;~,t~{;&~&fu4iJ~~irr,llfd~~;i~~ '}J:;~ ~~!cl:,;:~@ ~o~f~
i=:~JAml:~iR~~~:7:;~~Jf;RUr~0~=~:~1J~ I Residential, per unit, service included: . ~
~~lIol3~j3lmE~HNF,,0I3MAi1'IQNr/\lil[)]I!c:1GAmI0N~~~il&! 11,000 sq ft. or less (4) $134.00 $
Job site address: Y 150 t=r/J\Y\.k\;", R\~ d ~ E:.\4 . I ~~~~:fditiona1500 sq. ft. or portion $ 25.00 $
I City: t:lA~iLY\.S- r State: OR. I ZIP: en ~03 I Limited energy (2) $ 32.00 $
I Subdivision: " 1 Lot no.: I Each manufactured- home or modular
1~::~D:C~I~;~~~:=c:1~~~== I :::il~:: ~:~~::eo:s~~:;:l;~;'on, oileration, relo:at::~OO $
f\t:rrL- ~ ;;""(;)14: ~L-(\'S..W'- <; . I 200 amps or less (2) $ 61,00 $
ili1f"-il"'>>~~~~Rc:1~I:.Ril1t([{QWNI:B~rit~~~lIi1i!ii'jfl I 201 to 400 amps (2) $ 95,00 $
Name: SIA\'\dro. J. ~;td,\.e_\\ I I 401to 600 amps (2) $156,00 $
I Address: 4(,(,n F".?l'\ldiY\ \5IJd it: .3Y I I 601 to 1,000 amps (2) $205.00 $
I C. F Iso I 01110'2 I lOver 1,000 amps or volts (2) $469,00 $
Ily: lAo,Q.\'\~ tate: R. ZIP: I 1 _ )
I Phone: 5'11 - ~11- \ ~ 3 Y I Fax: I I Reconnect only (2) $ 63.00 $
I J I I' 0 I I \ I I Temporary services or feeders: installation, alteration, relocation
E-mail: WiI\l".tc.-\v\;.6... ~Lfl:\ (a) iIIDil'vl"'; .cDtv\
This installatiou is being made on residential or. farm property I 200 amps or less (2) . $ 63.00 $
owned by me or a member of my immediate family. This I 20 I to 400 amps (2) $ 67.00 $
property is not intended for sale, exchauge, lease, or renl. OAR
479,540(1) and 479.560(1). . I 401 t.o 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
1~~C.0NmRWcmQRl!INsmilil!l!,6;mll:)N~1I:~\iiL\~\~ I Branch circuits: new, alteration, extension per panel
I Business name:. . I I a. Fee for branch circuits with purchase of a serv-ice or feeder fee:
I Address: I I Each branch circuit I $ 5,00 I $
I City: I State: I ZIP: I I b. Fee for branch circuits without purc?a~e of~ service or feeder fee:
I Phone: I Fax: I I First branch circuit (2) I L I $ 55.00 $ ~
I E-mail: I I Each additional branch circuit V7&i1 $ 6.00 ~ i:;!-
CCB license no.: I.BCD license no.: I Miscellaneous fees: service or feeder not included ~ I
Signing supervisor's license no.: I Each pump or irrigation circle (2) $ 63.00 $ I .
I Print name of siguing supervisor: I Each sign or outline lighting (2) $ 63.00 $ I
I S. f'. . I Signal circuit or a limited-energy panel, $ 63.00 $ I
19uature 0 slgumg supervIsor:
alteration, or extension (2)
1~;;;~~0[l!~~~Ntr~6sE~;~~~
I (A) Enter subtotal of above fees
$ en_DO
(Minimum Permit Fee $58.00) "I.
