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Home My WebLink AboutPermit Electrical 2007-6-16 Electrical Permit Application . t 225 Fifth Street. Springfield, OR 97477.PH(541)726-3753.FAX(541)726.3689 I~Ft)DEeARiMEN]iusElONlb~~1 ",~r"";tf.1;-';--:'';''.._~:.'.:-:h:<'''_::;;'i;i...~~~1!;\i':''w~~;t.t I Pennilno:l~7-7oJ I I Date: id /1(;/ () /' I This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. r~~1J:'0:<:j~~J:;~QV;E:BNi\iIEf':lif~'.6iP.P.J(0V~~~ I Zoning approval verified? 0 Yes 0 No . 1.~Ct.mE(>~0RYIi0fJ[~~Gf\iS.i!iBlit~i1I.QN~~ I 0 Residential 1 0 Government 1 0 Commercial I~QI3!S.fjT~E:JjIN~GB:iYI~iJQN,wA'J{J:)~i!Q(}'A-;IjtGN~,* 1 Job site address: 5(C S')rll-tt R!,l?J/V --el') 1 City: I State: I ZIP: ISU5t;';";~H: 11m...?;O\\ .. ..... . .I,Lotno.: J)f)'D9U 1~~[;).E$~RIP.!fJ0N[QFJltW~B.~~~~~1 i /f'''':T /CX7k"67- / C//i:.-U--(J r J' F'~~-~eR0FlERt:i'e0WNERN"'*:"''i'''ff~'l'}iK7''' I::~=' '~'~Aj~. .' ..<<=r=. -~,.,... "I 1 Address: ~?m 15I4'F)c;8Ck I,A/ V 11"/ I 1 City; I--~;' '1 State: 1 ZIP;')'>7'O! I 1 Phone: ( I Fax: I 1 E-mail: 1 This installation is being made on residential or fann property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent: OAR 479.540(1) and ~79.5~0(1). . V. .....J..o' /' SIgnature' _ }f.;t1,1/1,,!.., c:::?\G-1 a-.-0) lHiii~OQf\ljli~CJTl0a:~INSmA'I!!l!A'm(0N~~;~;r,;; I Business name: ,;}fA/Ale'-7l-. I Address: I City: I Phone: 1 E-mail: I CCB license no.; I BCD license no.: 1 Signing supervisor's license no.: Print name of signing supervisor; Signature of signing supervisor: I State: I Fax; I ZIP: ~~~ ~~ ~(1/ . ~v..~ 440~2584.J (9/08/COM) $134.00 $ $ 25.00 $ $ 32.00 $ $ 63.00 $ $ 81.00 $ $ 95.00 $ $158.00 $ $205.00 $ $469.00 $ $ 63.00 $ Temporary services or feeders: installation, alteratio(l. relocation I 200 amps or less (2) $ 63.00 $ I 201 to 400 amps (2) $ 87.00 $ I 40 I to 600 amps (2) $126.00 $ lOver 600 amps or 1,000 volts, see services or feeders section above I Branch circuits: new, alteration, extension per panel , a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit I I $ 6.00 I $ I b. Fee for branch circuits without purchase of a service or feeder fee: I First branch circuit (2) I I $ 55.00 $ ~ I Each additional branch circuit ' I $ 6.00 $ I I Miscellaneous fees: service or fee~er not included I I Each pump or irrigation circle (2) $ 63.00 $ I I Each sign or outline lighting (2) $ 63.00 $ r I Signal circuit or a limited-energy panel'l $ 63.00 $ alteration, or extension (2) _Each additinnal inspeelion: (I) I $58.00 $ ~~~.~jgi1rKr-jJf~Q'~~_ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [A]) I (C) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through C): $)?: $~~~ $.~2~ $(;7.gi I Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-00703 ISSUED: OS/20/2009 APPLIED: OS/20/2009 EXPIRES: 12/10/2009 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5657 THURSTON RD ASSESSOR'S PARCEL NO.: 1702331100300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair Residential PROJECT 8ESCRIPTION: Plumbing Repair to Bathroom. Owner: WILMA LANTZ Address: 3700 BABCOCK LANE #114 EUGENE OR 97401 Phone Number: 541-688.9582 Contractor Type Contractor I G0NT>Rl\CfI10R-INEORMATION I . yOU to IU".UW rules adopted by the Oreqon Ut'"tv . NotrflcatlOn Center. Those ~j~."nJ.l(, set i~,~p'iration Date Phone ~nA~!'-~ ~52'001-00to through OAR 952.001'_ . --'-. .~~".m"'''''''''''''''M-tth I b I BUIhDlNG,INFORMA TIONlt ,e rhu es y e ep one ()umoertort~e Oregon Utility Notification . # o(StOIJ~~ti 1,800-332-2344) Lot Size: Height of Structure . Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VB Secondary Construction Type: # of Bedrooms: .r> N/TI'DlNELOPMENT INFORMATION I THIS PERMIT SHAL.L EXPIRE IF THE WORK AUTHORI~~[)~,lill!Rt'r~S PERMIT IS NOT COMMEN~~IJTs~'b ~'DONED FOR ANY 180 '1.. ' rR' /{ . , o 0 t ~ erage: REQUIRE8 PARKING Total: Handicapped: Compact: Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valua'tion Descriotion I Description Tvpe of Construction $ Pcr Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated ;(01) t]) 1:---U C- '7/l1"L€U-f Paee I of 3 _SI?~I.!'.9P'1~'9"" . "":b ' "If . Sta tus Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541,726,3676 Fax 54 I - 726-3 769 Inspection Line Total Value of Project Fp~~ p,qiriJ . Fee Description + 12% State Surcharge + 5% Technology Fee Fixture Minimum/Adjustment Plumbing + 12% State Surcharge + 5% Technology Fee 1st Appliance Add, Alter, Extend Ore Building Permit Minimum/Adjustment Electrical Amouut Paid Date Paid $6.96 $2.90 $57.00 $1.00 $23.40 $9.75 $79.00 $55.00 $58.00 $3.00 5/20/09 5/20/09 5/20/09 5/20/09 6/16/09 6/16/09 6/16/09 6/1 6/09 6/1 6/09 6/16/09 Total Amount Paid $296.01 I Plan Reviews I CITY VI' ~rKINGFIELD Building/Combination Permit PERMIT NO: COM2009-00703 ISSUED: 05/20/2009 APPLIED: OS/20/2009 EXPIRES: 12/10/2009 VALUE: $ 2,000.00 Receipt Number 3200900000000000382 3200900000000000382 3200900000000000382 3200900000000000382 3200900000000000464 3200900000000000464 3200900000000000464 3200900000000000464 3200900000000000464 3200900000000000464 To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Rpnuired Insne{'tions I Underlloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. F'raming Inspection: Prior to cover and after all rough in inspections have been approved,' Final Building: After all required inspections have been requested and approved and the building is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Paee,2 of 3 _1.il,~~!.~~lj,~~~~~~ "" ~f Status Issued 225 Fifth Street, Springfield; OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-00703 ISSUED: 05/20/2009 APPLIED: OS/20/2009 EXPIRES: 12/10/2009 VALUE: $ 2,000.00 By signature, I state and agree, that r have carefully examined the completed application anddo 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 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. r 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 011 the site at all times during construction. . . JtL~M~)rX~r- - I~U Owner or Contractors Signature Paee 3 of 3 'f)6/&l' 8ate 225 Fifth Street Springfield, Oregon 97477 541_726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 3200900000000000464 Date: 06/16/2009 2:40:27PM Payments: Type of Payment . Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 58.00 79.00 55.00 3.00 9.75 23.40 $228.15 Job/Journal Number COM2009-00703 COM2009,00703 COM2009-00703 COM2009-00703 COM2009-00703 COM2009-00703 Description Building Penn it 1st Appliance Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Amount Paid Check WILMA LANTZ CJC 1128 In Person Payment Total: $228.15 $228.15 cReceiotJ Page 1 of I 61! 6/2009 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052' Phone: 503-378-4621 Web Address: www.ceh.state.or.us Permit#: c.. 0; - 703 Address: 5Z-S7 Tl-I--'1/V 77Jt<l (Z.l::> (pI n/vc:/ Issued by: 6.;.. '--' Date: Stat~ment: Information Notice to Property Owners . , About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential coilstruction perm-it applicants who are not. . . licensed with the ConstruCtion Contractors Board to sign the following statement before a b~ilding permit can be issu~d.: 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 I and 2, and ejther box 3A o~ 3B: r- P- 1. ~ 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. I own, reside in, or will reside in the completed structure. " D 3A. My general contractor is (Name) . . . (CCB #) I hereby certify that the above information is correct and that I have read and do understand the Information .