HomeMy WebLinkAboutPermit Electrical 2009-11-4
-225 Fifth Streett Springfield, OR 97477 t PJI(541)726-3753t FAX(541)726-3689
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I pe~: ZOO"i:;-OI28'1
I Date;; 1(- L(-O ?
Electrical Permit Application
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~ert~: OJ!' SPRI~GFIELI>, O:REfi.,QN:, ''',
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This permit is issued under O,AR 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.
1,) ",' ,LOCAL GOVERNMENT ,A~I'ROVAL""~"\; . ,;,",'1 l~f~:~,;Iit~:;,: ,'....~jFEE ,SCHEDULE,:~~t!:r~:'?I?r.;.\?,.',
Zoning approval verified?.. 0 Yes . p No . I 1~~~';~;e"~iin~~~ct!'6~~"pe_~~:oi~t~~:~'("'~::~~:IQt;~1.~_:',~~!~Q,~I:;.rotal~
~H;~~~::;i~tTEGY~~:~e~~:~TRUr~O;o~~::;~';;" ;"i 11~~CS~~~:;ial: p~~ U~i~:~servic:'in~'I~'~'~~': ~.\.- ,_eJi~-"... ~ t.cost-~'l
~:Ei::;t~J.OBllSITE'.INFORMATION,' AND: toCA TION:li:~..tf-1 1,000 sq. n. odess (4) . J $134,00 $13';, I
I. J ~ < .... I I Each additional 500 sq. n. oc portion $ 25.00 $
Job SIte address; -,0 -::L (~, -1 ~ thcreof
I City: .<.p(';~.8# _J_State:~ I ZIp,:q}_Lf.1tl I Limitedencrgy(2) $ 32.00 $
i~~~~~~;'~:.;t~~~~~~~~N<Of;!~W!;~~~~~~~~~~~11 J~~71~:nS~~~~:~ ~e~~:r (~)odular $ 63.00 $ ~
---.J - - - ~ ,'w~<e. p _~ e (_-\-(lCod) To I Services or fceders: installation, altiralian, relocation
. _ q:Jf & \ >r.:.lJY\ I 200 amps or less (2) $ 81.00 $
;;~ilitt,'1i:,,\'i'i'1-~>i~,RRORE~T.Y.',~QWNER.,':,-:.;': :~\:i)!i~'i' 1"':~">:, I 20110400 amps (2) $ 95.00 $
I Name: \lorN'V\ C'( \.\.al'Cl ) \?,(l. v'1-o I 401 to 600 amps (2) $158.00 $
I Address: Lf 0 l I.n l SJ.- I 60110 1,000 amps (2) $205.00 $
I City: .so A r<2.. \-" dId> I State:O'li.", I ZIP: ~1'i7~ lOver 1,000 amps 0' volts (2) $469.00 $
I Phone",,\.{~ -'lL.<?:! d.. 1':> 1 I Fax: I Rcconncct only (2) I $ 63.00 I $
I E-mail: clo<(( v, 'Oa.l1u €) YCL\.M:.o. ~ I Temporary services or feeders: installation, alJera/ion, relocation
Th" II' . b . d 'd' I ' I 200 amps oc less (2) $ $
IS msta allOn IS emg ma ~ on reSI entIa or larm property 63.00
owned by me or a member of my immediate family. This I 201 10400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR I I
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signat\l10r@fi_^_-,' ~ ~ '. ,. lOver 600 amps 0,1,000 volts, see services 0' feedm section above
l~t.fr;~'-(>t7f;.fH~ I" I ~.)~l I Branch circuits: new, alteration, extension per panel
I BusineSUilih\eRIZEi!lMl}E)Y~ tltHM III "'... I a. Fee for;,r,ihrIl'Jl}T1r.s!\l,:it9!iIlQ~daI'UMI~Il'~~~}~:
I 'OM"ENCED OR I~ A'IDOOtONI:II~ I ' .vllv., ..,..vv vJ"Iltv~ 1:., (Lv 'V"VH ...1'1
Address: "'_ ~ Each ~I\'ffi/il!ffi\'.fi r."nt", Tn
I City: ANY 18U lJAY I'tnl~~late: I ZIP: - I I b. Fee fotrt@ll\\ll~S'2l{)lY~b{W)W'tlll~ (MAe9$!>OO~",e
I Phone: I Fax: I I Fi," bP.,Ql;llJoj,:!',\lI;U\lay O.btai~ c pies O'V~J ~ by
I I I "",II.. '1:1 ;[.~ v~"'~....' a
E-mail: Each adWlll'/lflA'f'Yl\'flWli"l'l,,,nnn II . , .
