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Home My WebLink AboutPermit Electrical 2004-6-1 tv CITY OF SCrnGFIELD, OREGON 0 SPRINGFIELD -\O~\O..,.n~~ .. \lIe . i It.. clllaS. cl'1l6e~! ; . b{l\l\\e '{IC'\e,l' . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-368gec\as~llllife'5119CI -~- '--. . \l1l'0\' \(9<1 i'::.. ELECTRICAL PERMIT APPLICATION " I / ~9\oI\O~;cl cl09S ,,0 ~ . . . '. City Job Numberco.uzoO'-{ _ ooG ;, 0 Date b/ (/0 l{ ~o,,\II~~e.l. I O~ ~ I. LOcATION OF INS1'ALLATION- - / li:C!!tl~iiiTEiE!! ;~H~l/"o~\"\l~. tOe ~'?~ I z.b;:, w A-r;! "?,-:;'PZ-r;- oe\9 Si9"e\ll ~ __ _.. . .._. "~Il,<<,-~~ed... "..'" A. New Residential- Single or Multi-Family per dwelling unit. LEGAL DESCRIPTION /70335'1 I 0$700 JOB DESCRlPTlONc.J'\{l!i.SU0-L+ (YlO&;,W!L 7n 5tLC IOeGJ fnck( ( &;o.c.e... Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Z Y' Feeder ~ · $106.00 $ 19.00 IOU $50.00 ,~ ~-~-~ _._~-_.- .._-_._-_.._--~ ~~----_._.._- -~--_.~---_._._."" 2 : CONTRACTOR INSTALLATION ONLY B. ' Services or Feeders - Installation, Alterations or Relocation: . l.__..______ _.___ ___..__ __ __ L-- ______.__ Electrical Contractor If Xl r-lu (d~f EC&tn(j;.i...Jl~~O Amps or less ~ $ 63.00 1" J'06~' 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 Constr. Contr. Number /.,- <\ R- 77 Expiration Date (,., ) ,;;; as' { .. C!':,e!.600 ~mp-" o.':IOOO,Volts see "~~~o~e. - -------'-...--, Signature ofsupe~i:; Ele;~cian ATTENT~~i~'~~~~~=~~a~;1 - - -. , --- - ___1 mA..--/./ -:Jf a/.AIP follOW r.u\e~ftm:u\those rules are set forth $ 43.00 - NOtlllcatlOn :tJ6~.t'~,wb{i~MUl~-OVI. In OAR 952 'Cib~~Wp~ltthe rules bv $ 3.00 . Owners Name D(,,< (' ( r,s i T OJ\.)(:::"';0090. ,YOU ~ay_o _ _ Note:.the telepho~e. __ ____ ____ Address J'd...fn <~. ./?'lti~.u sfr'f'd . call1~;fr:r~~~}i~8HsJ~5fr~UlBI illcl~e~ -Each Ins.tallaliO~ City 0 pC'! t\ ~.ce.1iJ Phone nUm CtaIltIP j~ iln~qp'~-2344). $ 50.00 S~ ;J..S Sign/Outline Lighting $ 50.00 OWNER INST ALLA nON Limited EnergyIResidential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intended for ~Om~r rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: THIS PERMIT SHALL EXPIRE IF Tr~~~TOTAi()F ABOVE ----- -. -'1 lOG AUTHORIZED UNDER THIS PERM -. ..._. ------~ r.flMMFNCED OR IS ABANDONED FOR7% State Surcharge ? ANY 1 BO DAY PERIOD. 10% Administrative Fee . /0 1> /!7~ Address l t /1 J<. (/' Ir/ b ~ 6e, 3cXQ City ;3rt'lltjVf)JI {(e.... Phone 9'/'1(, 705 Supervisor License Number ,,:S 'f0<..-.S ExpirationDate /0 -c/~ (l(j Inspection Request: 726-3769 C. L!.<'mp~a'ISer"ices or Feede~. --:- --- ) Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 TOTAL Shared Drivc(T:)/Building Forms/Electrical Permit Application I-OJ.doc . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1263 MAIN ST SPACE 25 ASSESSOR'S PARCEL NO.: 1703354108700 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00630 ISSUED: OS/27/2004 APPLIED: OS/27/2004 EXPIRES: 12/0112004 VALUE: $ 5,000.00 Springfield TYPE OF WORK: Manufactured Home in Park TYPE OF USE: New Residential PROJECT DESCRIPTION: MH in park OWDer: SOUTH V ALLEY ENTERPRISES INC Address: PO BOX 2567 EUGENE OR 97402 I CONTRACTOR INFORMATION I Contractor Type Electrical Manuf Home Inst Plumbing Contractor License NORTHWEST ELECTRICAL CONSTRUCTI 155877 A ACTION MOBILE HOME MOVING & DElV142807 OWNER Phone 541-466-3201 541-935-1786 Expiration Date 06113/2005 05105/2006 I BUILDING INFORMA nON I # of Units: Primary Occupancy Group: Secondary OccupaDcy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 # of Stories: Height of Structure Type of Heat: Water Type: RaDge Type: Energy Path: Sprinkled Building: VN D/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPlh"'lu ll,"uNMTION I ATTENTJON' nro',?AA '.n. --lI!, follow rules lf~iml =..~ ~otificatloh CEI, ..d.. I r Ib~s are set forth In OAR 952-001-0010 through OAR 952-001. Sidewalk Type: 0090.. You may obtain copies of the rules by Downspoutsmrains: calling the center. (Note: the telephone number for the Oregon Utility NotificatLQIJ. . Center is 1-800-332-2344), NuTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paeelof3 REQUIRED PARKING Total: HaDdicapped: Compact: Description Tvpe of Construction Manuf Home Manufactured Home Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 7% State Surcharge Manuf Home State Issuance Manufactured Home Connection Manufactured Home Placement + 10% Administrative Fee + 7% State Surcharge Manufactured Home Feeder Manufactured Home Service Total Amount Paid . . 