The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2009-6-25 225 Fifth Streett Springfield, OR 97477 t PH(541)726-3753t FAX(541)726w3689 '~Wtf[i;DEeARiM. 'EN, ;r.1usff0N.~,1Yi~':.' 1~I!!Oc'/';"?'Y":"'::"";i:"'-_"';"'i'P."'~"'~/~~~~.~:;;Fft!"~- I /lrI_ 94 () I Pennit no,' C '7 Date:;i~ /d 5/0 9 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. ' Electri~al Permit Application r:=::~:~~~~,~~E~f>lM~if;.~~RB.:rit~~I!!;::~. l1It~] ~,.~,~r~,,'h=;,ii!; ~~F.I)~,";~I~{~I~1::I=:: l~eAmE(IlDltYilDF.~elDNsffiRllJ'"tllDN;~""'''''~~<4 1~~"",,,,,,,,,,~__]f,'J,,, u '~~~'i' !_e!l'!\\:~ 1b~!'OH~ ~1iEy'::g,"3t~:g?11L~._._..",_.....;,.",. ,~_"J.",_"",__"","_'-"',,"_"_,'-'C"'">A_,..iit\%"!J:.~\'~Xg:',j~ I Residential, per unit, service include"d: r ,~~~~,Jt'i~~jiJ~,,;;;~~ I :;:;,:":::~;o(: h~"j :'::: i l,=~~~.~~\. ,I ::te. ~ '\~?~.~~,~[,.~_""~"",,,II I ;~~~:.;~~;~~;;~ re~~~r (~)OdUI, : :::::: I Mil ..~D,I:;;!>RIf?,ml!:l.N;!C(i),Fi.",WJ:>R~,'>lT']!!FiC_g;,-~\J1 ~ IJut,.kJe<:,<:,,, "'/, + I-I~f D~P I I Services or feeders: installation, alteration, relocation I - j'-'-- ,. II 200 amps or less (2) $ 81.00 $ I 1!llljf!l1li1!!:'.1ii~'I!Ii~'iJi~IRB!DaERlt1(~E5.\iVtilE:Rli4:fJ~1'IiJ~~)(;j(;{ii~ I 20 I to 400 amps (2)' $ 95,00 $ I I Name: "'/0 \A \~ I..,J 'iOn, <:,;::;+)1- I I 401 to 600 amps (2) $158.00 $ I I Address: 1%1-/ Co /.2 1/7 9r I I 601 to 1,000 amps (2) $205.00 $ I I City: <;' fliA) I State: 0 v I ZIP: f'?''I?? I I Over I,OOO,amps or volts (2) $469.00 $ , I I Phone: 1-1/ r:d!a h s" I Fax: II Reconnect only (2) I $ 63.00 $ I I E-mail: I I Temporary services or feeders: installation, alteration, relocation .1. Th" 11' 'b' d 'd' I ' I 200 amps or less (2) $ $ I IS lllsta atlOll IS emg ma e on rest entia or larm property 63.00 owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $ I property is not intended for sale, exchange, lease, or rent. OAR I 479.540(1) and ~7~0(1), ----7 401 to 600 amps (2) $126,00 $ I Signature: .;! ~ t:J I;-~ lOver 600 amps or 1,000 volts, see se[vices or feeders section above I ,lltj~lIl~il-i~:c:>tiljJ1~Cm~BT!i!f.I$If~~~,6;lJiI.(:)N~fi,*,ITi;;'1 I Branch circuits: new, alteration, exi~nsion per panel I I Busines;'name: I j a. Fee for hranch c~rcuits with purch'Pe ofa service or feeder fee: I I Address: I Each branch circuit I ' I $ 6,00 I $ I I City: I State: I ZIP: J b. Fee for branch circuits without pu~chase of a service or feeder fee: I ~ I Phone: I Fax: I I First branch circuit (2) I / I $ 55,00 I $ 6$ I E-mail: I I Each additional branch circuit I: I $ 6.00 I $ I CCB license no.: I BCD license no.: I I Miscellaneous fees: service or feede~ not included I Signing supervisor's license no.: ! I Each'pump or irrigation circle (2) $ 63.00 $ I Pri~t name of signing supervisor: I Each sign or outline lighting (2) $ 63.00 $ I Signature of signing supervisor' I Signi:ll, circuit or a li~ited-energy pan,el, I $ 63 00' $ I . " alteratlOn, or extensIOn (2) II ' ~;;;;;~~O~~~~~if~~~~~~~ . (A) Enter subtotal of above fees .' S i, (5'\:) (Minimum 'Permit Fee $58.00) .' $ I (B) Enter 12% surcharge (.12 x [AD" $ I (C) Technology Fee (5% of [AD' $ I TOTAL fees and surcharges (A t~rough C): $ ~.O\ \c: L>>' ~ ~~ ~--IC; 0 0J90 (/J 71 <[t=" 440-2584-J(9/08/CC>1<Q 'I. Status Iss u ed CITY OF SPRINGFIELD f Building/C~mbination Permit