HomeMy WebLinkAboutPermit Electrical 2009-10-5
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Date: 10/05/07 I
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2%5 Flftb SIrm.Springtkld, OR 97477.PR(Mt)726.175J. FAX(Mt)726-3689
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.
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I Zoning approval verified? 0 Yos 0 No I
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I .. Residential I 0 Govenunent J 0 Commercial I
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I City: 5ot\"'1~1;;. l State:~r, I ZIP:'; 1'1(~
I Referen~: \'OU1l.0'~'bA. I Taxlot.mS<6 I
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I Name: fYI~!v~" W~..... I
I Address: r.:.()~O,.CJ-.I"\ )......... I
I City: 7(}r.....J'fl-e.(~ I State(l),.. I ZIP: 17<t7<i!
I Phone&l.L:Zt~ - Jo ;;1(; I Fax: I
I E-mail: I
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sa/e. exchange, lease, or rent. OAR
479.540(1) and 479,560(1),
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I Business name: /'
I Address: ............ /
I City: '"'" I State: /./l ZIP:
I Phone: "-.... Lr6:
I E-mail: /"--.....
I CCB license no.: /' I BCD ~ no.:
I Signing supervisW<license no.: '"'"
I Print name o.u(gni;;'gsupervisor: ~
I Signaturec;f signing supervisor:
440.2584-1 (9108ICOM)
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Residential, per unit, service included:
1,000 sq, ft. or less (4)
Eacb additional 500 sq. ft. or portion
thereof
Limited energy (2) $ 32.00
Each manufactured bome or lIl1ldulBr I
dwelling service or feeder (2) $ 83.00 $
Servkes or feeders: Installtztion, alteration, relocaJ;on
200 amps or less (2) ~ $ 81.00 $
20 I to 400 amps (2) 1 $ 9&.00 $
401 to 600 amps (2) $1118.00 $
601 to 1,000 amps (2) $20&.00 I $
Over 1,000.mps or volts (2) ";' $468.00 $
I Reconnect only (2) 'f' $ 83.00 I $
I . '
Temporary len-ites or t"eedcl!: installation, alteration, relocation
200 amps or less (2) $ 83.00 $
20 I to 400 amps (2) iif,l $ 87_00 $
401 to 600 amps (2) II" $126.00 $
$134.00
$
$ 2&.00
$
$
I
Over 600 amps or 1,000 volts, see services or feeders section above I
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Each Ilroncb circuit I I $ 8,00 I $ I
I b, Fee for branch circuits witbout porchase of a service or feeder fee: I
I Fim bl1lllcb circuit (2) I ( I $ 55,00 I $S3"4
I Each additional brand! ci~uit $ 8.00 $ J
Miscellaneous fees: Stl'lllce or ftethr nol included' 1
Each pump or irrigation circle (2) $ 83.00 $ I
Eacl1 sign or outline lighting (2) $ 83.00 $ I
Signal circuit or a limited-energy panel. S $ I
alteration, or extension (2) 83.00
Eaeb addItional inspection: (I) I $118.00 I I
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(A) Enlersublotalofahoverees
(Miolmum PermIt Fee $58.00)
I (O)Enler 12%sun:harge(.Ih [AD
I (C) Technology Fee (1% of [AD
I TOTAL rees and surebar&~ (A tbrou&h C):
Branc:h eireultJ: new, alteration. extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
r ~
$~t::",,, :::>t,
:.1,/' 2 _ '10
$C.~I r;,.1(.<
$ ~ ~ I /7 0_
$ClfPl 0 '00
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01l73
ISSUED: 08/13/2009
APPLIED: 08/13/2009
EXPIRES: 02/13/2010
VALUE:
Status ISs.~,~~"!,,,,'_':;F "
225 Fifth Streei;"Sprlngfield, OR'" 'I,
541-726-3753 Ph~ne: '
'! 541-726-3676 Fax> '"
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541-726-3769 Inspection Line,
SITE ADDRESS: 6066 ORCHID LN
ASSESSOR'S PARCEL NO.: 1802033400'158
.,o~ .'h.
