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Home My WebLink AboutPermit Electrical 2009-7-15 , Electrical Permit Application D 225'Fifth Street+Springfield, OR 97477+PH(541)726-3753+ FAX(541)726~3689 1"s\.~).~E,]:&M~!=N.T.'U~'E. ONLY ,:'1 I pe~~~tO()I-OO~() 't I I Date: 7-/)' - C> , I This permit is issued under OAR 918.309.0000, Permits are nontransfer.ble, Permits expire if work is not st.rted within 180 d.ys of issu.nce or if work is suspended for 180 d.ys, I ?:,':',: ""L!OCP,.L:.GOVERNMENT;'.6.P.f!ROVAL[;\R;"'.'it"!if.~;\;1\':, ' 1>\'~f:~~i!,;/,~\:-fjl.,~i1'i\lN~~:lFEE~SCH E[)UI1E\l2&~\'1'l~~~11i,~~\i~~~~1 I Zoning .pprov.1 verified? DYes D No 1:}<,u}I1~ed~!ki~@6'~~;p.~'{iti~(.)(;~:I'Qiy;I,'~'p>~,~'::1 '::1~ta~'.;1 1~):"i}",j,l"";"CATEGORY{Of,;;-CONSTRUCTION~';>""";;; ",,'f: '... ,.........""""....",. "..' L", "..,."",....e.. . c ' " t,., I ~'~~~':l:;;~;';al. I D~~o~.~~ment - I ~ c~:~er~:1 ^ ~ 'I I Residential, per unit, s~rVice included: I . 1~_'tJ.0B~SITEilINFQRI\IIATION1~.6.ND~IIO~C'A'liION~~jll 11,000 sq ft, or less (4) $134,00 $ I I ' , , 'I I Each additional 500 sq, ft, or portion $ 25,00 $ I Job site address: ILf31. MILL ~T;2,(.['T 'thereof , City; Sl'tzl "\G-F II; Lo St.te: DR. 1 ZIP:'174 7 7 II Limited energy (2) Reference: /703 27L(l( I TaxlotD? '(00 I I Each manufactured home or modular I~"""'>" ":'''',,'DESCRIRTION,; 0F~.V\I()RI<'+[i'i{'if'i;';,,5,'fffi'~::'t;::'}1 dwellmg service or feeder (2) I MODI f'i o~ fl.lJD 1$ e RA->Jclf c., Itc.., II':> 1 I Services orCeeders: installation, alteration"elocation I I 200 amps or less (2) $ 81,00 I ", ' 'PROpERTY"OWNER;, I 201 to 400 amps (2) $ 95,00 I N.me; .:::JoEL SM ,.rH I 401 to 600 amps (2) $158,00 I Address: 1'/32 r'l1 LL ~ r It! E. r I 60 I to 1,000 .mps (2) $205,00 I'c' I S If:ZTITpr.:~'T''''''' "r 9 lOver 1 000 amns or volts (2) $469,00 Ity: .SP It,.Ir,.F I E:LO t.te: DR.. ..;' ~ 7 t./7}J " (.I" ImJ !~, :".. ,r, ~'~" ~ I Phone;rq', .~~~. "~,,... 1 F.x: N'~~Lf:"n;~''''~ ctUUf te ! R,conneCt'on[y;(2) Uti lily $ 63,00 $ 1 '"11..,,:1 1,llf> Inn ,ontt::'l, ir")SHnIlPc:::::::!rp~ottf"\~h , I E-mail: in OAR 952-001 ~O( 1 C t!~~,~;~a~,~~-::~e..: ~s~e~ders: Installation. alteration. relocation .. '" 'd ' """" mil moy 00 -ai )200 amps ort1ess i2l $ 6300 $ I ThiS installatIOn IS bemg made on reSl entlal or f~m,prop'erty. . .....u{.jn;;~ 01 lit: j we!=: h\l ' owned b~ me or. member of my immedi.te famHy!lT!iis'he ,centE r. r(riOj,~6,~OO ~iiips;(i)Jne ' $ 87,00 $ I property IS not Intended for s.le, exch.nge, le.se,loflrentfOPlRe 0 'e"':',, v"~' < ",u,ii,,c;<tllon I 479,540(1) anM,7'A560(I), 111, Center is I.ElrJ~Rll,tP~,gO<~j's l"! $126,00 $ Signature: 'filII ~~ lOver 600 amps or 1,000 volts, see services or feeders section above I I "; ,;;":CelNTRACT;OR;,INST AI!.L.ATION:- ,,:' : I I Branch circuit" new, alteration, extension per panel I Business name: 'I I a. Fee for branch circuits with pu'rchase ofa service or feeder fee: Address: I I Each branch circuit ' I $ 6,00 I $ City: I State: I ZIP: I I b, Fee for branch circuits without purchase of a service or feeder fee: I I Phone. I F.x: ~ _ I I First branch circuit (2) r I $ 55,00 $ 5> '0 I I E.m.il: NU \I,",~." C'u&1I F~P\ ~E lliIclihldiINlb\!M'2l-anch circuit ,q I $ 6,00 $ I I CCB license no,: I BCDIl~\ii\~~A~'~'~ ~NnER T~m ~i~.!Ii:lA~~\lslre~sl, service or feeder not included I I /'IV" IV' ..