PERMIT NO: COM2009-00940 ISSUED: 06/25/2009. APPLIED: 06/25/2009 EXPIRES: 12/25/2009 VALUE:' 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541.726-3676 Fax 54]'726-3769 Inspection Line S]TE ADDRESS: 1846 ]2TH ST ASSESSOR'S PARCEL NO.: 1703264103400 Springfield TYPE OF WORK: He,)'ting System TYPE OF USE: New Residential PROJECT DESCRIPTION: Heat Pump Owner: TOMSETH JOHN W & RHEA A Address: ]846 N 12TH ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION ~ Contractor Type Electrical Contractor OWNER License p , , Expiration Date Phone ., I, BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: ,Sq Ft Garage/Carport Sq Ft Other: Occu~~nt Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARK]NG Front yard Setback: Side 1 Setback: Side 2 Setback: ' Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: " Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMF;r.O:S,lnON: Oregon law rJquires you:,o follow rules Si<tew'aIR Ty~~:e., Oregon Utility Notification Center. Those rLiles are set forth in OAR 952_Gg?~,!sp_o~tsiD.,:!iiDs:\R 952-001- 0090, You may obtain caples of the rules by calling the center. (Note: the telepnone number for the Oregon Utility Notification r.Anter is 1-800-332-2344), Notes: ,NOTIl,;t: IRE If THl:- wvn~ I THIS PERMIT SHALL EXP VaTuatum-Descriotion HORIZED UNDER THIS PE,:!" - . . AUT . . ,:,~ 'r0-n Ie ^nfiNDO~&flS~Ft Square Footage DescnPtlOnCOM\VllU:p~o(Ul!ns <-nCtioll I . I' B'd A ' " - 'PERIOD or mu tip ler or I mount ANY 180 DAY . Valu Date Calculated Page 1 01'2 Status Iss u ed CITY OF SPRINGFIELD' Building/Crmbination Permit PERMIT NO: COM2009-00940 ISSUED: 06/25/2009 APPLIED: 06/25/2009 EXPIRES: 12/25/2009 VALUE: i' 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid $6.96 $2.90 $55.00 $3.00 6/25/09 , 6/25/09 ,6/25/09 . 6/25/09 Rece!pt Number 1200900000000000742 1200900000000000742 1200900000000000742 1200900000000000742 Total Amount Paid $67.86 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections Jequested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wiI,I be made the following work day. . I Reouired Insneetions I Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. , t By signature, I state and agree, that I have carefully examined the complete~ 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 describcd hcrein, and that NO OCCUPANCY will be made of any structure without permission oUhe Community Services Division, Bnilding 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. ow~~c~ I '~oH"--:~P Date Paee 2 01'2 .. . /J (.J /}_ P,ermit #: '7 '~ddress: / rY~ 12~ -.=fIM1rt.. ' 9- .... y~ e, , ' , , . . . , " .' , " .' ..sr , Date: CJ Ids/oj .' :.. . Stafeme,nt: Information Notice to Property Owners > . AboutConstruction Responsibilities , . Note: Oregon Law, ORS 701. 055(4/ requires residential construction permit applicants who are not licensed with the Construction Contractors Boardto'sigli the following statement before a b~ilding' " " ~;permJ( Cal;' be, is~ued. ThiS'statenientis required/or residential building, electrical, mechanical imd " plumbing permits: Licensed architect,and engineerapplicaizts"exemptfrom iicensingunder, . : ORS 701,010(7);need.notsubmit this statement. Thy,sti1!ement'ftlill befiled:;with the.permit. .. ,. , , "~_ . i Fill in the appropriate blanks ~d'initialboxes 1 and 2, i0d either box 3A or ~B: ~ D I.. I own, reside in, or will reside in thecompletedstructtire. ~~ ' '2. , Iunderstand 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 genera(~ontractor that all subcontractors who workon the str\tcture ~ust be " licensed with the Construction Contractors Board. ' , . ," ' OR IXl .38., I wilLbe my own general co~tracto( CeLl3C1!.