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Home My WebLink AboutPermit Electrical 2003-4-18 m "".. STREET . "mNGflELD, OR,.,'" . '.'(""'"'''' . m, \"(''''''~' .J. b- E'TECT.'T>TCALP'ERMIT C 0 h.followmgprojectas b . ~ .L.IU' APPLI :A17 N zOning. and does not su mlttedhasthetollowing City Job Number (0.'-'200) -00 z.. 7'7 Date 0 L( /7 0 ]. approval . reqUIre specific land Use ~-\~J:i~",_,-" '",~. ,~~_";"'Y ,_",.~O.Djr:t~-._~ ,,~,.(l:)a-~~"'7:f'~~ 3. !!.S9!)-!J',g;;:rE..'F.;.~ErJ!J!.IEDUEE1H::~9JY;~Kf':'b'T3:r:~ Authorized Signature c:rst.<J - A. (!~~,~~~id;~'t%I~~Es~fh1ffi~6~~IKili~F1k:il~~e;,~a;~iHng:'U~i~;~fl, ~_t....'~ ~-~'-"- ''''''. '~,\;"':__,....,.~.'..:..:w~~""'~t;;;~...~....~....r--'. ,J l. ~iocAtlb.N:.oE'1NSmli4T70NNl'~~-~'-'iij, L_...t:::;.".......;~c..'c.~~~...........~~_":O""";'.:...,.:..itC..!.... ,..~-,. ~ ?- '5"7 Z- j/]I! Ihvo R.. ~ Q LEGAL DESCRIPTION /70;;' 2333 Of &:> 0 JOB DESCRIPTION ,4):, 0 2 c.. \ "2-LJ-.>..:- [~ 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. ~9Rn,0,SigJr~S{A.L0JibN QHtr~ Electrical Contractor A8l.E. '(I t:J~IL A iVDf-~b'1...50v....) L" ) Address ,-Sa) City SfC?lO Phone 'J.2j.,-(o 70j Supervisor License Number <-l,?-)q~) ~ Expiration Date jQ ml '7 COG) I . . Constr. Contr. Number J ~ I (?<, 1 L/ 1 \\ (<j~ 170"W" ""'-.. Owners Name C' v 5> ,.....,1+ ( Address Z 0::;-'7 z.... f11 fJ;t( (}{L I") ft City '5 f' /':::D Phone OWNER INSTALLATION The installation is being made on property lawn which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Service Included 1000 sq. ft. orless Each additional 500 sq. ft. or portion the~eof Each Manufact" d Home or Modular Dwelling Service or Feeder. $106.00 $ 19.00 $50.00 B. WS~_~~~~F.ei~d'~.!t~ih~t~n1ti~AN~r~~tfunsCO-r~R~iffgiftiriri~',- ?~I ~ ~-:,;"~_""7".:.o.<~" ::-'r.:-~..,..~..,~.',-~..:.,".:"""."1.-,_,~.._-_~~)'.,.>..,..,... ~~t'<';,.:'1'\,_~,.....,', 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts .;'0 $375.00 Reconnect Only '0S 'Iv ,.;~,'t'l $ 50.00 0;';;\' ~v,. ~' c"' , 'd. ",.,c_o;m.....t~-a;(e~9 Se\l~l\", i '~~ C. lifT ~J.1lporary~~"e\\~~!,ee~:p.~f~1:Al"". .t',);., . , ~.0\ ~eO '0':1 0 (J0 ",W"J ~f&S") .1nsf.ir~io!.l;\S\?terlili&''? or~"Ig,ati.on ~~0~0 :(\ .... \\0'0 ~0\'. <<,'V' SO' . ~,. ,(\ p.. ~~ ~\fu\\sJ>\!>le~\)'\~ CoQ\0 ",P \~e .~,..,9-\'$l50.00 \0 7.f1~c~~~ ~C\'\.'O A ,-",(\ -e. \\" ~\O" $ 69 00 i\.\"",,,,:\.~ro"40 v,,",UPS~O' . .~\"l\' ., . ~o'tJl..W~~~to'\~'ob~!s "o~ \)\\n',?'P"''''. $100.00 \~ ' ;:: "{ 0 ~0 C r;al,.0'tJ .'?l'?i<- ~~~Q~~~,~~~~~fs_.s; ;~.~ ab,?~~.", _. . "'". -"".., D. ,~Btan"~\t,\iJ.c~" ,h": y".,~;,~ :. ","",;'\.. '~:,";j> ."""'1,;,",1 L._(\\),'\.\:t~~:~l.fr."'" . (t. \~- ~~ ~- ~~, ;:;~~~ 's< I New Alteration or Extension Per Pane' One Circuit Each Additional Circuit or with Service or Feeder Permit . ^"0l -;': :;. : ~- -."., ~<' I <-j3 J $ 43.00 ( $ 3.00 E. fl~iis,c~.I~n.N~,s .(S~f~i.~~r~,.ee<l~r. ~oi)!!cI~~~.i!L~~~~.i~~4n~ !iijiil .. . '.. .' ~~~O"'~ -. . Pump or irrigation \'?~ \~ \\\~ \~5,i\!ll~ SignlO~I~-eighti~~t-\.\. ~'/.~~ o~~ll\' \ '{$$I.OO Li~\QjV~~:~*~"\ p.....\\\\l~'t.V $ 25.00 Lim~\j?~~&b p..~ .. $ 45.00 Minim~~ il~~,~it~~~~~~9~. Fee ~~45.,OO + Surcharges 4 hS' U'B"' T.:::"'';''\j~~O~E'AB.~O. VE. '...'": '..J..',';,:;. < "." ~ Lf b .1 ~~ " .' .._.....-:.." '"I , . .', -.~ i ~ ~ . < '',I- _. ~ -, -., .'." "'_'. ,;, .. '. . .., '" ":::;,;,. . '"!:," - 1. . ,,_. '. ' . . '1.. ., ~ _~.. ....._ ". ,,' ,..... . ,~.2D- 4,\00 ~~.~ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)lBuilding FonnsJElectrical Permit Application 1-03.doc . CITY OF ~rlUl"lljN.J!,LtJ Building/Combination Permit PERMIT NO: COM2003-00279 ISSUED: 04/17/2003 APPLIED: 04/17/2003 EXPIRES: 10/17/2003 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2592 MANOR DR ASSESSOR'S PARCEL NO.: 1703233301600 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Add 2 circuits and 1 fixture for hot tub Owner: ZIV SIMHl Address: 2592 MANOR DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION' Contractor Type Electrical Owner Plumbing Contractor ABLE ELECTRIC ZIV SIMH1 ZIV SIMHl License 146374 I BUILDING INFORMATION" # of Buildings: # of Stor~: Primary Occupancy Group: He!J:llt~f~lfucture Secondary Occupancy Group: ~k~o'r)fi~~ Primary Construction Type ~">/l \0b\V~~13't~~:C)~:S' I'> Secondary Construction Type: ~o~ ~ i'l ~0 aant~pei\6'1> '0 # of Bedrooms: ~9\0 ~eO'O ~0\"I!a.l\~l!Ifl;:0~e f'~"~c. ~OO~(>.\ ~~~~\0~;0'1> 0 _ \0\0~~c:~.\0~ I\~~-tl \~~~ G~~\,~\j :.:.....;~oP~,--,.,;;.~.~l~rORMA TION , SETBACKS \0 .s.\c'l>~n,~7,JJ ",,\ (J' 0\.'" ~ v' n;t,.-' ~0"S ~"<J ~"0~~ rcJ~)O ~'?i" Frontyard Setback: . ~ O~ -{ O~ ~e <:J 0 0\ ~QVerlay Dist: Side 1 Setback: ~ ~~g~.~~Q, \o\~ ~\'1>'\' # Street Trees Rqd: Side 2 Setback: C:'il-,:oe\ Ge~\0 Paved Drive Rqd: Rearyard Setback: ~ % of Lot Coverage: Solar Setbacks: Residential Phone Number: 541-463-1441 Expiration Date 12/01/2003 Phone 541-726-6701 541-463-1441 541-463-1441 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' . B'f-. W WIC 'l'l~\ijet'alk Type: ~\C~:. <;,\\t>.\..\.. c'j..?\~~t.?-\'-tI\\ \~~nspoutslDrains: ~O <;, ?c?-\'-tI\\ Ij\-\Dt.?- \\\~\-\DD\-\cD f \\\~ \\I)?-\lt.D ()?- \<;, t>.~ t>.1j~\'-tIt.\-\ccD ?c?-\()D. c() "\'DQ Dt>.~ t>.\-\~ Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of2 . . Lil l' OF SPRINGFIELD" Status Issued Building/Combination Permit PERMIT NO: COM2003-00279 ISSUED: 04/17/2003 APPLIED: 04/17/2003 EXPIRES: 10/17/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line , I Valuation Descriotion I Description Type of Construction $ Per Sq Ft Square Footaee Value Date Calculated Total Value of Project I Fef's Paill I Fee Description + 10% Administrative Fee + 7% Slale Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Minimum/Adjustment Plumbing Amount Paid Date Pai Receipt Number $9.10 $6.37 $43.00 $3.00 $14.00 $31.00 4/17/03 4/17/03 4/17/03 4/17/03 4/17/03 4/17/03 1200200000000001021 1200200000000001021 1200200000000001021 1200200000000001021 1200200000000001021 1200200000000001021 Total Amount Paid $106.47 I Plan Reviews I To Request an inspection call the 24 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. I Rf'~f'dinns I 1 Rougb Plumbing: Prior to cover and including required testing. 2 Final Plumbing: When all plumbing work is complete. 3 Rough Electric: Prior to Cover 4 Final Electric: When all electrical work is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I furtber 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 tbe work described herein, and that NO OCCUPANCY will be made of any structure without permission ofthe 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 inspection~~sted at the proper time, that each address is readable from tbe street, that the permit card is located at the~~property, and the approved set of plans will remain on the site at all times during construction. / . I//;?/Q ? ,.. ^~ <----- ----- Own~ ~ontractors Si ature Date Paee 2 of2 Mise.~L.j~. ~~.....'..-.."...'i ._~.. 'J , , '; ^ ...~~",. ~.' . '~-1\}.