I CCB license no.: I BCD license no.: I 1 Miscellaneous feesOemercjsfq4tl&>OOi02844).
I Signing supervisor's license no,: I I Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: I I Each sign or outline lighting (2) $63.00 $
Signature of signing supervisor: I I ~li~~::i~~,c~~te~~nl~~~(g)cnergy~~~el, $ 63.00 $
I Each additional inspection: (1) $58.00 $
"./ I~;A,~::' ",;T~,>" ,;~ARPCicAr\fr:(!OSE~,;;;:,;:~i:: .."',,,,''';'1:;
~~ I (A) Enter subtotal of above fees $ 1'7 U
(Minimum Permit Fee $58.00) ~ 1
\\~~.r4V I (B)EnterI2%surchargc(.12x[Aj) $ /boB
~'7(' I (C) Technology Fee (5% of [A]) $ b""-L
~ I TOTAL fees and surcharges (A through C): $ / sf 7P
440-2584-J (9/08/COM)
Status Issued .y ,)
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225 Fifth Street, Springfield;OIfi?;;;',.F'
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541-726-3753 Phone/-,.:'::---, "';,.- :':'.;
541-726-3676 Fax' \ .:'
. 541-726-3769 Insp~ction Line
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CITY OF SrK11~GFIELD
Building/Combination Permit
PERMIT NO: COM2008-0128I
ISSUED: 09/12/2008
APPLIED: 08/25/2008
EXPIRES: 05/13/2010
VALUE: $ 32,685.00
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SITE ADDRESS:. '402 67TH ST' Springfield TYPE OF WORK: Single Family Residence
ASSESSOR'S PARCEL NO,:. 1702344102900
:. '. :. .,;;::j~.;.': ..', '.' .' TYPE OF USE: Addition Residential
PROJECT DE~C.RlPTION:1S\d_di!ioii to single family residence
. "~:-:'.. :~.:;~~.,:~~;~F::~' :.--::}:. .....,~~.:..~;t ;'.
, Owner:
, Address:
.' ELLARD KELLY J & DOREEN R
~, 402'67TH.ST; ,...,.. .
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SPR.lN GF-HiLl':' OR"974 78
Phone Number: 541-968-2702
I CONTRACTOR INFORMATION I
Contractor Type ::.;#,Contract"r
General ,~: '" "i:\'t, OWNER "
... -t 1 ~
Electrical ,... OWNER
Mechanical 't'" :' OWNER
. ,
Plumbing . j. OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
"'-"
# of Stories: 2 Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Electric Sq Ft 2nd Floor:
Water Type: ATTENTlON~rtigllflSlllW'~qulres yoU to
Range Type: follow rules a'tIb~~9ll#tj:Olllgfln Utility
Energy Path: Notification cElittdn qJJiDs9 rules are Iletfortlt
Sprinkled Building: In 0MQ52.()~IMlQJQh OAR 952-001.
";/,',_ "," 3999. '11:'. ..:,~.9i;'tAIRO~pi~tro.~fh6.tl'ACIo~
. J l!&Iift1ENTlN FO RMA TI ~Itlg the center. (Note: the telephone
NO"\CE~ l.l~'R~I' .', \aNOt _'II4QrfortheOr~~~G
Frontyar<t;~lPli,,~W1~~S~~ER)H.'$.~~tJI\'f fOWve,r:'a'y Dist: GenlIr 111 otal: -2344).
Side 1 set6;.~!r\ORI~EO UOR IS ~B)l._"EtJ # Street Trees Rqd: Handicapped:
Side 2 Set, :ivIME~CEO <>'0010.00 . Paved Drive Rqd: . Compact:
Rearyard S'e creQ:O~'l pEn 15.00 % of Lot Coverage: ,23.80 .