Springfield TYPE OFWORK: Mechanical Only
PROJECT DES,t'R1rTlbN:'
TYPE OF USE:
New
Residential
Installing air conditioner in residence
Owner: 'WALTERS MELVIN & PATSY
Address: 6066 ORCHID LN '::: '"
SPRINGFIELD O,R97478
Phone Number: 541-746-3026
I CONTRACTOR INFORMATION I
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Contractor Type? ~:':- Contractor
Electrical I' , . WALTER J CANNON
,'Mechanical .: " .' HOME COMFORT HEATING & AIR
License
76304
84164
Expiration Date
09/09/20 II
06/25/2011
Phone
541-747-0959
541-345-2838
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: .'
, . ,t : ~
. .
,
# of Stories:
Height of ;Structure
Type of H'~at:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOP~ENT INFORMATION'
REQUIRED PARKING
Overlay \?ist: Total:
# Street Trees,Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage: ' S you to
o on law reql1lre
ATTENT~O~~...~~?"'rl hv the Oregon Ut!litY.,
I PUBLIC IMPROV,EMEN;Ts;lmH3r. Those rUhle~~~ 952:00j:
.. 11_0010throug., b
,in UJ.\1i '1',><,-vv 'Sidewalk-.T~'J~e rules Y
> 0090 You may ob.., , ~p t lephone
Siorm Sewer Available:"- , cal'ling the centeDoWn~~~Jt.7D~airi's:alion
Special Instruc!iOii'"jCE' number tor theor1e8g0u~, 332~2i44).
. ~ . , ' .' Center IS - -
LHISPERMIT SHALL EXPIRE IF THE WO
d;;l~~E~~~~ ~I~~~~~HIS PERMIT /S N~~
ANY 180 DAY PERIOD. ANDONED FOR
Front yard Setback:
Side 1 Setback: '.' ,1:
Side 2 Setback:'! ',; .'
Rearyard Setback:
Solar Setbacks::i
Street Improvements: '
Notes:
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01173
ISSUED: 08/13/2009
APPLIED: 08/13/2009
EXPIRES: 02/13/2010
, VALUE:
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I Valuation Descriotinn I
; .Description .
, ,:.;,...T~pe ~f Construction
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$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
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Total Value of Project
Fppt;', Pqifi I
.:! ,~! .t. ~.:--
Amount Paid
Date Paid
Receipt Number
Fee Description',
+ 12% State Surcharge:
';. 5% Technolo1lY 'Fee .~,'
1st Appliance ,... .
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Minimum/Adjustment Electrical, .'
-!- .
: ,:1 :
Total Amount Paid
$9.48
$3.95
$79.00
$6.96
$2.90
,
$55.00
$3.00
8/13/09
8/13/09
8/13/09
10/5/09
10/5109
10/5109
10/5/09
1200900000000000917
1200900000000000917
1200900000000000917
2200900000000001134
2200900000000001134
2200900000000001134
2200900000000001134
$160.29
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Plan Reviews ,
To Request an inspection call the 24 hour reeording 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. '.'
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~irprlln~np('tiont;', I
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
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Final Electric: When all electrical work is complete.
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Status
Issued"
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection 'Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01173
ISSUED: 08/13/2009
APPLIED: 08/1312009
EXPIRES: 02/13/2010
VALUE:
..
"; By signatu;e, l~iate;and- agree, thal'l 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 Sp;ingfield 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.
I further agree to ensure that allreq'uired inspections are requested at the proper time, that each address is readable from the
',' ~.,' . 0>' .' , _
street, that the perm}fcard islocate~ at the front of the property, and the approved set of plans will remain on the site at all
times during colistru'ction. .
