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Home My WebLink AboutPermit Electrical 2010-5-11 22:' Firth Sll'ret+SJll'iugtitld, on 97477. PH(541 )726.3753. FAX(541)726-3689 DEPARTMENT USE ONLY CO~'Z.OIO-OO S'""&- Permit no.: Date: S -(( - , C:> This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if worl" is .1I0t started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes D No CATEGORY OF CONSTRUCTION Residential 0 Government 0 Commercial JOB SITE INFORMATION AND LOCATION Job site address: t a~ ~ Reference: Address: City: Phone: E-mai/: ces license no:: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of sign ing supervisor: ~\.o <r:1'~ ~~ ~01\ct~ .~ S ,\-\IS I'~:~ttl \} 1\\)~l'J'\t~cttl Cl\~'/ '\ 'CO tll\'/ 44(J-2584-J (9/08/COM) , FEE SCHEDULE Number orinspeclions per itcm U Qty. Cost Total ea. cost Residential, per unit, service included: 1.000 sq. II. ur less (4) $134.00 $ Each additional 500 sq. n. or p0l1ioll $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or fecder (2) Se."vices or feeders: illstallatioll, alteratiol/, relocation 200 amps or less (2) $ 81.00 $ 20110400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to LOOO amps (2) $205.00 $ Over 1.000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Tcmponlry sc.....iccs 01' fecders: il1sfa//a(ioll. altcmtioll. relocatio/1 200 alllps or less (2) $ 63.00 $ 20 I to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 vollS. see services or feeders section above Branch circuits: nell'. a/fentlion extel/shm per pallel a. Fee for branch circuits with purchase ofa service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or reeder lee: First branch circuit (2) i $ 55.00 $ '7 5> Each additional branch circuit $ 6,00 $ Miscellaneous fees: service oi..teeder /101 iI/eluded Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline ,IJ~_IHll;_g (2) $ 63.00 $ S,igI!~J;cC.iSE~.!tb(~)i1'~m~t.)~ panel. $ 63.00 $ . ~Itera!lon. or exten.s:.ict.II':J .. t;t<~\'!'lmft,lrj.'.R.tt~l\YJ I $58.00 $ Ir,~,;" 1\\\sr'" ICANTUSE '3~ i"',". .~t;T ( ~ lJ!t'a~~<~i.orabove fees $ <;'8;"U j\: ?.D~1Um Permit Fcc S58.(0) rt lj) Enter 12% surcharge (.12 x rAn $ r;'/J! (e) Technology Fee (5% of[^l) $ ..,0 ;L- TOTAL fees and surcharges (A through C): $ ";'''/~ / ...--' CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00586 ISSUED: 05/11/2010 APPLIED: 05/11/2010 EXPIRES: 11/11/2010 VALUE: . IT'", . . '.1,.1. -~: ~!~;..: Status "! Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3987 DOUGLAS DR ASSESSOR'S PARCEL NO,: 1802061108600 Springfield TYPE OF WORK: Heating System PROJECT DESCRIPTION: Install ductless split system TYPE OF USE: New Residential Owner: CARR JACOB Address: 3987 DOUGLAS DR SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical' Contractor OWNER J COO INC License :;;:....T.= .~. .... ...,. '. ..; 10,,"' ., J'.~'~~ .~ t' .-'1,1:;' 169209 BUILDING INFORMATION~ # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Watcr Type: Secondary Construction Type: AnENTlON: OregGllllllgtl~llires you to # of Bedrooms: follow li'U11tS adoptecD<lttlJ\Djl~on Util~ NoUflcatlon Cent8l'. lllpslill'l\lOIlMtdlIlt~orth n/a IR 9AA gila OO~ 0('4ftth.ftllgh nAR Q~2'..oot. OO:il.;:uth8~.~I!~,~ION I IiiYmOOr for the oregon Utility Notificatlolll Center 16 1~-:m44). # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Front yard Setback: Side I Setback:' Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Speciallnstrnction: I PUBLIC IMPROVEMENTS ~ . ... 'ff . Expiration Date Phone 05/06/2012 541-746-7065 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: fl- '~'"-' I.' Sidewalk Type: Downspouts/Drains: . ....,....., ,~, , Notes: . IT "f. NOTICE' c, .,.,:','ij.i~'iiii#1'ii;",1!}?;i""", THIS PERMIT SHAll ~P1RE IF THE WORK! AUTHORIZED UNDER THIS PERMIY IS I\IOT COMMENCED OR IS ABANDONED FOR. ANY 180 DAY PERIOD. ..","'" .."."', . Paee I of 3 r ",_ CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00586 ISSUED: 05/11/2010 APPLIED: 05/11/2010 EXPIRES: 11/11/2010 VALUE: ~ l.~ . .i Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line :h.