Solar Setba~ : ' . ","'0' ~ I~! ;.:
# of Units:
Primary Occupancy Group:: .. T]:R-3
Secondary Occ~pan~y"Grotip: --"; ."~
Primary Construction)'ype VB
Secondary Construction. Type:
# of Bedrooms: ~" j I' ' :.' . . '
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8,276
597
I PUBLIC IMPROVEMENTS I
'Street Improvements: Sidewalk Type:
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Storm Sewer Available:':' ..,~: ,"." Downspouts/Drains:
Speciallnstruct;on:;1 .: 'Stormwater to tie into existing system-drains to weep hole in street
Notes:
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Status . Issued\. , : .
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225 Fifth Street;Sprin'gneld;-ORA,.::
541-726-3753 Phone .. ':';'''' {[};:
541-726-3676 Fax'
541-726-3769 Inspection Line
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Description. "...':"..Tvpe.of G<!nst.ru~tion
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Dwellin!!s V Wood Fr,;'in';
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F;ee DescriPtion;;,: I ~\.. --~',
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Plan Review Residential'
-Mech Iss 2+ Appliances-
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Building Permit, .: ~,' . '::-:, ;.
Fire SF Fee _ R~sidential ~i
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Fixture ..
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Furnace - Unit Heater ;.
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Minimum/Adjustment Mechanical
Plan Review Minor - Planning --;
Sanitary Sewer - 1st 50 Feet
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement .r.
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SDC Sanitary/Storm Admin . _' ~ '~. ,.
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Storm Drainage Impervious Area ".
Storm Sewer - 1st 50 Feet
Vent Fan ~ ifi. ~r... ~
Water Line ~-lsHo'F';ej"' -"--";
+ 12% State Surcharge
+ 5% Technology'Fee
Residence Wiriug 1000 Sq Ft
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CITY OF ~nUj'l\.d'lJ<..L1J
Building/Combination .Permit
PERMIT NO: COM2008-0128I
ISSUED: 09/12/2008
APPLIED: 08/25/2008
EXPIRES: 05/13/2010
VALUE: $ 32,685.00
I Valuation Descriotion I
$ Per Sq Ft
0" multiplier
$105.00
Square Footage
or Bid Amount
597.00
Value
Date Calculated
$62,685.00
$62,685.00
08/25/2008 .
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Total Value of Project
F"t>< PlI.ilU
Amount Paid Date Paid Receipt Number
$200.84 8/25/08 2200800000000001285
$42.00 9/12108 2200800000000001382
I" $61.48 9/12108 2200800000000001382 ..
, $70.20 9/12108 2200800000000001382
$35.20 9/12/08 2200800000000001382
$308.98 9/12/08 2200800000000001382
$29.85 9/12/08 2200800000000001382
$68.00 9/12/08 2200800000000001382
$15.00 9/12/08 2200800000000001382
$29.00 9/12/08 2200800000000001382
$119.00 9/12/08 2200800000000001382
$52.00 9/12/08 2200800000000001382
$147.26 9/12/08 2200800000000001382
$193.66 9/12108 2200800000000001382
$28.95 9/12108 2200800000000001382
$238.13 9/12/08 2200800000000001382
$5MO..!'. 9/12/08 2200800000000001382
$,8.00" . 9/12108 2200800000000001382
$52.00 9/12108 2200800000000001382
.,' '
$16.08 11113/09 2200900000000001290
$6.70 11/13/09 2200900000000001290
,.$134.00 1l/13/09 2200900000000001290
Total, An!.ou,~t Paid ..:,.~ " $1,908.33
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Initial Review" ."
Structural Review
08/26/2008
08/2612008
I Plan Reviews ,
08/26/2008 APP
08/26/2008 WE
NJM
C.IC
Waiting for energy option, missing
truss sheet and for applicant to
define use of spaces
Public Works Review' l' . ,":",08/26/2008
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08/29/2008
APP CTM
Stormwater to tie into existing
system-drains to weephole in street
Plannin!! Revie~ "', "" 08/26/2008
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09/02/2008
APP DDK
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CITY OF SPRIN&,HELD
Building/Combination Permit
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Status . Issued",' . it.;"hF":"'':
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225 Fifth Street, Springfield, OR "
541-726-3753 Phone
541-726-3676 Fax ..;,/,:^.