~(C~ ) , .. , . If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. .IiI change my mind and hire a general contractor,'I will contract with a contractor who is licensed with the CCB' and will iinmediately notify the, office issuing this buildingpennit of the ' n'ame'oftlie contractor. ..:"<' , ;1 hereby certify that'the abo~e infi.rniatio~ is correct aDlJ..that-I have read and do understand tlieInformation : Notice toProperty.,Owners ,about Construction Responsibi~itiesl!n the reverse side of,this form. ': 'l'U~~ 0:'PZS:-CJl,9 ~Si,",,(=OfpJfmit.'PPH,mt) . ' .. (D,w) (White copy to issuing agency permit file, pink copy to applicant) PropertY _ oWner.doc 06-01-04' "..,t' (' , -,-- .~'~'\.-~::.:.. ~~, "-~- . -._._~, " .j,,,,> A~ting as Y 01:11:: QWn'General'Contractor.?' ", - .\y...,:\......)':..\. ,; ,~~',r.:~:r!',. -IN!,:ORMATION-NOTICE TO PROPERTY OWNERS ;, ABOUT,CONSTRUCTlON ;RESPONSIBILlTIES "~. . - '. ':--,~'- ... \. ", ~,.' . ,'. . iJ ,~r' '. '. 1'... " _..... . -~- t- ---,- '. I, 1",\ , '1 ~,.~ . , '- ;, c: ~ .: l, , , , , ....' 0'" :.'~ l . ", .;' ,i.'. t NOTE: This'lnformation Notice to'Property Owners about Construction Responsibiliiies was d~veloped by the Construction Contractors Board in a.ccordance with ORS 701.055(5), passed by the 1989 Oregon Leg~slature, .,', ~o'" "";:," "~~'..I.I..t41' 'f,;.. '. ~. ....','.. .':' ~ ~.' . ~ .:".- 'If you are acting as your own contract.or to construct anew home or maKe a substantial improvemen(to an existing , istructure, you'can preventrrllmy problems by ,being aware ofthefollowing' responsibilities and concerns, I ' " . . . Employer ~esponsibiliti,es " ~. . , ~'. ,. 1 .,' 1..' .':'~':' ~;) ;':~;J:"'{ '." : ,. ~~" ,J.;., ,t>:...' .i.. "'....'.. , ,Y ou,~iII, il)cll)ost,i!1stances,b.<?f:)Jled.to:)>e::;n "emp!<?Y\l[-\and the, contrac~~r~IYo.u contrac,!,w.it.~ wjl~be "~1Vp'loyees" if IYou!-'8<: !,olltracto~s not Iic~ns<?p ~jtMhe9o!l~truslion CJ~tract<?~sI;3olll'd;to,?o labptip CO!1s,~pting,or to.l!.s_s.i~tjn the ;construction or improvement Of aresidential structure. As the employer, you must comply with the following: .'i' 'It', '~. ~-,':" ,.1.':" \;-r",~....j-~.,~ ..,'~"'.'-'.',..' .'~ .~;;;,.,f :~".,., ~ ."~'.'.' ~,h..,:'" .f '}.' ...,. ~,....,~'\ ,Oregon's Wltlih61tling j~x Lli\Z';"A's'~riefupi~~~~,'yJo"inust withI1bld\rico'meiaxes 'from e'm~loyee'w'ag~;' a\'l~e time jemployees are paid. You willbe liilb1e /6,r the,ta;' payments even if you d!Jn't a.ctually witphold the tax from you~. 'employees. Formoreinfomlation, ~all the;C~~;,;:';:dlf of Revenue lt503-378i4988;-'u; ,',C'.';. , ,,' ~- ~", "'I ' , ,iiuilemPIOyment Insurance Ta:lp As an employef;'you,are,requitedto,pay,il !li,(:forUnemploymenl'insurance purpose,;\:; ,on'the wages ofall employees. For more information"call the Oregon Employment Department at 503-947-1488, ""~)} , ,~:'.:.....,. ...T, ':',. :;',.-t,'.. ','''. :,,-, '"':t,;~,,:.i - :", .