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Owner'or Contractors Signature
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Construction Contractors Boarlt
700 Summer St ~$uite300
PO Box 14140
Salem OR 97309-5052 ,
Phone: 503-378-4621 _
Web Address: www:ccb.state.or.us
.,
Date:
"
Statemeht: Infohnation NQticeto,PropertY Owners
" - ,About Construction Responsibilities.
Note: Oregon Law, ORS 701.055(4) requires residential conltruction'per:mit 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 requiredfor.residential building, electrical, mechanical and
plumbing permits: Licensed architect and engineer applicants, exemptfrom licensing under
" .' ORS 701_010(7), nee.4 not submit this statement..This statement will be filed I!-'ith the permit,
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Fill in the app.~p.:ate blanks and initial boxes 1 and ~,. and either box 3A or 3B:
. .
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0'2.
I own, reside in, ;or,will reside in the completed structure, '
I understand that! must become licensed as a construction contractor ifthe structure,is sold or
offered forsa1e before or on completion. '
. ' .
. . ~ '. -
o 3A. My general contractor is
. ;"'
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(CCB #)
I Will instruct my general contractor that all subcontracto~s w~o work on the structure must be f
ljcensed with the Construction Contractors Board.
, OR
( e0~~>tU)
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~
3B. I will be my own general contr~ctor.
~. .
. If I hire subcontractors, I ~ill hire orily subcontractors licensed with the Construction Contractors'
B6m;d. If I change my miJld and hire a general contractor" I will contract with a contractor, who is
'licensed with the CCB;and will immediately notify the office issuing thi~ building permit of the '
nameofth'e contractor: '
. ,
I hereby certify thanhe above information is correct and that I have read and do understand the Information
Notice to:Prop~rty Owners about Const~uction Responsibilities on the reverse side of this form.
~)i l J.M ~ ' .. (')~ f..- ~,~COq
~ ' { (SignatureVof permit applicant) (Date)
(White copy to issliing agency permit file, pink copy to applicant.)
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, 'Property_owner,doc 06-01-04'
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Acting- ~K-Y 9ur-.Own GeneraHConl1ractor?
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. ,\, INFORMATI6N~NbTICE TO,PROPERTY OWNERS'
>';,,> :"._ ABOUT CO~~I~4,C:"lqN)RESPONSIBILlTlES :"- " ,I. ,.
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NOTE: This Information Notice'to Property Owners about Construction ResponSibilities was developed by the
Construction Contractors Board in accordance wi/h ORS 701.055(5), passed by the 1989 Oregon Legislature.
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If you are acting as your 'Own cotltfactor to construct a new' hom~ or make' a subst~niial improvement (0 an existing
structure, you can prevent many probleilli;"by,being'aware_ofthe,followli1gresponsibilities aildconcerns,
. -. .
Employer Responsibilities
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y ou>~ill;j!11'i1ost inst~ge;;J PS,ruledto p~,an .\:~lp.ployer:' al1d tJ?t; SQntr,act!)r~ you cot,ltract ....~fu will1J~ ':~~ployees" il
you use contractors, not liceI).sed with'the Construction Contractors Board to do labor, in constructing or to assist in the
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construction, Qr imprQvel1).tlnt of a ie~identjal s,lt'1,1cture. A~_ the euipIoy~~, YOJ! must comply with the fonow~l1g:
. ." . .._.... ,-,. ~ .. , ",.. ..; '-... ",' . '.... -.. '. '.: .' .:. _ ~ '..{:, \', _. 4.