541-726-3769 Inspecti,!~Lin~,~);';,~!J(ii>
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Structural Revi;\v f \." 09/11/2008
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PERMIT NO: COM2008-01281
ISSUED: 09/12/2008
APPLIED: 08/25/2008
EXPIRES: 05/13/2010
VALUE: $ 32,685.00
09/1112008
APP
CJC Approved as noted on plans
To Reque'st a~' insp~ctio'ii c~!llhe 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. ..'
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:t'.:;S:;~i;,:;{'i)i~~~~;r Rp~llPPtion< I
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Footing: After trenches are excavated.
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Foundation: After forms-are' erected but prior to concrete placement.
Post and Beam:' Prior to Iloo'r insulation or decking.
Floor Insulation: Prior t~,~~~king. ,)
Shear W~II Nailing: Before-c~vering sheathing with finish materials.
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Framing Inspection: Prior to cover and after all rough in inspections have been approved.
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Wal! Ins~latio.n: ,Prior to cover.
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Ceiling hisul~ti~!J: .p'~ior to cover.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Final Building: After all r~quired inspections have been requested and approved and the building is complete.
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Perimeter Foundation'Drains: After gravel and filter cloth is installed but prior to backfill.
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Unde~llo'\,r'piu'mbing: Prior to insulation or decking.
Underlloor Drain: Prior to cover or placement of concrete.
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Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior io filling trench and including required testing.
~ .,. .
Storm SewerI,in~: Prio~ ~'O fi'lii~g trench. .
Final PI~~j,i~g: 'When all pl~mbing work is complcte.
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Rough Mechanical: Prior to Cover
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Final Mechanical: When all JlIechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all eiecirical work is complete.
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Electric ~.ervife:.,;.Approval. required prior to utility company energizing service.
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CITY OF SPRINGFIELD
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Building/Combination Permit
,;.' .
225 Fifth Street, Springfield, OR':)::': ,:, ,
541-726-3753 Ph ","".'..' ,\;:..,id',i,i,:" .
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541-726-3676 Fax .,'-"'\ "".: I . . ..,\
541-726-3769 InspeCtion. Line
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PERMIT NO: COM2008-01281
ISSUED: 09/12/2008
APPLIED: 08/25/2008
EXPIRES: 05/13/2010
VALUE: $ 32,685.00
Status
Issued
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By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all
information hereon is trne and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of SpringfieId arid the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY:will,be..mad~.of any structure without permission of the Community Services Division, Building Safety.
I further certifY"thjj~'.o';iy"co~t':achi~i iind employees who are in compliance with ORS 701.005 will he 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
Sfreet, that ,the permit c~rd is located at the front of the property, and the approved set of plans will remain on the site at all
. times during con'struction.. ,,.' i' _
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Owner or Contractors Signature
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Date
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ii5iFifth Street~~tl;'~i~.~~.;):;; .,' ." .'
Springfield, Oregoii97477'1~':"'/f,';;;
541-726-3759 Phone. ' '.: "":'
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City of Springfield Official Receipt
Development Services Department
Public Works Department
, . RECEIPT;#: ,.- 2200900000000001290
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Date: 11/13/2009
2:17:48PM
Job/Journal Number:r-:~,~-~e~:~:~i'Pti~~ . .~f.'~{'
COM2008-01281 ',,' . 'Residence Wiring 1000 Sq Ft
C0M2008-01281 'h:....!.,;t- Sr. Technology Fee
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COM2008,01281'" '+ 12% ~~te~uf~harge
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Payments,
Type of Payment
CreditCard
Paid By.
DOREEN BARTO',';f",. .
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Item Total:
Check Number Authorization
Received By Batch Number Number How Receind'
Amount Due
134.00
6.70
16.08
$156.78
.,
Amount Paid
KR
683463 In Person
Payment Total:
$156.78
$156,78
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Page I of 1
11113/2009
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Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052'
Phone: 503-378-4621
Web Address: www.ccb.stilte.or.us
1
P~nnit #: ~ffl U'tJl8 -O/Zt6/
A~dress: trt1 Z 6 7-1'1-t f.!'
