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Home My WebLink AboutPermit Electrical 2006-8-15 SPR'NGF'ELD -=:! ZON ~ lll.---../'---.....J INITIALS I\J IV\. " ~'" DATE ~-15-~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PII,(541)726-3753 . FAX: (541)726-3689 ' . "\iiIIF SOURCE (\Ati ~'S~ J "4,, ELECTRICAL PERMIT APPLICATION S- --.J ~'" '=;:~ ~:;;:;~,~"~"" 7 ~ Ci'MPLfTEFEL::HEDVLE ::L:' b ~. LE<~'L~E~:TIO~ A t N S 1 A. N~w.Residcntial- Sillgl~ o~ ~Iulli-Family per d',,:ellillg Ilr 17 D 2 "5 Lf Lf <.( 0 I ( <:) 0 Se~v~~e ~nclllded . ~e~ ~;u :~,,' . --,- leo,\l 1.)\1,1., 1000 sq. ft'&5'~'>N 0le9ol\ ,\01\\1 .Each~addmonal\.:i90\S~. fL,or,le s~~ 00\' ..:\-\"V' . ",leV (vI"" g"t-- 1>-\1<- p~rtW!l(ihereOii;\lose \I Op.~ ,~c. 'O'J , 1l-lIU Ie' Dl\\el. ""ou9 'he \~.- \O~\O ,.Each WanufactUJ\Home.QrO\ ' ?i'lOl\e '\ICo'- "n' -v' . r.J)~:; \e\e . l\ ~O\I h~C!5IiIlar D~SlJing ~'6\1J~~\& O\I\IC"3\IO $50.00 il\ Of>' ~eder~"3'J tel \.~ U\I\I\'J ~ oogo. , V" \\le cel\ o;e901\ "-2.?-:>1I1I). . - -. '. . 6~\\llS~p\!s~sl::&.Fee_t!.ers-3'Instal\ation, Alterations or Relocation: l\U~'oet c1ll\\e\.lS \ .. - . - : -' .. 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 Amps/Volts>>O"" $375.00 Reconnect Only ~'l $ 50.00 . .. . - - \~~_\)ld\ ,I'lf\~ C. Tempo..[~1)&Vic~IO"~ile~~ - .\)U\~ ~~,,),..-:>- ~'l.~~ ~l3wn\\''l.~it~l~~oS'r~~n 't\C\1I.'ii~ID~~~\\S 'l.\~ ""J~\').O~ $ 50.00 ';)\'\ S\ 'l.\ ~~~'4g 400 Amps $ 69.00 ;'t\C\N\ ~\\ I Amps to 600 Amps ' $100.00 Over 600 Amps or 1000 '! olts see .:'B" above. n..' Branch Circuits New Alteration or Extension Per Panel I One Circuit $ 43.00 Each Additional Circuit or with /(J 11 I :n JJ r Service or Feeder Permit Owners Name (, L/d /~~ L1J( 7/P /Z/' . Address C Sf r &-"9/;; J ( E. " .i\'~scellaiteo,us (Sen'i~e/feeder_not included) -Each' Installation' City _J/:;)/1/ Phone :;.]t>I--":;( 2-.. Pump or irrigation $50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges .. ~ , 3~Z. l/?O 2l(J bo'0- JOB DESCRIPTION: A-d~ CI.rc..v.. lK 3 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. CONTRACTOR INSTALLATION ONLY . . ~. ~ - _... -- - Eleclrical Contractor Address City Phone Supervisor License Number ~A~ a~ , Expiration Date Constr. Contr. Number Expiration Date .J:,j' Signature of Supervising ElecuVn O\VNERINSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. OW7!ig;f);;: ~' ~ , Inspection Request: n.,," oj ~ I $106.00 $ 19.00 / o , $ 3.00 If) b 4. ,SUBTOTAL OF ABOVE 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)JBuilding Fonns/Electricnl Pennit Application 8.06.doc -~4iI . .ITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00278 ISSUED: 03/08/2006 APPLIED: 03/08/2006 EXPIRES: 02/14/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6585 MAIN ST ASSESSOR'S PARCEL NO.: 1702344401100 Springfield TYPE OF WORK: Heating System TYPE OF USE: New PROJECT DESCRIPTION: Install gas furnace and heat pump, gas fireplace and 3 circuits Residential Owner: DALE BRYANT Address: 6585 MAIN ST SPRINGFIELD OR 97478 Phone Number: 541-736-8362 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Contractor OWNER PACIFIC AIR COMFORT INC License Expiration Date Phone 39237 03/25/2010 541-672-9510 I BUILDING INFORMATION I VN # of Stories: Height of Structure Type of Heat: Water Type: " ~. \. R,~ng~I;I)p'~.: requires you to , Energ~ E~t~.:.e Oregon Utl\it~ Sprinkled Buildiugare set tonl1 .~r. IIIU~\J''''''-......^nnht')J\n1.. Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: - .. " ........~. " " ". .........' " I DEVELOPMENT INFORMA.l1]@N'f . J >J' ,\~c' II."", u~.-. (Not'e' tlie telepno\ '" . Antar . . . . CC.,I" \~ the <O'verl~y Disf:Jtility Notltlcatlon ior1'\HVI._C...... ) numb"r # Street~Trees:Rq'd:A4 . C ti':)rl::> '-0...,.....-'- en Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC iMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. \',\ o " () Paee 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Descrintion Tvpe of Construction Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 8% State Surcharge Appliance Vent Furnace - up to 100,000 btu Gas Outlets 1-4 Heat Pump Minimum/Adjustment Mechanical + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Minimum/Adjustment Mechanical Total Amount Paid . .CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00278 ISSUED: 03/08/2006 APPLIED: 03/08/2006 EXPIRES: 02/14/2007 VALUE: I Valuation DescriDtion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Amount Paid Receipt Nnmber Date Paid $10.00 $4.50 $3.60 $6.00 $12.00 $4.00 $12.00 $11.00 $5.30 $2.45 $4.24 $43.00 $6.00 $4.00 3200600000000000112 3200600000000000112 3200600000000000112 3200600000000000112 3200600000000000112 3200600000000000112 3200600000000000112 3200600000000000112 1200600000000001253 1200600000000001253 1200600000000001253 1200600000000001253 1200600000000001253 1200600000000001253 3/8/06 3/8/06 3/8/06 3/8/06 3/8/06 3/8/06 3/8/06 3/8/06 8/14/06 8/14/06 8/14/06 8/14/06 8/14/06 8/14106 $128.09 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. IR~rr~ Rough Mechanical: Prior to Cover Final Mechanical: When all mechauical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Paee 2 of3 . .CITY OF ~rKll~t.-t<lJ!.LD ' Building/Combination Permit PERMIT NO: COM2006-00278 ISSUED: 03/08/2006 APPLIED: 03/08/2006 EXPIRES: 02/1412007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Liue By signature, I state and agree, that I have carefully examined the completed application aud do hereby certify that all information hereon is true and correct, and I 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 Oregoo 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 furtber 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 inspections are requested at the proper time, tbat each address is readable from the street, tbat tbe permit card is located at the front of the property, aud the approved set of plans will remain on the site at all times durC;OlJ1 ~ f _ /1 ~ t){ Owner or Contractors Signature Date Pa2e 3 of 3 -. . . . . . . '. " ". .' . .' . 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 pennit#:CO""'."....(;" - 002-715 6r-g-') MAt"';~) ~ Date: 8 It/..{ /. (, I Issued by: , Address: 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 required for 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 befiled with the permit. Fill in the ayy,vy,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~l. ~ 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. D 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 Construction Contractors Board. \/ OR -[J 3B. I will be my own general contractor. If! 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 notify 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. (! {lp /~ r-/Y-6{' (Signature of permit applicant) (Date) , (White copy to issuing agency permit file, pink copy to applicant.) :"v"..;Lowner.doc 06-01-04 Adnnn~ ~~ -AUIlIr cQ)wnn GcennceIr~n C!lcIr~~lc@Ir? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRlICTION 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 make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. JEmjplloyeIr lRe!ijpoIIn!illlMmne!i You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As tbe employer, you mllst comply wntb 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 more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance ']['lIJ!: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. -~ The Oregon Business Identification Number (BIN) is a combined' number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.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 your employees. If you fail to obtairt workers' compensation 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 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.-- You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal ElN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. <DrrIlneIr JResjploIDlsfi[l)finW.es amll Atrea!O olf COIDlt(~eIrIDlS Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and !Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from 'pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills 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 inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 06-01-04 225 Fifth Street Springfield"Oregon 97477 541-726-3759 Phone .iJi~ Job/Journal Number COM2006-00278 COM2006-00278 COM2006-00278 COM2006-00278 COM2006-00278 COM2006-00278 Payments: Type of Payment Check cReceintl RECEIPT #: 1200600000000001253 Description Minimum/Adjustment Mechanical Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + 10% Administrative Fee + 5% Technology Fee Paid By Received By OAK HA YEN ADULT FOSTER djb Page I of I Caof Springfield Official Receipt _Iopment Services Department Public Works Department Date: 08/14/2006 Item Total: Check Number Authorization Batch Number Number How Received 4561 In Person Payment Total: 11 :05:39AM Amount Due 4.00 43.00 6.00 4.24 5.30 2.45 $64.99 Amount Paid $64.99 $64.99 8/14/2006