-- ^R^t1r..n"1-1I r,lh, , , I Signing supervisor's license no,: "'1,,~'fllCMr.FD OR IS "'1" l""nonp!ltnp'br Irrlg.tlOn Circle (2) $ 63,00 $ I Print name of signing supervisor: ~~\Y'180 DAY PERIUU,! I Each sign oroutJine lighting (2) $ 63,00 $ I 'I Signature of signing supervisor: I I Signal, circuit or a li~ited-energy panel, I $ 63.00 $ I alteratIon, or extenSIon (2) . I Each addition.1 in,pection:/I) I $58,00 $ 1,";;~W"'~4,q;*".,i1A,..-'A'nni'''I~C''A''N'T''''U''''S''E''i'''~it''~'.'!;";"'i,,"",l''o'''' . 1\(~~.,~11f.R~&~r:J?~ ^ r."r;.L: _, . :I;:-:!-'i_ . ~-3=#\~,,::t'(~';;i,m:!{~r,Pt!..'i_"; $ 32,00 $ $ 63,00 $ $ $ $ $ $ ~ \\" \Wm ~~~ ~ ,(A) Enter subtotal of above fees (Minimum Permit Fee $58.00) ,I (B) Enter 12% surcharge (,12 x [AD I (C) Technology Fee (5% of [AD I TOTAL fees .nd surch.rges (A through C): $13'~ $ Ib~ $ 611- $ WJ. fi- 440,2584,) (9/08/COM) _'G:!,!RI,~o,"I~~; -,i:L " \' Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009.00809 ISSUED: 07/1512009 APPLIED: 06/0912009 EXPIRES: 0111512010 , VALUE: $ 2,000,00 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541.726.3769Inspeclion Line SITE ADDRESS: 1432 MILL ST ASSESSOR'S PARCEL NO.: 1703274407400 Springfield TYPE OF WORK: Dryrot TYPE OF USE: Repair PROJECT DESCRIPTION: Dryrot Repair, Enlarge Window Header, Relocate four (4) Fixtures Residential Owner: SMITH JOEL M Address: 1432 MILL ST SPRINGFIELD OR 97477 Contractor Type General Electrical Plumbing I CONTRACTOR INFORMATION I Contractor ATTE:-JTION: OregofJJrcen~euireSB'XJtJi\lBtion Date Phone OWNER fullC'N rules adopted by the Oregon Utility OW~ER Notification Center. Those rules are set forth in OAR 952.001.0010 through OAR 952-Q01- BARNES HIGH TECH Pr,"T.JMB'N,~(~,Il![nhl";n~3,~~Xo nfth" "d"Y~P/2010 BUIlJDING' INFORM1\:T10N", the tele~hone ',,,",,,"". ._. ..'_ _'""'_.. _dllty Notification # of Sto.fe'S~ter is 1.800.332.2344). Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: SqFt 2nd F!oor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: 541.726-9854 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R.3 VB I DEVELOPMENT INFORMATION I ' REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: 'N@fIIf\!J(;overage: !~I,S .~~R_~I! :<;HAI' J:'\(P'O~'~ 'TIll:: \\'~rm I PUBL}'Cj.'IMPRt}VEll\lllBNl[${ITHIS PERMIT IS NOT . -,.....~"VL.U un '" ABAN!IiQ~' , ANY 180 DAY PERIOD. ' e: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Downspouts/Drains: Notes: Page 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541.726-3753 Phone 541.726.3676 Fax 541.726.3769 Inspection Line I Valuation Descriotion I DescriDtion Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project J;'pp<, P~i.-l . " 'loA Fee Description + 12% State Surcharge + 5% Technology Fee Building Permit Fixture + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $16,08 $6,70 $58,00 $76,00 $16,68 $6,95 $55,00 $84,00 6/9109 6/9/09 6/9/09 6/9/09 7/15/09 7/15/09 7/15/09 7/15/09 Total Amount Paid $319,41 Plan Reviews I CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00809 ISSUED: 07/15/2009 APPLIED: 06/09/2009 EXPIRES: 01/1512010 VALUE: $ 2,000.00 Value Date Calculated Receipt Number 2200900000000000631 2200900000000000631 2200900000000000631 2200900000000000631 1200900000000000807 1200900000000000807 1200900000000000807 1200900000000000807 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. ~eollired.ln~,,,p('t~ Framing Inspection: Prior to cover and after all rough in inspections have been approved, Wall Insulation: Prior to cover, Shear Wall Nailing: Before covering sheathing with finish materials, 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, Final