The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2007-6-18 r; SPRINGFIELD ZON l.,P '- U~. ..~ INITIALS NT"'. 'f"" .. ~. DATE ,,, "'III' v 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541).'26-3753 . FAX: (541)726-3689 . "",. "'" SOURCE f"'~ ELECTRICAL PERMIT APPliCATION '/ I City Job Number CDMLoO,-CO g-7Z- Date tlfft/V7 _, ,~ -.--~. '~r~ V.\.,." .~. ,'" ~..."..... -'-'.' ..~...,-o. / ...-/~-:...... -, #.-.' 1. 'LOCATIONOFINSTALIA'TioN:.' ,', 3. ~COMPLEiEFEESCHEDULEBELOW' 5-q ~ir(iYi-\jIJZ-~c\~r-~\';'- -'.~': .'.'-~= ~.~.~~~.-~:"_'''~~: ".~-~':" .' ..... u -, LEGAL DESCRIPTION: A.' N.ew Residential. Single or MUI!i-Family p~rdw~iling ~itit. I t02.0 523 (:) <6-S'00 Se-~ice'I:c;~~e~-' -.' " - . .'.. - ~ AJZc~;:~ ~ -P'^- tU -tu b lAl:~~ . f~~" '''';. - o!.. ",,_..' ~ r~./. ,,'l .... ~ 9I.~ " .,~" .'-":;.... ,t;' ,.)!"- ,t.>'GT"J"'(T orr'splHK.dfifFTn"' OREGO~T ' -- ~,:.;~~~~.~~~~~i:':~;" , r~~. /~ Ji~""" ,. It ~ ' . .', '1 '\f .~ :, '~::M:\' 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Permits are non-transferable and expire if work is Each Manufac!' d Home or - not started within 180 days of issuance or if work is Modular Dwelling Service or Snspended for 180 days. Feeder '';.._~_'',_ ...__. '_~......._"._~, .____.__ ,~""'~_~'.:-v~:",-:--'____"'___'_ -..... 2. C;o.NTR:'1c:.o.f:?!:l~T:~p~T!.Oli. ~~L1::_:.~e"> '10~~\~~~~~es~ F~~del~~ l~s~a~~~on-,..Alterat~ons. ~r R~loca~io~: o:~' ,,0<::- ,p';-. (';~ Electrical Contraclor ., \~ ,,-\e'<> ,\I '2OQ:J\mp~ or less $ 63.00 '\,) '" I ro.' 0\,) ~ ':I 0<::- ''',,'S'0 ."-\1"> ~""2~~m~ to 400 Amps $75.00 \1<:$ -,'0' \V 0 " . ,0" " 0\ ,"I-' 0,,>e ,(f !I.-r401;<.Amps;ro 600 Amps $125.00 .<\O",.'I>OO\!~\~'\" ~\()~,,\e"> ~\I'6ii~-~ to 1000 Amps $163.00 .~, f;,~" 0" .~. :';\0". ' QJ(6he.,,~'lJ- ('f?,<::' :.<:-- G O~\I' .,{\0ve~~roOO AmpsNolts $375.00 :\ ,. ~" - '.;'. ,~' ....~ ~ ~O~~'n5)<::l o'O~ ~ ~~ ~ v ,RetonneclOnly $ 50.00 \0 .~. ~:>.: '1>'1 ~,\I' e~O ~":Jv _\O~ i:>~ C,e 0\ !Q<::l<::l l-','". - '~-.7: ~- - -- Supervisor License Number '--::~ ro ,.:s-e o(<::-e.r;, V C. !~,!elll~o~.9'_S.eR'~ ~r ~':.~~~~__ ... ... _.. uI ~ ~\<::''<> ~'u' ^,0' . c,7> 'SJe r!?"- AJ . Expiration Date ,!,<S' v Installation, terallon.or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ ~OO 401 Amps to 600 Amps . ~(jji~ O:er 690 A~p'so~I!!.O.o ::0!!S "see~B" ab~ ~ ~~ D. :.!3!aI'5~ <:i!~~i~.~_"__ .~. -..4 #~._ New Alteration or Extension Per P!!-..~I~~ $ One Circuit i~ ..!::'j'.~ 43.00 Each Additional Circuit or with .;:;-' ~. .;;- Service or Feeder Permit .~ I~ _<:0 . $ 3.00 ~.~-':?' . ce,', '''. ',-:-.; --. ?"'f:;......jf li,....~. ---, -- - ...... E. ,l\1isceIlan~ilU~ (Sef.ylCeJ$~e~,n~ihC!uded) -Each Installation' --~= ~Q..~ f::fffJ:Q.<<;--- --- ____. ---. Pump or irrigat~ ~ .# # _~ $ 50.00 Sign/Outline Lightiilf ~ $ ,,<;::, v no.oo limited EnergyIResid.;g(i@S ~ .....- $ 25.00 Limited Energy/Commercial~ $ 45.00 . l\1inimum Electric Permit Inspection Fe~Q.O_-j,.S)Jrcharges r -:'" ..-- -. _~_h._...... -~..'" ,- - -.---.- -- ~..+.,....<-. 4'1.~0!T2}'AL6;F;1BqVE __.___. l(J-- 8% State Surcharge ~ bD 10% Administrative Fee 'I ~..... 5% Technology Fee ? 7 ~ -r)S ':>..