~. . l:\t,,,;~';:. \;... I V al~'~tjon jj~scrintion ~ DescriPtion Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $6:96' 5/1II10 2201000000000000486 $2.90 5/1II10 2201000000000000486 $55.00 5/11/10 2201000000000000486 $3.00 5/11/10 2201000000000000486 Total Amount Paid $67.86 I Plan Reviews ~ """"";'" .-...,. n;', . 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. ~p.nllirecUnsnec.tions ~ 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. ,.;1 1;.;~~. :.~t.;~'":,~.\v::~ .~. .. ''''~' '" ~~., Paee 2 01'3 Issued 225 Fifth Street, Springfield, OR 54)-726-3753 Phone 54)- 726-3676 Fax 54)-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00586 ISSUED: 05/1lI2010 APPLIED: 05/11/2010 EXPIRES: 1lI11/2010 VALUE: By signature, I state and agree, that I have carefully examined the completed application and do herehy 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will he made of any structur~:~ith,??,! ,!,er".'ission of tbe Community Services Division, Building Safety. I further certify that only contractors and employees'who'are'jn' compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections 'are req'uested 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. ;," . IIA.....r G~ Owner or Contractors Signature \':'-~f~ ".'i'w' <~:-;' '''\~ bJ.;,\.' 'j rL ~.t~, ','" ,',' . ~ . ... " ;-"; "page 3 of 3 . J, . i" 5/11 j 10 Date I I , Information Notice to Owners About Construction Responsibilities (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following 'responsibilities: . Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: . . Oregon's Withholding Tax Law: Employers 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 Insurance Tax: Employers 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. . Oregon's 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 go to htto:/lwww.oreoon.oov/DOR/BUS/docs/211-055.odffor the appropriate forms. · Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their 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 workers 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. . Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the 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 website at www.irs.oov. Other Responsibilities of Homeowners: · Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. · Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. · Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. fjproperty_owner adopted 12-04-07' CONSTRUCTION CONTRACTORS BOARD 700 Summer SI NE. Suite 300. PO Box 14140. Salem. OR 97309-5052 Telephone: 503-378-4621 -.Fax: 503-373-2007 WebsiteAddress: www.oreaon.oov/ccb This Copy for Permit Applicant . ~ Property Owner Statement Regarding Construction Responsibilities Oregon Law 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. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.0~O (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: . 1;( I I own, reside in, or will reside in the completed structure and my general contractor is: Name GGB# Expiration Date . D I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or Ix I I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office . issuing this Building Permit. . I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. ::r v-c..o'o ~. v..a Print Name of Permit Applicant . wA a.~ 11fgnature of Permit Applicant 0" .19.10 Date Permit#: CO>fl'\.ZOlbrC>O S-8'b Address: '39' S' 7 0.,...~ /.;1 S ~ Stl~, C>~ ""17l.(7,F' Issuedb~6 Date: -:;;/"j,c> I I This Copy for Permit Offices 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ""~.~'~. .~c..N.A(l...F1'.SJ...ELO.'.'_'.'ij'.i. '................ ., - , \ J.. .., y, .,'" - r' : City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000486 Date: 05/11/2010 2:59:49PM Job/Journal Number COM20 1 0-00586 COM2010-00586 COM20 1 0-00586 COM2010-00586 Payments: Type of Payment CreditCard cReceintl Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 55.00 3.00 6.96 2.90 $67.86 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 12% State Surcharge + 5% Technology Fee Paid By TARA CARR Amount Paid D18 592565 In Person Payment Total: $67.86 $67.86 ,.. , , . ~ ~; ,~ -,: .;' Page 1 of 1 511112010