I (B) Enter 12% surcharge (.12x [A]) $ ~10L
I (C) Technology Fee (5% of [AD $ 4 JS I
I TOTAL fees and surcharges (A through C): $ ~
113 'J:i--
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440-2~S4-J (9/0S/COM)
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00217
ISSUED: 02/13/2009
APPLIED: 02/13/2009
EXPIRES: 08/13/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4750 FRANKLIN BLVD SPACE E14 EUGENE
ASSESSOR'S pARCEL NO.: 1803031103500
TYPE OF WORK: Single Family Residence
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION:
Owner:
Address:
Owner:
Address:
MITCHELL SANDRA JEAN
4660 FRANKLIN BLVD SPACE ,034
EUGENE OR 97403 ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
BARTOW DENNIS & DONNANotification Center. Those ruies are set forth
4750 FRANKLIN BLVD SPACI);-,F<99?, 952-001-0010 through OAR 952-001-
EUGENE OR 97403 0090. You may obtain copies of the rules by
\Jctlllll~ lIlt: litjl Hel. tl\lUlt:::. U Ie U::HepltUflld
'1"(i;0NTRAGTOR IINFORMi\;'FION"I1tion
........."...., ...... I '-'vv V'-'''- ..........J.
Contractor Type
Contractor
License
Expiration Date Phone
BUILDING INFORMATION I
VB
# ~f Stories: Lot Size:
HeIJ;lht of Structure Sq Ft 1st Floor:
N OT'WJie:of Heat: .:, Sq Ft 2nd Floor:
THIS~~\llfvID'~HALL EXPIRE IF THE WOM<Ft Basement:
AUn~J/Wl'~UlmER THIS PERMIT IS N~ItFt Garage/Carport
COMEner~ ~'R I~ ~B ANDO ~q Ft Other:
S'IfrJ~i<LI ullMn. N~p" FOR Occupant Load:
ANY HHmA FRIO .
, DEVELOPMENT INFORMATION ,
REQUIRED PARKING
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gronp:
Primary Constructiou Type
Secondary Construction Type:
# of Bedrooms:
R-3.
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Disl:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instructiou:
Sidewalk Type:
Downspoutsillrains:
Notes:
Paee 1 01"2
,
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009"00217
ISSUED: 02/13/2009
APPLIED: 02/13/2009
EXPIRES: 08/1312009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Liue
I Valuation Description I
Description
Tvpe of ConstruCtion
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Exteud Circ
Add, Alter, Extend Circ Eo Add
Amount Paid
Date Paid'
$11.64
$4.85
$55.00
$42.00
2/13/09
2/13/09
2/13/09
2/13/09
Receipt Number
1200900000000000103
1200900000000000103
1200900000000000103
1200900000000000103
Total Amount Paid
$113.49
I Plan Reviews ,
To Request an inspection call the 24 hour recording at 726-3769. All inspections I'equested 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.
I RellU "-erllnsnectillns I
111111
Rough Electri~: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state aud agree, that I have carefully examined the completed application and do hereby certify that all
informatiou hereon is lrue and correct, and 1 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 eusurethat 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 plaus will remain on the site at all
tim;;~ngc=j)oD J^-/A Q2-//3 /Lo~0
Owner or Contracto;~ Sign~re Date I
Paee 2 of2
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Construction Contractors' Board
. -,
700 Summer St NE Suite 300
PO Box 14140 .
Salem OR 97309-5052
Phoue:. 503-378-4621
Web Address: Www~ccb.state.or~us
Permit~: ~r - :;J...17
Address:J-I7){) rJ'!./fI'l,k..L / IV
"Issuedby' OY' Date: ;L! J 3/cJ/
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statement:] nformation N6ticeto Property Owners
'. 'About Con~truction Responsibilities. ",
0,
Note: Oregon Law, ORS 701,055(4) requir;s residential co'n~truction permit applicants wh~ are not
,. ' licensed With 'the Construction Contractors Board to sign the following statement before a building
" permit cali be issued. Tiiis,statement is requi.re~f;r residerltial building, electrical, mechanical and
plumbing permits, Licensed arcHitect and engineer applicants, exemptfrom licensing under '
o~s.. 70.1, 010(7), need n'ot submit this,statemf!nt. This .statement will be filed with the permit
. ... - . I >< . ,- ..~. - .
,
, Fill in the a~p,~!,,;ate blanks and initial boxes I and 2"and eii~ei1iox 3A or3B:
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"~ I: ",I omi~ resi~,e in, or~illresidein th~completed sti-u~ture.
. . . ,-' . ,.'. .. !' . ...... ,
~ 2.'. I tinderstandthat! must become lice~sed as a constructiqn contractor if the structure is sold or
offered for sale before 01' on completIon.