Plumbing: When all plumbing work is complete, Rough Electric: Prior to Cover Final Electric: When all electrical work is complete, Paee 2 of 3 Status Issued 225 Fifth Street, Springfield, OR 54\.726.3753 Phone 54\.726.3676 Fax 54\.726.3769 Inspection Line <2ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00809 ISSUED: 07/15/2009 APPLIED: 06/09/2009 EXPIRES: 01/]5/2010 VALUE: $ 2,000.00 By signature, I state and agree, that I have carefully examined the completed application and do herehy 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 descrihed herein, and that NO OCCUPANCY will he 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, I further agree 10 ensure that all required inspections are requested at the proper time, that each address is readahle 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. 9);1 ~*1 .II. Ii \ ' Owner or Co.,ractors Signature Paee 3 of 3 7 ~ I ~ ~ C99 Date -, , , , , '" ,.' " " Construction Contractors Board 70'0 Summer St NE Suite 300 PO Box 14140 ; Salem OR 97309.5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: COrn zoO 9-OO~O 9 1l{~Z W\,'t{ ~ +- ~ Date: rcrju9 Address: Issued by: 'Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4) requires residential constrnction permit applicants who are not licensed With the Constrnction Contractors Board to sign the following statement before a b~ilding permit can be issued, This statement is requ{red for residential building, electrical, mechanical and plumbing permits, Llcensed'architect and engineer applicants, exempt from licensing under ORS 701,OJO(7)" need not submit this,statement, This statement will be filed with the pe,,"!it, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: rzg 1. 'I own, reside in, or will reside in the completed structure, @ :' 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: o 3A. My general contractor is (Name) (CCB #) I will instruct my, general contractor that all suIic~ntiactors who work on the strucru;.e must be ' licensed with the Construction Contractors Board,' OR ~ 3B, I will be my own general contractor. In hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors, Board, In 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 perinit of the name of the contractor, ' , . I hereby certify thatthe above information is correct and thatI have read and do understand the Information' Notice to Property Owners about Construction Responsibilities on the reverse side of this form. YJ;j~~ 7- K- ~q ?J~Signature of penn it applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) ,Property _ owner,doc 06.01-04 \ ~ '-, - \ ...-" " ,,' '\ l.'\ \,.' -- . '\. \ 1\~~i~g ~s ?Y9~r\~OW~ '~eneral Con~ractor1' ( PINF6RMATfo~ NOTICE TO PROPERTY dWNERS " "',. ABOU.I.CONSTRUCTlON:RESPONSIBILlTIES. " ..... ... , , '. NOTE: This Information Notice to Property Owners about Constru~Non R~~ponsibii!ties was developed by the Construction Contractors Board in accordance with ORS 701,055(5), passed by the 1989 Oregon Legislature, :".:.:.;~... ",',;.'-,: '.' 'J', it":.:(';" ,'-t ~ ,'~. If you are acting as your own 'contractor to construct a rew home or maKe a substantial impro,,~ment to an existing structure, you can prevent many problems bY,being awate,of the:'following responsibilities and concerns, r Employer Responsibilit~es ,.. "". . .,' . '\. ',' ). I ~.' . . ,::' \~ -' \ . . You rill, i!l m<}st instap.ces,.be,fUI<;d to, be an "employer'" ang !he contract?rs you contr~ct.