1..11 i" OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00630 ISSUED: OS/27/2004 APPLIED: OS/27/2004 EXPIRES: 12/0112004 VALUE: $ 5,000.00 I Valuation Descrintinn I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 5,000.00 Value Date Calculated . Total Value of Project $5,000.00 $5,000.00 OS/28/2004 Fpp< PiWIJ Amount Paid Date Paid Receipt Numher 1200400000000000817 1200400000000000817 1200400000000000817 1200400000000000817 1200400000000000817 1200400000000000833 1200400000000000833 1200400000000000833 1200400000000000833 $20.50 $14.35 $30.00 $45.00 $160.00 $10.00 $7.00 $50.00 $50.00 5/27/04 5/27/04 5/27/04 5/27/04 5/27/04 6/1104 . 611/04 6/1104 6/1104 $386.85 I Plan Reviews , 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. UeouireCUnsnections I 3 Manuf Home Set Up: When installation of all piers or stands is complete. 1 Final Manuf Home Set Up: After all required inspections are requested and approved aDd porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. 2 Manuf Home Plumbing: After home has been connected to water and sewer. 4 MH Electric: When blockiDg, setup and plumbing inspections have beeD approved and the home is connected to the panel. 5 MH Service: Approval required prior to utility company energizing service. Pal!e 2 00 . . CITY OF ~rK11~GFIELD Building/Combination Permit Status Issued PERMIT NO: COM2004-00630 ISSUED: OS/27/2004 APPLIED: OS/27/2004 EXPIRES: 12/0112004 VALUE: $ 5,000,00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that I bave carefully examlned the completed application and do hereby certify that all information hereon is true aDd 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 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 all required inspections are requested at the proper time, that each address is readable from tbe 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. Owner or Contractors Signature Date Pace 3 013 225 Finn Street Spdngfield, Oregon 97477 541-726-3759 Phone . ~~~"'I!I!!.Fl~.___ i IIIL. UA!: I ~! " ---. ,"'. .' IllliJi.ty of Springfield Official Receipt Wvelopment Services Department Public Works Department RECEIPT #: 1200400000000000833' Date: 06/01/2004 12:05:52PM Job/Journal Number COM2004-00630 CO M2004-00630 COM2004-00630 COM2004.00630 Description + 7% State Surcharge + 10% Administrative Fee Manufactured Home Feeder Manufactured Home Service Payments: Type of Payment Paid By CreditCard MICHAEL RODOLF Item Total: Check Number Authorization Received By Batch Number Number How Received djb 000399 001019 In Person Payment Total: Amount Due 7.00 10.00 50.00 50.00 $117.00 Amount Paid $117.00 $117.00 6/1/2004 Page 1 of 1 . CITY OF SPRIN\..-t<lJ<..LU . Building/Combination Permit PERMIT NO: COM2004-00630 ISSUED: OS/27/2004 APPLIED: OS/27/2004 EXPIRES: 11/27/2004 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1263 MAIN ST SPACE 25 ASSESSOR'S PARCEL NO.: 1703354108700 Springfield TYPE OF WORK: Manufactured Home in Park TYPE OF USE: New Residential PROJECT DESCRIPTION: MH in park Owner: SOUTH VALLEY ENTERPRISES INC Address: PO BOX 2567 EUGENE OR 97402 I CONTRACTOR INFORMATION I Contractor Type Manuf Home Inst Plumbing Contractor License A ACTION MOBILE HOME MOVING & DElVl42807 OWNER I BUILDING INFORMATION I # of Units: ~TTENTION: OI1lClOft taw w;..Jj;:""~WtD Primary Occupancy r~\?Jl& rules adb'PtecI by the~~bltl\5li!ilyture Secondary Occupan 100lllion Cell\<<. Those NlirJIM! l.bW!lrttl Primary Constructi QJj2-o01:ob10throu9\~~1. Secondary CODstrucllO t'... obtain copI&e'! by # of Bedrooms: 0090. OU may . ~.'w, calling the cent9t (Note:. . ing: nla _. .~h... ,^, t+>A Orll!1.on Util ~ , CenterIs1~NTINFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: . NOTICE: T SHAL' I ~.l),I.U.~.~M,I\W:NTS ~ THIS PERMI L - ., Street Improvements: AUTHORIZED UNDER THIS PERMIT IS NOT Storm Sewer Av~i1ableOMMENCED OR IS ABANDONED FOR SpeciallnstructioD: ANY 180 DAY PERIOD. Expiration Date 05/0512006 Phone 541-935-1786 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: DownspoutslDrains: Notes: I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa~el of2 Value Date Calculated . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00630 ISSUED: OS/27/2004 APPLIED: OS/27/2004 EXPIRES: 11/27/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project FI'I''' Paid. Fee Description + 10% Administrative Fee + 7% State Surcharge Manuf Home State Issuance Manufactured Home Connection Manufactured Home Placement Amount Paid Date Paid $20.50 $14.35 $30.00 $45.00 $160.00 5/27/04 5/27/04 5/27/04 5/27/04 5/27/04 Receipt Number 1200400000000000817 1200400000000000817 1200400000000000817 1200400000000000817 1200400000000000817 Total Amount Paid $269.85 I Plan Reviews I 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 Re~ed Insn~ 1 Manuf Home Set Up: When installation of all piers or stands is complete. 2 Final Manuf Home Set Up: After all required iDSpections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. 3 Manuf Home PlumbiDg: After home has been connected to water and sewer. 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, aDd 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 pertainiDg 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 all required inspectioDs 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, aDd the approved set of plans will remain on the site at all tim~onstruction. \';;W ",<<~,uru.. :f~ 7-;,<1 Paee 2 of2 225 Fifth Street , .. Springfield, Oregon 97477 541-726-3759 Phone . [!~;~~ ~-.. '" llllfiijj,ty of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2004-00630 COM2004-00630 COM2004-00630 COM2004-00630 COM2004-00630 Payments: Type of Payment CreditCard 5/27/2004 RECEIPT #: 1200400000000000817 Date: OS/27/2004 Description Manufactured Home Placement Manuf Home State Issuance Manufactured Home Connection + 7% State Surcharge + 10% Administrative Fee Paid By ANGIE JANZ Item Total: Check Number Authorization Received By Batch Number Number How Received djb 000396 027426 In Person Payment Total: Page I of I 1:30:47PM Amount Due 160.00 30.00 45.00 14.35 20.50 $269.85 Amount Paid $269.85 $269.85 e. . . . . \'" ,./ " " . . . €onstruction 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 Permit #: L.OV'Il./..f-OC6 ~ 0 Address: I Z-b '3 ;m~AI ~ s.f 2 ~ Date: S/2.~y Issued by: 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 archi1ect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submil this statement. This statement will be filed wilh the permit. Fill in the "pp.vpriate blanks and initial boxes I and 2, and either box 3A or 3B: ~l. ff'Z. 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. o 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. Ifl 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 certi that the above information is correct and that I have read and do understand the Information Notice to Pr ' erty Owyet1bout Construction Responsibilities on the reverse side of this form. i /M--1 /b .5 ",J.?-CJ r/" '---/' c1'ignat~JPermit applicant) (Date) ~ite copy to issuing agency permit file, pink copy to applicant.) r.......,:...owoer.doc 03/11/03 . . Acting~s Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . NOTE: This Information Notice to Property Owners about Construction Responsibilities 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. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and lhe 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 the employer, you must comply with the following: Oregon's Withholding Tax Law: 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 a State Business ID number, call the Business Information Center at 503-986-2200. Unemployment Insurance Tax: 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. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CV'''I'~..sation 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. Internal Revenue Service: 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 EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities an~ Areas of Concerns Code Compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. 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 spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, 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. Property_owner.doc 03/11/03 . . . t ~ ~ ~ ~ 1,' t i I~' 1 . . I . e.,L \ sf) " j vVl ~ ~I k; '2.,'1 I I -...I 2- v Sucle. I ole:: Ib' . -exis-h, CtvfX'Y+ {).J1t! s hed .!- ~' I0e w rn~1 Ie- hcrYne.. (" .,<{,' 1\ I -z.} /" \ \/ - ~ e)(l~ VYlob}!€- I, o:,~ s ~ I6'blDD \~? rYla.i n st. .#ZS ,. / tJrf~