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o 3A. My general contractor is
(Name)
(CCB #)
:1 Will instruct my gem5r~I'contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board. '
OR
.-- ~ 3B. 1 will be my oWn general contractor.
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'IfI hire subcontractors, 1 will hire only subcontractors'licensed with the Construction Contractors>
Board: IfI change my mind and hire a general contractor,I.will contract with a contractor who is
licensed with theCCB imd will immediatelynotitYth~office issuing this building permit of the ,
name of t\1econtractor.' .
I hereby certify that ~he above information is correct and th'at I have read and do nnderstand the Information
Notice to Property Owners about Construction Responsibilities on the reversdide ofthis form. '
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(riate)
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(Signat e of permit applicant)
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(White copy to issuing agency permit file, pink copy to applicant.)
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Property '- o'wrier.doc 06-0 i -04
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Acting as\YourOwn -Gener~I'Colitractor?, ',,1' .~; <?
, '~\ -ir:JFbfRMA TldN\~OTICE'Tb :PROPERTY dVvNE'RS' -, ": '~.
'"'- \, ", 'i::. \ \ _~'.. ABOUT_f9N~~RU~I!QNjREsPONSIBILlTIES - ", '~'; .~ ' ',." :,.'
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NOTE: This Information Notice to Property Owoers about Construction "'~esponsibff;ties was 'developed ~y the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
, .~ :~,-~;';(,. ~ . ~.~_j{: :;,~.~ 't:.1 f . .:,;,-",:'f',l.' .t', _...~ ~ ,". ,- . -; ~. . ;1_. .., "'.' .:;' 'i':J;~~ ~
,If you are acting,as your owncontracfor fO'construcf,a new hOIl}e or malf-e it sUDstantial improvemenfio' anexisfing
structure, you canjJrevent many problems'by,beifig aware,of ihe:f6llowmg responsibilities and~concerns_
Employer Responsibilities '
. ~ :..;J' :'!~, '::;,.' . ,,:'C' --; '_.' . .. :~'- >~ .>l\.:r...:j.i':';;'~ "r, _ ~~'.. \ '1 "~~'\ ~-'. 1... J :~:.. ~ "',,.:,..t...- f ,',
Y ou ,ynll;.il1mp~t.inS!anc~s,be.1J1Ic;.4:!0< ~~ ~ :'ep1ployer",!l!ld\th~.~,g~[a~mrS YO~C?l1tr~ct w,ith ,wi!! be~~mBloy,,,esn it
you use contractors not licensed with the Construction Contractors Board to do labor.in constructing or to 'assist in' the
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constructIOn Qr .jmproye~.ent o,f a,iesldef.ltj;tl s.fn.i~ture. As t~e elI!-pl.oyer,Y9!l must cQmply wit\i;the foll!lwing:
..' .. ".",_t...~_ ..' .;\~."Y,J-.[., \..}..J'I.... ".~1"..\-..:;..'...,'ll.:_.~....:.1o.'..\..} '. '0'. .,"l""."_~\~'\. .~.~..l~.
Oregon's Wiin~ol~i~g 'Tai L'a~:A>ah ~~loY~rjc\u~li~t-~Ahhtjldii~ollie 'faxes fr~;n emplo~ei~ig~~'it~e it~e
employees are paid. You will be liable f9r the taxpaymen!s even,if you don'! a,ctually :wit!1hold the tax from your
. employees, For more information; caii the 1D~pgrtffieiHof'R'e;e~ii'e' at 503C3~8-4988;' ,.. " '. "i ;J -,I"~ \~"+" ,'1~" (<, ; '.
