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Home My WebLink AboutPermit Electrical 2005-1-25 ,,. ~ " 1: , c "".. "',,,,0 'c " _, , " _", " " '" - ~'~\'j ~ -.-. Ie ;: ^~', ",' CITY OF ShJNGEIELD,UREGON.~; .' ~?~". ':'; , I ,'" , ~, ' '" "K .::...:' :. .,,: .>: !t~ 'i-~ \ /T", . SPRINGFIELD - "---" 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 r~~~~ ELECTRICAL PERMIT APPLICATION ~ ' City Job Number COWl Z06 z... - 0 I 5. 7 L. Date J - Z~~~::cq S- 1. '~EOCATIONOFiNSTAiiAridN-' --, - 3. 1'(;OMiiETEFE.e;-'CH{8~~w~: -~, ~>"i Cb- ~-i-~-- - ;;;~~;;;--$ r ---._- - ~_- - ~~:t;::~- '<'~~g- ~~O~;:~'7/~~~<--_~ LEGI7~~3O:t(~ () 1(0 () A. ;;~~e ::~~:al ;S~g~~;~,. u!lIc a:~~~~~:t:l:-, _J JOB DESCRIPTION 1000 sq. It or less "'" "86 '~g -" \ Each additional 500 sq. ft. or ~~ <;;:t;-(L Ii lc..e- iN t &-Ro &:. <t:S ,.-,,,'2-(,;;-1":) portion thereof ~ . 0 Permits are non-transferable and~XPire if-work ~ - Each Manufact'd Home or ~ , not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder r-.----. --..- . -,-........ ---'-' --.-' -.---. B. I.Se~ices or Feed~rs ;:}~.5'!latio..., Alterations or, R~ocati~..:...._ I $63.00 6"3 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $50.00 r'--:~'-_.~--:-:----'''''''--' .-~'-. - -.-~~-'-l 2 ! CONTRACTOR INSTALLATION ONLY . L - _____--'-. ___.--.1 of Supervising Electrician /> 200 Amps or less / ATTEt\~qt-j\,.m~r!?'l:\WfarePs . follow r@1'~~r!o~600 ~JroqUireS you to .w ~~u""'~U~ lITe reg I. / N01ificati60If,A-s'o'!' ..l.mns. on Ul/}Ity . &",a.uto'~j':. ....,~1j"Trnt::s are s Ph In OAR 90VetClOOO'A..._LVnlt. b,lulUI one -"'>'>'>'// '-':0-;:1 OAR 952-Vu . u090.. YORetbtyle<i~!il!llYcopies of the rui~" ~.- n~~~r ~i;;~:~:~=~f.ft~~t~~ 1 Center IS 1-800-332-23441. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. r-- -...-.... --. ---- _.,~-- ~.--_..._-~_.- -_.._._--;_._--~.., D. ~!anc~<'iIr~uits_ . _~___...___n_~'___ _ __....:~' $ 50.00 $ 69.00 $100.00 Electrical Contractor Address City Expiration Date Owners Name N C;New.l\lteration or Extension Per Panel IIVt-. THF2nf{!f.,qit; SHALL EXPIRE IF TI-I~ ,^,nRr~ 43.00 ~U EachbdditionaJ ,<;:ircuilLO"Swith RMIT I~OT. I nL'.11ILC' I U"h..1.-n 1.'11 rc $ 300 ~ n I ~ f? Semce or_feeder P.ernut " <-, V.Ale.... I. )J<' <(11 AJ COMMtNGtU UK IS AtlANDONEu ~UK /: .5- rr h /7 ,: AJ PE!fJ:fi~cJlI~~~~[i~ce/fe;der;;;'t included)=E;~I~I~staU.ti~~~~ L___.":--""'-._ __..L....._.__ _ ._ ._._._._ .._- .._,,^J rY Z Phone 73 C-rfJ(Z '7 Address City Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 OWNER INSTALLATION The installation is being made on t'.vt'....~J I own which is not intended for sale, lease or rent. Owners SiMre: f! ;t ~~/e _ ~/_) - c..-- Minimum Electric Permit Inspection Fee is $45.00 + Surcharges r:~-c--'--"-'''''' --~'-, __n_. 4. , SUBTOTAL OFABOvE , . 7% Stale Surcharge 10% Administrative Fee 7Z 5U'-( Inspection Request: 726-3769 TOTAL 71.-0 3'iz:L Shared Drive(T:)lBuilding Fonus/Electrical Pennit Application 1..Q3.doc . . \..-11 f OF SPR11'lut<1~L1J Building/Combination Permit PERMIT NO: COM2002-01372 ISSUED: 01/17/2003 APPLIED: 12/1212002 EXPIRES: 07/12/2005 VALUE: $ 37,300.00 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: Single Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: AdditionfPlease check on # (NUMBER) of bedrooms for this Adult Care Facility Owner: BRYANT C DALE Address: 6585 MAIN ST SPRINGFIELD OR 97478 Phone Number: 541-736-8362 I CONTRACTOR INFORMATION I Contractor Type Contractor License Expiration Date Phone General DALE BRYANT ATTENTION: Oregon law requires you to Electrical DALE BRY ANTfollow rules adopted by the Oregon Utility Plumbing DALE BRY ANrontifj"~tjnn r.pntpr ThMA flJlA" arA "P.t fortJ'l in O.,nBUfUDlN(NNFORM'A!