- Notice to. Property Owners about CIJDstruction Responsibilities on the reverse side of this for~. ~ ,-'/I~~f k//~~7 . (Signa&re/o~~errciJ ~p;lfdant) (itat';) / (White copy to issuing agency permit file, pink copy to applicant) Property _ owner,doc 06-01-04 ~'. . Acting as Your Own'GeneraIlContractor? '. ~', \".,- iN FOk'MAildN' NOTICE TO PROPERTY oWNERS ',' ",,:0' \'3\..> \-:.:, ." ABOUT.CONST:RU~:rION:RESPONSIBILlTIES.... 0, _4..... _ \' ~ ~ ".J t , : , . NOTE: This Information Notice to Property Owners about qonstructionResponsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. . I;, " " ':', " , I ~ , " . ~ .. . ,- .- . ~ -:- . '. " If you are acting 'a; your oWn ~o~tr~~i~r to con~trUct a new ho~e or mak~ a subsumtial improvement' to an existing structure, you can preventmany problems by_being awareofthe following ns'sponsibilities and concerns, Employe,r Responsibilities '. ' ..'. .. ": '"'' ..t. '. \.' . .:~', . ' ' _ You wil),.i!l mos! i!l~tances, .be ruled,to be an "employer" an9 the. coptraqtors,.yol! ?,?ntract with,Y'ill be "empl()~ees" if you uSe .contractors not,licensed with the Construction Contractors Board to do labor in constructing or to assist in the . . 0 . ... . . . . "'.,' ., .' " ". ~ , '.'" " ' , construction orimrroYement of a re~i.den!i~1 s~cture.. As the, employer, you!I1ust ,comply wlth'the. follo,!,ing: _. ......, \. . ,~., . 'I ~, ~ ,- ". ~ 'I . .i.', . .. . ~ ..,' 4 . Oregon's WitbIioidi~g Tax Law: As'an e~pl<iy~;yo'ii mu~t witIilioldi~com~ taxes froIii employee ~ages at ihe time employees ~re paid. You will beJiable f?r the tax.payments eyen if you don't actually withhold the tax from your employees. For'more informatiOli, c'ailtne Depru:tinent'ofRe~eiiJe'at 503-378-4988." . ,! . .,' .- .,'.' ~, Unemployment Insurance'Tax: As an employei',;you:are:requiredi6.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. . ' .1~~."':"'. ~ l':>J":r. .,j:;;'-.i~":. .c.~"'-', '....~.. .(.~. "f:, The Oregon Business Identification Number. (BIN) ..is.a com1:>ine~I.'nwnber for both 'Oregon Withholding ant. Unemployment Insurance Tax.' To file for a BIN, ca1\'503-945-8091.0r www,dor.state.oLusfformsnav.httnll for the' appropriate forms. . ...... . .' " Workers' Coinpensation Insurance: As an employer, yim'are subject to the Oregon Workers' Cvwp,"..sation Law, .and must.obtain workers: c'ompensation insurance for your employees. If you fail to obtain workers' compensation . insurance; you ;~tiia i:;~ suBject ii> 'peiui1ties ~ndbe Idble '[of,all claim costs if oneofyonr employees isinjured on the job. For h10re information, call the Workers' CompensatIon Division at the'Departmen't of Consumer and Business Services at 503-947-7815. . , - . 0 1 U.S. Internal Revenue Service: As an employer, yoll must withhold federal income tax from 'employees' wageF" 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 I-800.829-4933'or visiftheir web site,at.www,jrs.l!Ov. " .. .' .:' ,'.:.'~ ,j. , .'.' -~,-;'r!~ ., ' j. ..t.... !l.~->/J!."I. ')', '...'.;c..... .~. ":.. t.. ...C. :, GtheJ:,~esponsibilit~,es and Areas of CODCen.l~,_ ~, . .. ~.'> , ... ","f Code Compliance: As the permit holder for this project, you are responsible for re~olving any failure to ~eet code, requirements thaJ may be brought to xour attention tprough inspections. _ ...ro'.... :,......t. ., ~'. .....:' ',' 11;'~ ;t'-' :.~ '. :'. . .".' -. " ,,~' ;'. ,., I. J" ." ,.~ ...... t. ..' '. 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 5pr~y, water damage from pipe punctures, fire or work that must be redone. . " , . >'. :'.... - - .--.. " . .~ - . . _._ - . _' .... . __ - . 0 ...... Time: Make sure you ha~e sufficient time to supervise your employees,., ,J .' \,r., . ." " .... _..... , '0 ' '.. I' r " \'\ 'Expertise: Make sure you have the skills to act as' your 'oWn generalcoritractor, 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. w,;" .\ Propcrty_owner.doc 06-01,04