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Home My WebLink AboutPermit Electrical 2010-1-12 Electrical Permit Application 1~'[f:['-E~Ai'ffMENT;US'E' ONLy:., ,I ..;.,_,; . L -'.., :'~,i':~;;'" c - ., '. . ..,' -",~"".., . ,.~. -. I Permit no. d7- /%'-1/ I I Date 1//2/10 I 225 Fifth Streett Springfield, OR 97477. PH(541)726-3753. FAX(54 1)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, .1,:,;,o"'i;,jO"'A'L"'GO' V' E R' N' M'E N"';'A'''''R'OVA'''in<'\''m'ry;;~'''~''.1 '..L.: ~; ,,:'. .' .,',.... .1'"., If,r:;::.____. L:,,"~I~..f:,.;,',:,,:.~.<.::<, I Zoning approval verified? 0 Yes 0 No I f~t!r'*;t;!i;,StJ,CATEGORYjfo""C:ONSrRUC:TIONX;i!5\';:',';:iiL': ,,';i,'. i~~~.~~~~ITE~IN~~R~At7~N~;AN~~~~c:~;7;~~*~~,!il I Job site address flip S. '1'1'0 S-J- ' I I City: <:po'nc,lieM I State: Oil I ZIP: 7 It?? I I Refer;Jce: V \ fl rY~'/,fY) 4- ] Taxlot.:. ',_ I~'-"'" :',:, : ';',DESCRII'TION2oFWORK'~Jf.'t;':t';';"'\fW!'i;"'~r IIcc1-ck:c-..-/ -t" "jUC,It"SJ he<<t- rumP I I f I ] ;PROp,ERTY;OWNER," '".1 Name: /';he.. l0a{~()1- I Address "1/0 5:. 4"~ Sf I City: </Jr'I>JMI I State OIC. I ZIP: 97'176' . I Phone:,YI-Y"'- 327! I Fax: 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 sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature:~) )---P "c.CONTRACtOR . INSTALLATION :,1 Business name: BW rvU':L- I I Address: I City: I State: I ZIP: I Phone: I Fax: I E-mail: I CCB license no.: I BCD license no,: I Signing supervisor's license no.: I Print name of signing supervisor: I Signature of signing supervisor: . \,~~ ~ \>1-..\'0 "'>> ~. 4'40-2584.J (9108/COM) 1~{~~~~~~~~~~~~~f~~~SPH~PO~E~~~~~~~~~~ffi )~u~~e!~f,i~.s~~~ii~:n{:P'![;it~:m;clrXIQt~,1 p~t;'I.i:rcital ~.I . """""'''''J,.-..,.~.,."",~"'.:.,"",r,,,...'i.'~ ",k.,.t..~..,.".,.'<, 'i".1...e:~..__ , -. C9st, ,',' Residential, per unit, service included: I 1,000 sq. ft. or less (4) I Each,additional 500 sq. ft. or portion thereof I Limited energy (2) Each manufactured home or modular dwellingservice or feeder (2) I I I I, I I I I I I I $134.00 $ $ $ $ $ 25.00 $ 32,00 $ 63.00 Services or feeders: installation, alteration, relocation I 200 amps or less (2) $ 81.00 $ I 20 I to 400 amps (2) $ 95.00 $ I 401 to 600 amps (2) $158.00 $ I 601 to 1,000 amps (2) $205.00 $ lOver 1,000 amps or volts (2) $469.00 $ I' Reconnect only (2) $ 63.00 $ 1 Temporary services or feeders: installation, alteration, relocation I 200 amps or less (2) $ 63.00 $ I 201 to 400 amps (2) $ 87.00 $ I 401 to 600 amps (2) I $126.00 $ lOver 600 amps or 1,000 volts, see services or feeders section' above I I Branch circuits: new, alteration, extension per pa~el I I a. Fee for branch circuits with purchase of a service or feeder fee: I I Each branch circuit I 'I $ 6.00 I $ I [ b. Fee for branch circuits without purchase ofa service'or feeder fee: I I First branch circuit (2) I $ 55.00 $ 5'>1 I Each additional branch circuit I $ 6,00 $.(", I I Miscellaneous fees: service or feeder ~ot in~luded I I Each pump or irrigation circle (2) $ 63.00 $ I Each sign or outline lighting (2) $ 63.00 $ 'I Signal circuit or a limited-energy panel, $' 63.00 $ alteration, or extension (2) I Each additional inspection: (I) "", $58.00 $ I \;:E~~!4~2dt}~if%f~~!ARF!iij(fgNtrrf(i5~E~~fl~&~~ili;1~:~~;;~~r-:tl I (A) Enter subtotal of above fees $ (Minimum Permit Fee $58,00) t; ( I (B) Enter 12% surcharge (12 x [A]) $ '7"J,;!- I (C) Technology'Fee (5% of[A]) $ '" '" S' I TOTAL fees and surcharges (A through C): $ 71 q. CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-0l847 ISSUED: 12/31/2009 APPLIED: 12/31/2009 EXPIRES: 07/12/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 416 S 44TH ST ASSESSOR'S PARCEL NO,: 1702323404317 Springfield TYPE OF WORK: Heating System TYPE OF USE: Residential PROJECT DESCRIPTION: Install ductless heat pump in residence, Owner: MARCHANT ALAN K & TINA M . Address: 416 S 44TH ST SPRINGFIELD OR 97478 Phone Number: 541-746-3271 I, CONTRACTOR INFORMATION' Contractor Type Electrical Mechanical Contractor OWNER MARSHALLS INC License Expiration Date Phone 25790 BUILDING INFORMATION I .j,c 12/23/2011 541-747-7445 # of Units: Primary Occupaucy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I Froutyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved'Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTSI Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Paee I of 3 ,: ii- CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01847 ISSUED: 12/31/2009 APPLIED: 12/31/2009 EXPIRES: 07/12/2010 VALUE: Status Issued 225 Fifth Street, Springtield, OR 541-726-3753 Phone 541-726-3676 Fax 541- 726-3769 Inspection Line ,C I V~luatio~ n~script~on I Descriotion Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Fpp~ P,ilU Fee Descriotion + 12% State Surcharge + 5% Technology Fee 1st Appliance + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $9.48 $3,95 $79,00 $7,32 $3.05 $55.00 ,.,j $6,00 ", '.' 12/31109 12/31109 12/31/09 1112/10 1112110 1/12110 1112/10 Receipt Number 1200900000000001369 1200900000000001369 1200900000000001369 2201000000000000032 2201000000000000032 2201000000000000032 2201000000000000032 Total Amount Paid $163,80 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. Rrollirprl Tn~np(':ti~ Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete, Rough Electric: Prior to Cover Final Electric: When all electrical work is complete,. ,'- . Page. 2 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01847 ISSUED: 12/31/2009 APPLIED: 12/31/2009 EXPIRES: 07/12/2010 VALUE: 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, and 1 further,certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the La,vs 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 all required iuspections 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, and the approved set of plans will remain on the site at all times. during construction. -~77 7-f Owner or Contractors Signature \."'~f ,". Page 3 of 3 ://2/ / ? Date " -' , , , . . . , . '. " - ',,' . 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 #: .'" (JQ.,/9'17. If/ ~ 50, q'frl. - ST Address: I~suedby: Cb Date: /);2./1'0 5tatemen~:"ln" formation Notice to Property Owners.' . About'ConstructionResponsibilities. . , , ,Note: Oregon Law, ORS 701,055(4) requires residential construction permit applicants who are not licensed with !he Construction Contractors Board t~ sign t~efollowing statement'beforea b.~ilding permit'can be issued, This statement isrequirepfor residential building, electrical, mechanicl}l and. plumbing p~rmits, Liceilsed~rchitect and engineer applicants, exempt from licensing under ' ,ORS 701 Y 10(7), need not submit this statemen(, ,This statement will be filed, with the permit, , . - . .' .~.,. ; - -.... Fill in,the appropriate blanks and initial boxes 1 ,and 2, and either box 3A or3B: .... " ~. L . .I own, reside in, or will:reside in the completed structure.:.' 1fJ" 2, I'understand that I ~ust become licensed as a constriJction 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 tlie structufe.riiust be ' lic(m~ed with the Construction Contractors ~oard.' " . OR '" .~ 3B. I will be my own general contractor, . If I hire subcontractors, i will hire only subcontractors:licensed with the Construction Contractors Board, If! change my mind ~d hire a general contractor: I will contract with a contractor who is licensed with the.COB and will immediately notify the office issuing this building permit ofthe naine of the contractor. . . ' , I hereby certify that the'aboveiJ;lformation is correct and that I have read and do understand the Information .' . Notice to Prope,rty Owners. about Construction Responsibilities on the reverse side of this form. ~)?Y' , //l~//O (Signature ofpermjt applicant) (Date) . (White copy to issl}ing agency permit file, pink copy to applicant) " . . PropertY ~ owner,doc 06.0 I '04 r --- ~- -.. ---- - - '_--~-""'_..'- . .-. ,'- , . . ' . . Ac!hl~ta~~Y()1ir,~Own GeneratCont~actor'.r .,. - ,\.' ,,-:.. '\oJ. ~. '\ '. \ . ,. - , . - ' ~'- . . ' . " INFORMATION'NOTICE TO PROPERTY OWNERS.. ABOUT CONSTRUCTION RESPONSIBILITIES,'" .~: ~ '9 ., _\~ , \' ~. .