~, ,~'. ..' , ;:': _.. _".. _ 'h:,~,.,-.....t.',.... .rj'_ .','.' ':.~ ,"c,t!: .:- '.J ;The Oregon Business Identification NJl1I1ber, (BIN) is a cOll\l?,in$l,<\:,number, for ,b9th,:Or~gqn- \Vithh!>Jding and iUnemployment Insurance Tax. To file for a BIN" call 50,3-945c8091 or www.doLstate.oj..us/forrnsnav.htmll for the appropnate forms. , ; , '. " ", ..- , f -, -- --. - - ',; .. .. ' " -.. - ',- - " , .. "',,, ) '. " " - ,0 . I!. l~ I ..~ ,. .. ., I " , . ,Workers' Compensation Insurance: As an employer, you'are subject to the Oregon Workers' Compensation Law, and must obtain workers' cVUlp~usation insurance for your employ'ees. If you fail to obtain workers' compensation , ; . . ,',.",.r: ~'". ,f....~" c.d'......" ' 'l:' .: ,.,'~' ," ~~.,","'~' '" < . ,,- \ .. ,I,. insurance, you could be'subject to'penalties'and'beliable fadII claim'co~ts if orie'ofyour employees is injured on the job'. . For more information, call the'Workers" Compensation Division' at the Department'cifQ;onslimer'and Business 'Services at 503-947-7815, . ,V.S. Internal Revenue Ser~ce~;s\~' Jm~i~e;,' ~t';' ,;(ll;t ~ithholdfederal 'income tax from ,employees' "'ages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the :IRS'-~t"I'-800,8:i9:4933 or v!sit'their,.web site 'at "M'{\y:irs:gov".'r ", i I r'~' '. c' ,': ,':.:,' C ,;"", ~;".........'..' J,' r}";',. 'J.H,-' It\" , ,"'"J{' (1 ..,......f.l:;,.';; . ':"'r' i ~:.. ", .-;,. ~ :~!,~., .- ....- , '--',;',.,,, ,. J)tl,1er. Ite~i)OnsibUitjeSI~~d AreasQf t:Q~ce.rlts ;,,: ~,~:,' " Code Complian~e: As the pe~it holder.for this project, you are responsible for res;)l~f1ig'~-;,if~ilV~d'io:tneet code requirements that may be ,bro~ght te) your ~ttention through inspections. ,,' ' : _ . 1,'.~"'<' . .f"':.'..'~":"I"t'{t'J r!':!",.,':;':1.":-_"~~..3~"1.<' '.(1': . ~.... ;":... .../'i..... ,,~.,' ~"..-"~ .,....;:'...":'0'.;... .., Lability and Pro~erty D~niage "titsitra~'ce: ,'b'iihilc'f yohr'insi.n'arice:~gent to: see if Y(llr'have'a,~eq~ate fnSiir~ri~e: ' , toverage Jor accidents and omissions such as falling 'tools, paint over spray, water damage from pipe punctures, fire or I ' . .. . . ~ work that must be redone., ,,' ,', '. '- ',' , ! " '- 'c "', ---....", . , '. ' I ,j"- f'.', "r.~.." ". ,I lime: Make sure you haves~ffi:ien~ tJm~ to suP:~s;:~~r~~Pl~~e~~i<, '."'~;~ .l:':,~'~,~: '::, :;"';' . . - . , ~xpertise: Make sure you have the skills to act asyour own general'cotltfactor, to coordinate',the work ofrough"in and finish trades, and to notify building officials as the app.vp' iate times so they can perform the required inspections, I 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. ' I , Property~owncLdoc 06-01-04 , , , I kIr.A':,O. Fl.;. jj . ..., City of Springfield Official Receipt Development Services Department Public Works Department 225 Fifth Street Springfield;Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00940 COM2009-00940 COM2009-00940 COM2009-00940 Payments: Type of Payment Check cRcceiotl RECEIPT #: 1200900000000000742 Date: 06/25/2009 2:49:54PM Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Amount Due 55,00 3,00 2,90 6,96 $67.86 Paid By JOHN TOMSETH Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid njm In Person Payment Total: $67,86 $67.86 2399 Page I of I 6125/2009