~.t~ will be ',"employees" if you u~e coI;ttq9tors not,ligensed ",:\th the Constru~ti?n C<?ntr~ct<?!S Board to do,lab,?rin constructing o,r,to as~ist in the construction or imprqvement of,a,residentjal.structure, .Af~h~ employer, you must comply with the fo~o~ing: . '_ '. . _., ..".. \ \ I ~\\ '. '\ <.l . \ . " __ _. .,' ~ . . . ..' ,'tt ' ~':"'.".. , . , '. .' " - '.'~' ',~ - , ' . ~ ~ . Oregon's Withhollling Tax 1.:3W: As an 'empJ'oyer, you'lnust WithholO 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, ca1l'the'Departn'Jent ofRevenU'~'at 503:378..4988:', '. ',". ' ~;, ",;( Unemployment Insurance Tax: As an employer, 'you are;required to' pay a tax for unemployment insurance purposC:sY: on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, ,_ '_:' :'.'-' -r'!"~' . . ..', r ... '_. -. .' '-'., ;. '. _ , " ..:. .t5r-i The OregonB,usiness .Identification Number (BIN) is a combined, num,ber for, ~oth, Oregon Withh,olding and Unemployment Insurance Tax, To file for a BIN, call 503-945.8091 or \I\>'Ww,dor.state,or,us/formsnav,htmll for the appropriate forms, " .. / ..' : ~ .. . 'r, ' Workers; Compensation Insurance: As an employe;; you are subject to the Oregon Workers' Compensation Law, and must qbtain workers' <;ompensation insurance for your employees, If you fail to obtain workers' compensation insur~nce', you 'cotild b~ subjbtno;p~iia1ties:aridb1i'IAb!e''for, all chlinl'costs if one Of your employJes is irijuredon the job, For'more'information, call the Workers' Compensation DivIsion at the Department of'Consumer arid Business Services at 503-947.7815, U.S, Internal Revenue Service: As an employer, you must withhold fedehilin'come tax froin employees' wages': 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 at-IC800.829'-4933'-or'v1sit'their web site at ''''VW,ii'sOl!OV. ,,', , ',/, :", : ',' < ' , ,;' .' .. ;l~"./ \.\. r,~-, , ,.;"" -'. I~ ... ',;, . ',', ,,_ .' ' ~ ...... \..~,~ , 'j'~' J. t: : ,: ,Other.,~esponsibmties and Areas ofCoQcer~s , Code Co~pliance: As the, permit holder for this p;oject, you are responsible for resolving any'failbre to meet code requirements that may be brought to your attention t.ht:ough inspections, l' . t~.. .' ,_,4~ .' :.- i ' ".'. '.- _", -. _" :,.r: " -d', 1',.'- -:,~ Liability and Prope'ny' Jj~in:i:ge Insiuance:Contact your insuran$e agent to see if you have adequate insurance coverage 'for accidents and omissions such as falling tools, paint over spray, water damag~ fro.m pipe punptures, fire or ." ."\, work that ~ust ~er~~~~e'f\,_ '\ .,. ", . ~ _ ' _ ,'~~ ,': '_" ,I Time: Make sure you have sufficient time to super:iseyour employees." '. ' " " <" ". " Expertise: Make sure you Ji~v~ ih~ skiils to act as your owil' general c~ntractor; 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, [fyou have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052, _ . . f ~ Propcrty_owner.doc 06.01.04 225 Fifth'Street Springfield, Oregon 97477 541-726.3759 Phone "',P,,_..,'N,..G_.''''_,~~'' '.'..".'...,' ~ A... ,,__ " 8L',,"',',..,,' , , ;:,' ,^",_.., w; c.._ .' _. / --- City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009.00809 COM2009.00809 COM2009.00809 COM2009.00809 Payments: Type of rayment Check cReceinl1 RECEIPT #: 1200900000000000807 Date: 07/15/2009 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge Paid By JOEL SMITH Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1330 In Person Payment Total: Page 1 of I 9:57:46AM Amount Due 55,00 84,00 6,95 16,68 $162.63 'Amount Pllid $162,63 $] 62,63 7/ 15/2009