~ .;:...,".....c,....,J 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Line Items: Job/Journal Number COM2003-00279 COM2003-00279 , COM2003-00279 COM2003-00279 COM2003-00279 COM2003-00279 Payments: Type of Payment CreditCard Paid By ZIV SIMHI Description Fixture Receipt #: 1200200000000001021 Date: 04/17/2003 Minimum! Adjustment Plumbing Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Received By Check Number Confirm No djb 000045 731307 Page 10fI 4/17/2003 2:38:23PM 4 City of Springfield Development Services Department Public Works Department Official Receipt Line Item Total: . Amount Paid 14.00 31.00 43.00 3.00 6.37 9.10 $106.47 . Amount Paid 106.47 $106.47 How Received In Person Pavment Total: cReceipt.rpt . Cbnstruction Contractls Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us e. . . . . . . . . '. ..- . . Permit #: C0lA1z.4 - oc) Z. 7 '7 Address: -Z 5 '7 z. /Il4 A-tV'0'tL Pes Issued by: ~(L ()'-{ noJ Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from 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 3B: ~1. Ar2. 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. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Consiruction Contractors Board. OR ~ 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notifY the office issuing this building permit of the name of the contractor. I bereby certify that the above infornurt'ion is correct and that I have read and do understand the Information Notice?W:s~t stru:ion Re~ponsib: on the reverse Si~/I; f70 3. / (SigrtatUre1)[ ti~Hit applicant) - (Date) (White copy to issuing agency permit file, pink copy to applicant.) prop-own. doc OS/22/00 . ,) . A.~~nlffi~. Sll~ y ~1illIr.(OhWIill CGteIilleIrSllll Ci!llIill~IrSll~U:i!llIr? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES , . . . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or ft1l\ke a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. . \ Empnoy~r R~S)]llI()JJUsilbm~ies You will, in most instances, be ruled to be an "employer" and the contractors your contract with will be "employees" if you use contractors not licensed with i:he Construction Contractors Board to do labor in constructing or to assist in the construction o~ improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding 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 payments even if you don't actually withhold the tax from your employees. For a State Business 10 number, call the Business Information Center at 503-986-2222. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unelnployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-378-3524. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain ,workers' w....I"'~nsation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7810. . u.s. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable. for the ta"< payment even if you didn't actually withhold the tax. For a Federal EIN number, fax the IRS at 810-620-7115 or write to them at IRS, Mail Stop 6271, PO Box 9941, Ogden. 1)1\ 844Q9. OtllneIr Res)]lIoJIllsnlbnDities ~md Areas of <ConcerJIlls Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet coae requirements that may be brought to your attention through inspections. Liability and. Property llamage Insurance: Contact your insurance agent to see if you have adequate insurance coveragc for accidents and omiSSIOns such as falling tools, paint oV~r spray, water damage from pipe punctures, fire or work that must be re-done. As any employer, you may be responsible for injuries sustained by your employees. Time: Make sure you have sufficient time to supervise your employees. Expertise: Ma!ee sure you havc the skills to act as your own general contractor: to coordinate the work of rough-in and finish trades, and to 1)0tifY building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378"-4621 ext. 4900}or write thc agency at PO Box 14140, Salem, OR 97309-5052. . ; prop-own. doc OS/22/00