ISSuedby:~'fl.t<1l<dl<Wlfil1 Date: //-/~-t)7
Statement: Information Notice to Property Owners
About Construction Responsibilities_
:'
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare 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 thisstatemeni. This statement will be filed with the permit.
F;ill in the appropriate blanks and initial boxes I and 2, ,and eithet box 3A or 3B:
'.4 I. < 1 o~:reside in, or will resid.e in the completed structure. . . .
[J 2. 1 understand that 1 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 #)
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-I will instruct my gerierarcontractor that all subcontractors who work on the structure must,be
. . licensed with the Construction Contractors Board.
OR
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3B. 1 will be my own general contractor.
.'
. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. IfI cl1angemy mind and hire a general contractor, 1 will contract with a contractor who is
licensed with the'CCB and will immedialely notifY the office issuing this building permit of the
. name of the contraclor. .
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I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners aboutConstructiim Responsibilities on the reverse side ofthis form.
.
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(Signature of permit applicant) (Dale)
. (White copy to issuing agency permit file, pink copy to appli~ant.)
Property_owner.doc 06-01-04
Acting''. 'as -You.rOwn General Contractor-?
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'INFORMATION'NOTICE TO PROPERTY OWNERS
_~ - ~\: \\- o~~.ou:r C,qN~!~UC"!"IONiRESPONSIBILI!I~S
,
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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.
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If you are acting a; your own contract~r to construcf a new home'or m~ke a subst~ntial improvement to';m existing
structure, you can preven(many ,problems ,by being aware.of the following responsibilities and concerns.
Employer Responsibilities
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You wi]l, inJllost jn\s!~c~s> be rule~. tc? be 3!l "employer", and ,the contractors: youconu;act :vith. wil11?e "employees" if
you pse contractors not licensed with th,e Construction Contractors ,Board to do labor in cqnslrl!cting or to assist in the
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construction orloi~pr~vclTIcent of a res~d~l).tial slrl!fture, A.~!~,e ~liIployer, you !}1U~t cO.'11,ply wit~ ,tbe following:
Oregon's Withhtldin'g Tax L~W: As:~n e~lo~er, you ~u~t'withhold income'taXes from employee ~ages at the time
employees are paid. You will be ,liable for the tax pay,rnents even if you d9n't a.ctually withhold the lax from your
employees, For more inforrnatiot(, call tlie'Departineht oH~evenue' at 503'378-4988/ . ".' ..; - . ..'.
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Unemployment Insurance Tax: As an employer; yoifarereqiJired to pay.a lax for unemployment insurance purposes~,
on 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 comJ;l.ineq n~mber ~~r bQ,tp'Oregon Withholding and
Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www,dor.state.oLus/formsnav,htmll for the
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Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' cV'''I'",,,sation insurance for yoUr employees. If you fail to obtain workers' compensation
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insunince, you could be subject to penalties andb'e liable for all c1aim'costs' if one'ofyour employees is injured on the
job. For more information, call tlie Workers' Compensation' Divjsion "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' wage~/\
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'lo800'829'4933 opiisit'their:web site at www.irs.Q:ov. . :;',,,." . , " ,
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0,.. :Other'~e.~lPonsibili.t~es am:l Areas of Concerns
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Code Compliance: As the permit holder for this project; you are responsible for rcsolvirig lmy failure'to meet code
requirements thaI may be brought to your attention through .inspections,
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Liability and PropertY Damage'Insilhnc~~" Cpntact YOl.irinsur~hce ~gent to s~e if you have adequate Insunince
coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire .or
work that must be re'done'. ( . I '
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Time: Make sure yo'u.have sufficient time to supervise your employees:
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Expertise: Make sure you' hrv~'the ~Jeii1~'to act 'as your own general ci:mtracto?, t6' coordidate the work of rough-in
and finish trades, and to notify building officials as tbe appropriate times so they can perform the required inspections.
If you have additiqnal questions caIJ 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