> - $50.00 Address City Constr. Contr. Number // V Expiration Dale Signature of Supervising Electrician {l3 Owners Name 1JA.Yl b ~ _ l-\f. {l.\.!t <C.Lfr-AJ D ' Address 51 g'-j M T t/ fJ( NmV '1< ~ City ~'Pf.b I:l R Phone :541 - 5:;" -tp.,~CO OWNER INST ALLA nON installation is being made on property I owo which is no . ende qor sf.A=1 lease or rent. o rs Sign-Je: JA V~ '~. Inspection Reqnest: 726-3769 TOTAL Shared Drive(T:YBuilding Fonns/Electrical Permit Application S-Q6.doc . . Lll i' VI' ~YKll'll.l'l~LD Building/Combination Permit PERMIT NO: COM2007-00872 ISSUED: 06/14/2007 APPLIED: 06/14/2007 EXPIRES: 12/14/2007 VALUE: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Liue SITE ADDRESS: 5984 MT VERNON RD ASSESSOR'S PARCEL NO.: 1802032308500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Add circuit for hot tub Owner: DA VID HEA VIRLAND Address: 5984 MT VERNON RD SPRINGFIELD OR 97478 Phone Number: 541-556-8400 .~ ......JOV.,..hl 1<:"t}CONXRJ\CHJR INFORMATION I \'3-'l'l 01"'''' <;"'-' ro.,(:i'- C - ,,(\ ~'(\e '3-le <;~.v on~~ctor'O,!' 'VW'" ~ 9'J <;'0'1 'OWNER,\eO Se 1 01>' I'VW _...\1:.' _........ -{\"\O .,,'(\. ~""e _",0 1>-'\ \ ~~ I'VW'O (,e(\\e~O\\) \'(\\~~I\'GBUihDIl~G-'lN?ORMA TION I \O\\~\c\l.'i.\O(\ ,\)\)\- 'f:J\i$\ C ole. :"';:1 ""J! # of Units: ~o\\ rr-..'?- <?J<:'~ \\1'0-'10 \el, ~ (\ $\~\#,,o.fSt\;ries: Primary occupancx;G}AJ~P:O'V ~e c,i{-tleQ,O \).~",7Height of Structure: Secondary Occnpancf6ronp:; \0' \'(\e. . ~ V'O\! Type of Heat: ~\\' ,\ .~~ Primary ConstrnctioD TYpe(\'Oel Ce(\\v.B Water Type: Secondary Construction ~pe: Rauge Type: # of Bedrooms: Energy Path: Sprinkled Building: Contractor Type Electrical License Expiration Date Phone Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING ~tal: &. ~"~~icapped: '\~ ~Compact: ~~ ~'\ ~~~ <-~~c. ~<v<<:'~,y.)> <<. I PUBLIC IMPROVEMENTS 1:.:,~'I>-'\.'&.~5'<"~~~\J' ".'V' ~, .,,<::i ~'(:) l'.'\\'\} 9;.~ <'. ,\>\"Sid~walk Type: ~'\} ~~ 0v<V'v (\,~ ,IJ'\)' ~ *-C:> ~~ ';.;<v~ D~tnspouts/Draius: ~ ~'\~ ~<v~ ~~ ~ ~~~ ,'t;,~ "r~ Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Cov~rage: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvemeuts: Storm Sewer Available: Special Instrnction: Notes: I Valuation DescriDtion I Description Tvpe of Construction $ Per Sq Ft or multiplier Sqnare Footage or Bid Amount Valne Date Calculated Paee I of2 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00872 ISSUED: 06/14/2007 APPLIED: 06/14/2007 EXPIRES: 12/14/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726,3753 Phone 541-726-3676 Fax 541-726-3769 Iuspection Line Total Value of Project L.Fp.p... P3id I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid $4.50 $2.25 $3.60 $43.00 $2,00 6/1 4/07 6/14/07 6/14/07 6/14/07 6/14/07 Receipt Number 1200700000000000767 1200700000000000767 1200700000000000767 1200700000000000767 1200700000000000767 Total Amount Paid $55.35 I Plan Reviews I 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. Rongh Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state aud agree, that I 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 Spriugfield 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, Bnilding Safety, I further certify that only coutractors and employees who are in compliance with ORS 701.005 will be nsed on this