< , ~" NOTE: This Information Notice to Properly Owners about Construction Responsibiiities was developed by the Construction Contractors Board in accordance wfth ORS 701,055(5), passed by the 1989 Oregon Legislature. ., . -~ ". "", ,:. , :':,1. , " , ...., - .' .... - '. : " ". If you are acting as your OW\1'contraeto,r to construct a new home or' make a substantial improvement toaii existing structure; you can prevent many problems by. being aware.of thefolIowing respbnsibilities and concerns, Employer Responsibilities 1;1\ r. ". .... '; "~' :::.., ,- . You wi!l;\in'1JI0f?tin~tances, be f).!le~ h>.bean "employ~r~' !IfId,the ~ontract!l~s,yoltcontra~,t with will be "employees" if . you us,e: c<;mtracto}s pot li~~n~ed ~th),h~.Construciion Coptra~to~s Board to do ,labor in construc!ing or. to ass,ist in the construction?.r\j~pr?:vem.en! ~[,~.r~~identiai ~truci!J1'e, ~,~h,e, e~pl,oyer;Yl!u ~,ust comply w~tIi th,e fOlio)Yhi~: O~egon's wiihh~ldi~g T~ d~: As:~einpI6y~; you ~u~tfuthhoHl income ti1'xe's from employe~ wages ai the time' employees are, paid. You will beJiable'r<,lr the tax payments eyen if you don't ac\lli1lly wilhhold the tax from your. . , . .f. ""'. ,., ',_, ~ ' ~ ,.,._." " , _ ~ employees. For more information; call tlfe'Department 6fReveriue'at 503-378-4988, - " ,j'" ..' ". . . '. ' Unemployment Insurance Tax: As an employer; you are feqUire'd to paY'a taX fbrunemp10ynierit inslirance purposes"')". on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488, ).;_::..t''"'?~'~'~'.' ~..,,_'-:~rH?r{:;'..~_'."'th~'C', ,7', .,_..! "'J. -'t ...... .. ".':1: .:., :,.,.. ';j 1 "',.~. The Oregon. Business Identification Number (BIN) is a combinec:l munber; for both Oregon Withholding and' Unemployment Insurance Tax. To file for, a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for ,the appropriate forms, .' .- .. .~':,. , .. , ~ . .~. -: ':~'~ . . " 't'. . . . . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain ~orker.s' cv,ul'~usation insurance for your employees, If you fail to obtain workers' .compensation .' ' "', _'.,~ ..... '..... ,-, ~ ' .'.~' .."'1''"'' .t't/ .,. ~': ,. ' : " , .' ..... . ' . . , r .' , . . >. ," ." insurance, you'coulO besubject'to'penaltic's and be'liable' fOI: all claim costs if one Of your'emp10yces is'injured on the 'Job, For'mbre' ipformation; call the Workers' Comperlsaiion Division'at tfie'Departinent'~f Consume'f'ilrid Busines~ Services at 503-947-7815. ,', j" ,- U.S. Internal Revenue' Service: As 'an 'emp1oyer, 'you must withhold'federal ihcome tax' from einpioyees' wageg, ~ 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 al:I-800-829-4933,or visittheir \\kb site 'ahV1.v\'v:il'S'dlbv. _, '!., i'", ;:,' " .' .\'~ yo,,' . , it Ii. ;~ 0." ..:'" ... 1 ',' '.. . ' .' l , J~' j'~' . . - ~'(.~ __,; if' ' ':\ ,o.thel1,~eslP~msibmties ..aI1\~ ^r.e,as ,of CODcer~s . , . Code Compliance: As the pe~it holder for this project, you are responsible for res~lvihg ilrty failure tb;'meet code requirements that m~y be bro1Jghl to );our attention through inspections. . ~ :,;~:\- ....t '.. "-"~''';:'~''': "~"(.- '.;, .' "~ '. '."'.,- -. ',.\ :J' ." Liability and PropertY Da~iitinsurance: . Contact"y61lr insurance'ageht to see if you have adequate ihslirlmcc 4 coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punciures, fire or work that must be redol1e, '. - " .". .-. Time: Make sure you Da"e sufficient tiineto supervise your employees.. '" \1 ....cT , \ \.." ..... '\.'';' ~ ...... "I~"""; ;',t. ~ '-~'~', - I'.' ;". ~." . Expertise: Make sure you' have the skills to act as' your own general contractor, to coordin'ate' the work of rough~in and finish trades, and to notify, building officia Is as the apt" vp' ;ate times so they can perform the required inspections. Tfyou have additional questions call the Con~truction Contractors Board (503-378-4621) or write the agency at PO Box 1.4l40, Salem, OR 97309-5052, J~ Proper1y_owner.doc 06-01-04, 225 Fifth Strcct Springfield, Orcgon 97477 541-726-3759 Phonc Job/Journal Number COM2009-0l847 COM2009-01847 COM2009-01847 COM2009-01847 Payments: Type of Payment Check cRcccintl RECEIPT #: City of Springficld Official Rcccipt Dcvclopmcnt Scrviccs Dcpartmcnt Public Works Dcpartmcnt 2201000000000000032 ] :22:29PM Date: 01/12/2010 Item Total: Check Number Authorization Received By Batch Number Number- How Received Amount Due 55.00 6.00 7,32 3.05 $71.37 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Pee Paid By ALAN AND TINA MARCHANT Amount Paid cjc $71.37 $71.37 580 In Person Payment Total: '~n . I, .'i"; , ': "0:.'.; Page I of I 1112/2010