Orego~'s WithIiolaini~~;.;, L~:.w; As~n' erriployer, ybU ~us.t -~ithhbid iric~ri1~taxes from empioye~ w~~'es a; ~e time
employees are paid, You will beli"ble f9r the tax,payments even if you don't aCJ:ually with)1old the tax from your
employees. For more informatiort; call,the'Depilrtlnent ofReve~ue at503~378-4988. -. J,~' "'~-' ,,.J'; ~; "' ,,'"
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Unemployliuint Insurance' Tax: As anemployeF; you are' requited to paY'a tax: for\ll1efuploynieritinsurance purpos~s ;,r
011 the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, ' \
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The Oregon ,Business Identification Number ,(BIN)' is a combin~(l\number, f~r: !1~t:J?.:9rt;'gqn', \Vithl1.olding and"
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091, or www.dor.state.or.lls/fonnspav.htmll for the
; appropriate forms. ~,; ~f'" "~~\'I.' :".-t........'. . t- t
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Workers' Compensation In~urllDce: As an employer, you are subject to the Oregon Workers' Compensation Law
and must obtain workers' compensation insUrance for your employ.ees. If you fail to obta,in workers' compensation
, insunin6e, yoUto'~lirb~-subj~c;t ;t:;'~e~altib~' ana btf[hoje 'rJj.',ali cial~' costr;f'9neofyoUr empioye~sis:inJured on the
joo: For more irifonTIaiiOll, cali the Workers; ComperisationDivisiou' at -tne Department 'of ConsJmer:ahd Busines~
Services at 503-947-7815." "
...
U.S. Internal R~~enue Serviee:' AsC\eiriPI6~~;yo\;:m'li~t ~ithhold'federal-iJico~e.ta~.':~m employees' wages, i
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 aU-800-829-4933 or visiOtheii' web site'at:\",vwjbi~gy. """,', ,;, r '7";~ .- !~ ,,; i. ,,; ',;
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.c.;, J.,@j:he.tRespo_n&ibiUtie~ ~J!ld ~1;~aso.lQ:)li.cerns,.;, ,'. :, ' ,
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Code Compliance: As the permit holder for this project, you arc responsible for nisolving any-failure to'meet code
requirements that may be brought to your attention t,hrough jnspectiQns. '
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Liability and Prop~rty' Damlige"Ihsiii-anc"e::" Cbntac{f6uf' ilisui';;nce agerlt 'to see'ifYou '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, ' ,_" '\ ", ",.".. _~- -
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Time: Make sureyou'have sufficient time to supervise your employees. ',,' " ::"f'...., '.....:, ","::,: \
Expertise: Make sure y~u hav'c"ihe' skills 'to act as y6'ur 6wTI g~n~iar'c6niractot, to' io~~in~t't! the work of rough~ib
and finish trades, and to notify building officials as the appropriate times so they can perform the required in~pections,
If you ha"e additional que~tions call the Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
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Property_owner.doc 06_01-04 '
225"Fifth' Stre'~iit,r~;jM~:;~\,;:'ftlh:(J'~;l'?i'
Springfield,Oregon974n
541~726-3759~~,:"~",,~,,l),J:,~,t,,'i,},,:',;~ic,~: ': :
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City of Springfield Official Receipt
Development Services Department
Publie Works Department
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i RECEIPT#:',' 2200900000000001134
Date: 10/05/2009
10:52:19AM
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Job/Journal Number,,> . De_~cflptlOn:..",:,:,:.".:/~/_./", .. .::
COM2009,0 1173 \"1,~,;tA~.4;:i\)ter.'1;:~i~,!dJ::irc:','
CO M2009-0 1173"ji;j:'>;:Minim'iiciiA<ljhs~ent Electrical
, ' .. ,',-.,;',.".-,..".,:,' . ..
COM2009-0 1173 ,J>:'1'+'5% Technology Fee
COMz009-0'1173'<\t,"i; ,':+;)2% State Surcharge
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"MELVIN WAl;TER~: ";: "
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Received By
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Item Total:
Check Number Authorization
Batch Number Number How Received
Amount Due
55,00
3,00
2,90
6,96
$67.86
.....
Payments:
Type of P~yment
.' .,0'
Paid'B;
. Amount Paid
Check
2354
In Person
PaymentTotal:
$67,86
$67.86
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10/5/2009