project. I fu gree to eusnre that all required inspections are requested at the proper time, that each address is readable from the treet, th t the permit card is located at the front of the property, and the approved set of plans will remain on the site at all ti:es dU, i~g co:t:u~\~_ (I) _ I L{ _ 200 ~ _v-v"\.. ~ Owner or Contractors Siguature Date Paee 2 of2 e. . . . . . . . . ". " . .' " ' . Construction 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#:COV1A~7- ouo7z. Address: 57F'f vVlT Vc-t1-v\.o",,- Issued by: ~g Date: ~y I~ '7 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 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 1 and 2, and either box 3A or 3B: ~l. !@-2. 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. If! 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. MebY certify that the above information is correct and that I have read and do understand tbe Information =,~~~\r..~m~::~'dbm..~" m. '~~"~'~'7~'~~ i-- \ QJ (Signature )fpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 o '. . A~~nnn~ ~~ 1i IUllUlIr ((J)wnn CG~nn~Ir~n C({Dlffi~Ir~d@Jl"T H\lFOROOATION NOTICE TO PROPERTY OWNERS A80UT CONSTRUCTION RESPONSI81L1TIES , , . , 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, lEmJllln~yeJr JRe!;JllI~nn!lnlbnnn1bie!; You will, in most instances, be ruled to be an "employer" and the contractors you contract with wiII 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 more information, call the Department of Revenue at 503-378-4988. Unemployment Insnrance 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. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms, Wor/.ers' Compensation Rnsurance: As an employer, you are subject to the Oregon Workers' Compensation 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. InteJrnllllRevenue Service: As an employer, you must withhold federal income tax from employees' wages: You will be liable for thc tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.pov. ((J)~r';1<eIr lP&<e!lJPli!Jlnnsfilb>fiilfi~fi<e!l ~llTII[j] AIr<e~!l <wif Ci!JllTI'.~eIrrrnS Code Compliance: As the permit 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 linsurance: Contact your insurance agent to see if yor have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage!roJ'!l pipe punctures, fire or work that mu&t be redpn~J r, . '- . _I I I I ), ), (v . 1 I J", . ."1 t I ./ -, 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 06-01-04 225 Fift~ Street Springfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2007-00872 COM2007-00872 COM2007-00872 COM2007-00872 COM2007-00872 Payments: Type of Payment Cred itCard cReceintl RECEIPT #: ........~' . QOIIIUl! .. 1IIc' . . . '." .,. ',' ..,. " ~ of Springfield Official Receipt .elopment Services Department Public Works Department 1200700000000000767 Date: 06/14/2007 Description + 5% Technology Fee + 8% State Surcharge + 10% Adminislrative Fee Add, Alter, Extend Circ MinimumlAdjuslment Electrical Paid By DA VID HEA VIRLAND Item Total: t:heck Number Authorization Received By Batch Number Number How Received djb 281958 In Person Payment Total: Page 1 of I 9:28:53AM Amount Due 2.25 3.60 4.50 43.00 2.00 $55.35 Amount Paid $55.35 $55,35 6/14/2007