Unemployment Insurance'T'ax: As an effiployer:yoihirdrreqhirbdtoopay-a tix;for:unemploynieht'ins~ce purpose~ >\.
on the wages of all employees. For more information, call the Oregon"Employment Department at 503,947-1488. '
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The Oregon Business Identification Number. (BIN) is a comNned'?l!mber fQl'o'\J.91t::Qt.l'g(m~iYj!N:to!ding and -
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 ,or www.dor.state,oLus/formsoav:htmIl for tJ:ie
appropriate forms._ ,_.._ , .__ _ ...., _ _~ _ _ ~ ' 7.... 1(' ~:'::_}t'.~ ',f :; ,. ',t't ,....;: ;...,_~
~, :Wo;'kers' C~m;ensation Insurance: As an employe;;'ygJ'~re subject to the Oiegon Workers' Compensation Law,
. and must, obtain workers' compensation insurance for your employees, If you fail to obtain workers 'compensation
lnsuran6e~ y7;u coui~'~e-;i(jbjdct ~o:~~naltJes'ro;dbellaJ))efdr all cl~lm'cosls1f'onci;ofY0l1i'emjil~y'ee:s is injured on the
job, ' For more information, call the Workers' Compensation DiVisloif'at 'the Deparnnen't'of-Consumer'arid Business
SerVices at 503-947-7815.
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U.s. Internal Revenue Service: As an employer, you musi withhold federaltTIcomeJax from em'ployees'wage;. ?-
You will be liable for the tax payment even if you didn't actually withhQld the tax. For.a Federal EIN number, call the
.IRSari-800"829-4933'orvisi~their;websiteat\~ww:irs.[!Ov., ,',I !{i, c..' ,'''' ';,":;"'''' "'.; "
~._:':-. . '!-l.r~~.." ,.. ..0 r", ':J. _ '......,:.~.r~:~~.~.;,.",t.'., -~. 1'\. ,'-...1'~'.':' .~~~f'.~';';' -J';~"
'. Cj':'....., "1..,Qth~r ~e~poQSibmti~s an~Ar:.eas~()f.<::;Qnc~rnS~t.J' F ;.'
Code Compliance: As the permit holder for this project, you are respon'slole for r~k'ol'iing'~nyfajli.ir{to meet code
requirements that may be brought to your ~ttention through inspections,
. ~ -.... "'. . . ':;..:. "_'~'~ .,..h .. I. ... ., -.. . .:'~' '~.: .,~ '", ...,_~. . ......~. .. . :, t . L-'; .i~.~" I .. _,~ .~..r.... __'
Uability and' Prop'erty Da~,ig~ 'Insurance: " Contact 'yofu'instirahce 'agent toJ~~e 'if you 'hive . adequatejinsuran~e ' .
coverage for accidents and omissions such as falling tools, paint over spray, water damage'from pipe punctures, fire or
work that must be redorie. 1. l J--"':' ~~ I, t- "'.
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Time: Make sure you have sufficient time to supervise your emplriyeer'" '.; [."'1' ::", :" ,:~. ',,: .l'e"
Expertise: Make ~Ure y6Jh;v~ the skills 'to lih~ ris'y~ur ow;'g~n~f~i c6&ffatt~r; tb co6;:dl~~fe' the 'Work offou~h~in .
and finish trades, and to notify building officials as the appropriate times so they can perform, the required inspections.
rfyou have additional questions caB the Construction Contractors Board (503-378-4621) or write the agcncy at PO
Box 14140, Salem, OR 97309-5052. ' ,
Property_owner.doc 06-01-04
." .', J' :0..--: ;ell_~!.':';'j~''''
225 Fifth Street . ..... . .. .
Springfield, Oregon 97477
541-726:3759 Phone
City of Springfield Official Receipt
Developm.ent Services Department
Public Works Department
Job/Journal Number
COM2009-00217
COM2009-00217
COM2009-00217
COM2009-00217
Payments:
Type of Payment
Cash
Change
Job/Journal Number
COM2009-00217
COM2009-00217
COM2009-00217
COM2009-00217
Payments:
Type of Payment
Cash
Change
cReceint I
RECEIPT #:
1200900000000000103
Date: 02113/2009
Description
Add, Alter, Extend Circ
Add: Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SANDRA MITCHEL
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc
In Person
I n Person
Payment Total:
Description
Add, Alter, Extend Circ
Add. Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SANDRA MITCHEL
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc In Person
In Person
Payment Total:
Page I of I
2:00:34PM
Amount Due
55.00
42.00
4.85
11.64
$113.49
Amount Paid
$120.00
($6.51)
$113.49
Amount Due
55.00
42.00
4.85
11.64
$113.49
Amount Paid
$120.00
($6.51)
$113.49
t
, 2/13/2009