~52.001. 0090. ,uu "".; lfufbl/, Wt1:~~ur 1IlJrules by # of Units: calling t#rof;Stlitl~:(Note: the telephonez Lot Size: Primary Occupancy Group: R-3 number tHetght lirS!JtIrCtlitility Notificmo Sq Ft 1st Floor: 424 Secondary Occupancy Group: Ci!l\ll!flitIf4tlO-332-2344). Sq Ft 2nd Floor: 240 Primary Construction Type VNSpr Water Type: Sq Ft Basement: Secondary Construction Type: Range Type: Sq Ft Garage/Carport # of Bedrooms: Energy Path: Path 1 Sq Ft Other: Sprinkled Building: n/a Occupant Load: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: , DEVELOPMENT INFORMATION I 66.00 NO TI C E Overlay Dist: 60.00 THIS PEPti'Sfre'i,j":-N.1e.rRQd~E IF THE WORK 3 46.00 AUTHORiiilif'eciIJJHv[1R1jd':S PERMIT IS NOVes 28.00 COMMEf\%~<i.fI;'ot Qoveragii:JONED FOR 16.00 28.00 ANY 180 DAY PERIOD. I PUBLIC IMPROVEMENTS' Fullv Improved Sidewalk Type: Curbside 5' Yes Downspoutsmrains: Curb and Gutter Connect roof drains to curb weep hole. May connect to existing roof drain system if existing roof drain system is in good conditions and inspector approves. REQUIRED PARKING Total: 2 Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of3 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction V Wood Frame Dwellines Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Building Permit Plan Review - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - 1st 50 Feet + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Water Line - 1st 50 Feet + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm ServlFdr 200 amps or less Total Amount Paid Initial Review 12/13/2002 Plan nine Review 12/13/2002 Public Works Review 12/13/2002 . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2002-0I372 ISSUED: 01117/2003 APPLIED: 12/12/2002 EXPIRES: 07/12/2005 VALUE: $ 37,300.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $74.60 Square Footage or Bid Amount 500.00 Value Date Calculated Total Value of Project $37,300.00 $37,300.00 12113/2002 FpP~, PIiIIJ Amount Paid Date Paid Receipt Number 2200200000000000297 1200200000000000569 1200200000000000569 1200200000000000569 1200200000000000569 1200200000000000569 1200200000000000569 1200200000000000569 1200200000000000633 1200200000000000633 1200200000000000633 1200200000000000633 1200200000000000633 1200200000000000633 1200500000000000111 1200500000000000111 1200500000000000111 1200500000000000111 $195.29 $34.55 $24.18 $300.45 $55.00 $9.25 $185.03 $45.00 $15.00 $10.50 $43.00 $6.00 $56.00 $45.00 $7.20 $5.04 $9.00 $63.00 12/12102 1/17/03 1/17/03 1/17/03 1/17/03 1/17/03 1/17/03 1/17/03 1/31/03 1/31/03 1/31/03 1/31/03 1/31/03 1/31/03 1/25/05 1/25/05 1/25/05 1/25/05 $1,108.49 I Plan Reviews I 12113/2002 APP LLH DON MOORE - Please check squarE footage on plans. applicant indicated addition at 500 square feet. Plan review was calculated at 500 square feet. Plans indicate ovedr 600 square feet of addition. Please adjust plan review and structural page to reflect actual addition size. Greg Fersch~eiler to determine if existing trees will count toward street tree req. 12123/2002 APP AID 12/24/2002 APP DPE Paee 2 of3 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO:COM2002-01372 . ISSUED: 01/17/2003 APPLIED: 12112/2002 EXPIRES: 07/12/2005 VALUE: $ 37,300.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 12/13/2002 01116/2003 APP TCM 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 Renuir~ti TIWl.WilwLI Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place hut prior to concrete. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Storm Sewer Line: Prior to filling trench. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and 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 Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made ofany 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 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 plans will remain on the site at all times during construction. L 1)4 LJ~ Owner or Contractors Signature ~...J 2 S~ 0;--- Date { Pal!e 3 of3 . Permit#: (D"" zo-o. CO 7 Z. -. . . . . . . ". ," ". ..' 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 Address: Issued by: (;, '58 <) 01 A-"v bl3 ~I 1-7..-)-O~ 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 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 app.vp.:ate blanks and initial boxes I and 2, and either box 3A or 3B: --ml. --5t 2. 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 ~ 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. (!rO,t ~)~ :J/?.J -2J~ ZJ/- (Signature of permit applicant) (Date) I (White copy to issuing agency permit file, pink copy to applicant.) Property_owneT.doc 06-01-04 . A~~TIIID~ ~~, ([Dililrr (Q)WIID CG~IID~rr~n (C@Iili~rr~~lc([Drr? INFOR(MAT~ON N01~(cf TO P~O?IERTV OWMiE~S ABOUT CONSYRlJICTiOI\; RlESPONSlBIUTilES NOTE: This Information Notice to Property Owners about Construction Responsibilffies 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. lEJJllllJlllnoy~r lRe~JlllolID~fibnnntl:ne~ 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 tile employe~, you must comply witll tile following: Oregon's Witbholdicg '[ax lLaw: 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. :Jcer!:jJeoyment nElSu~!:::lce ']fall: 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. T.le 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. Wor/{ell's' Compe:Js2tion 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' 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. llnterl!w Revenue Sel'V!ce: 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 EINnumber, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. ((])1lberr IResjpi!lill1l5u!b>fillfiitue5 3lll1lirll Arre315 Oll Ci!liIltCerrll1lS Coc1e CompliaElce: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremcnts that may be brought to your attention through inspections. :L:2:l:f!::y l:C:O ]J>i"Ope~Zy Df::::~g2 [;:!5:2r::.::ce: Contact your insurance agent to see if you have adequate insurance coverage for accidcnts and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redom:. T:22: Make sure you have sufficient time to supervise your employees. lEl(::2~:5e: :v!akc sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and iimsh trades, and to notify bUllding officials as the a.......vp.;ate times so they can perform tl:e required inspections. If you ,lave ~dditional qu~stions 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 . -~'~..,.m..'...,.'" 1*:, , ;: ~ ..., ""Ii, ." City of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journal Number COM2002-01372 COM2002-01372 COM2002-01372 COM2002-01372 Payments: Type of Payment Check 1/25/2005 RECEIPT #: 1200500000000000111 Date: 01125/2005 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Item Total: Check Number Authorization Paid By Received By Batch Number Number How Received OAK HAYEN ADULT FOSTER djb 3762 In Person HOME LLC Payment Total: Page 1 of) 1:27:18PM Amount Due 63.00 9.00 5.04 7.20 $84.24 Amount Paid $84.24 $84.24