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Home My WebLink AboutPermit Electrical 2007-6-27 3. , I) ZON ,-" _./. INITIALS rJr ~ DA TE 1 - ?. - u ., ~? SOURCE {Y1 ~.:::- b/z7/D 7 I COft.lPLETE FEE SCHEDlILE BELOlV 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERNIIT APPLICATION City Job Number (' ovV1 '700-7 - 0 ~ 9 t.( Z- 1. L. OCA.TION OF INSTAfrLATION: .' / --cl ';;/ /) jll.G~ ; / ~~ ~?<. LEGAL DESCRIPTION: )/:.J 170'2 ""303' Cf JOB DESCRIPTION: C5 bzc,o 7-:::-! J. .Do (,J p ( Permits are non-tI~nsferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number J ~ Ii Expiration Date \ }-J O\J Constr. Contr. Number 1/ Expiration Date Signature of Supervising Electrician Owners Name /;~ --)k,::: b Address dJ. h t: 0 rk t City ~ ~,LiJ PRon'S'Yl) ?:2b d~S1 \.. D/( Cd/(S;l(l) c;/.5-S~f0 OWNER INST ALLA nON Date A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. Services or Feeders- Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/V olts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps ( $ 50.00 $ 69.00 $100.00 S-O Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Miscellaneous (Service/feeder not included) -Each Installation PutXlP-Ofi11'igatiqp._ . $ 50.00 Sign!O~tlin~'LigpjJp~-,.,:::,:'.l )gw requires you$toO.OO r;ittiii&l~etgy~s~~~~ '~he uregon UtmiWi.oo , L~vl."_ll",'.1~O~l/;2J,.:i4 ...(j~'i J:l.... ~~t)~r9Uh'~ :~l.t: n_l)~e_~ fprJb..OO The installation is being made on property 1 Own which "l:'/tn'U.drr;(~~umrn\l;l....~qJU """" =" aol~ is not intended~or sale, lease or rent' l\1inimum:t~~gt~tftt..RlitH\9deQfltftSmfel~9 5.Surcharges ... ,JJ~~.. ~enter. J~Qte: the teleph T cO /OJ.'n~Signa~. E~~ _ - .-- 4. scm W1C:;t:~S~8tfdiAJtO i1ity NotjfjO:ti~n~' . ~~ ~.. _.. "J/. 8% State Surcharge 0-332-2344). L{ I H ;:, t'ERMIT SHALL t^t-'IKt: IF THE WORKo% Administrative Fee S- AUTHORIZED UNDER THIS PERMIT IS NOJ% Technology Fee Z S ..:; COMMENCED OR IS ABANDONED FOR / f S-"" Inspection ReCWFW 11fO-i~j~ PERIOD. TOTAL c;r .-- Shared Drive(T: )/Building Fonns/Electrical Permit Application 8-06,doc Status In Review 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1189 32ND ST ASSESSOR'S PARCEL NO.: 1702303406200 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-00942 ISSUED: APPLIED: EXPIRES: VALUE: 06/26/2007 12/26/2007 $ 188,374.00 SPRINGFIE TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence - Same As State Master Plan Residential Owner: KENNETH THOMAS Address: 2266 9TH ST SPRINGFIELD OR 97477 Contractor Type General Electrical Mechanical Plumbing Phone Number: 541-913-5086 I CONTRACTOR INFORMATION I License 593 136298 136298 147077 Expiration Date 03/1912008 08/06/2007 08/0612007 03/02/2009 Phone 503-645-1156 541-741-8844 541-953-6747 503-932-2719 Contractor ADAIR HOMES INC BEAR MOUNTAIN ELECTRIC LLC BEAR MOUNTAIN ELECTRIC LLC 3T PLUMBING INC # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 20.00 5.00 5.00 65.00 0.00 Street Improvements: Storm Sewer Available: Special Instruction: Notes: BUILDING INFORMATION I 3 # of Stories: 1 Lot Size: Height of Structure: 18.00 Sq Ft 1st Floor: 1,702 Type of Heat: Wall Heat Sq Ft 2nd Floor: Water Type: Electric Sq F~_~J!semen :to Range Type: ATTENTlO~~ 1~ffi'RWLft lifrt 484 Energy Path: follow rule, aI@ptod by~StI?t forth Sprinkled Bu~atlon~. ~ . 1- ill e!J1 em rr....M.nth - - . DEVELOPMENT I -'. 1. ~.-.....;", n (No\'~~ PARKING , number tor the Oregon VUH~\._ Overlay Dlst: Center 1I1-ioO-132~I: 2 # Street Trees Rqd: 2 Handicapped: Paved Drive Rqd: Yes Compact: % of Lot Coverage: 22.50 I PUBLIC IMPROVEMENTS' Sidewalk Type: NOTICE: THIS PERMIT SHALL EXPIRE IF THfWDR1{uts/Drains.: AUTHOR/ZED UNDER THIS PERMIT /S NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Paee 1 of 3 CITY OF SPRINGFIELD Building/Combination Permit Status In Review 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: cOM2007-00942 ISSUED: APPLIED: EXPIRES: VALVE: 06/26/2007 12/26/2007 $ 188,374.00 I Valuation Description I Dwellines Garaee Tvpe of Construction V Wood Frame Garaee $ Per Sq Ft or multiplier $103.00 $27.00 Square Footage or Bid Amount 1,702.00 484.00 Value Date Calculated Description Total Value of Project $175,306.00 $13,068.00 $188,374,00 06/26/2007 06/26/2007 ~ Fee Description Amount Paid Date Paid Receipt Number + 10% Administrative Fee $5.00 6/27/07 1200700000000000831 + 5% Technology Fee $2.50 6/27/07 1200700000000000831 + 8% State Surcharge $4.00 6/27/07 1200700000000000831 Temp Power 200 amps or less $50.00 6/27/07 1200700000000000831 Total Amount Paid $61.50 I Plan Reviews I Initial Review 06/26/2007 06/26/2007 WE LLH "Express process". Need information on structure that has recently been demolished to provide credit for the fire fee. Plan nine Review 06/26/2007 06/26/2007 APP TAJ Survey required because of minimum side setbacks. Public Works Review 06/26/2007 Structural Review 06/26/2007 06/26/2007 APP DLM Same as State Master Plan reviewed 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. ~eouire<Unsnections I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved, Paee 2 of3 CITY OF SPRINGFIELD - Building/Combination Permit Status In Review PERMIT NO: cOM2007-00942 ISSUED: APPLIED: EXPIRES: VALUE: 06/26/2007 12/26/2007 $ 188,374.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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 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 inweftjons are requested at the proper time, that each address is readable from the street, that the permit card is located autie front of the property, and the approved set of plans will remain on the site at all tim"~rU'tt~ ~ ~ 6-';; 7- D7 , Owner or Contractors Signature Date Paee 3 of 3 , . 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#: CO,:1/t Z-C07- 00 ?Y2. Address: II ~7 7Z~ ~.- Issued bY:~t.1'" Date: (/z,7/u7 I I Statement: h,fo'rmation 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.notsl!bmit this statement, This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~-1. ~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 1 hire subcontr8:ctors, 1 will hire only subcontractors licensed with the Construction Contractors Board. If I 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 certify that the abo.ye informati().n1~rect and that! have read and do. understand the Info.rmation Notice to Property \.. wnen ~bont~/ Responsibilities on the reverse side oftbis form. ~ --- . . ./ 6'-e:27-o7. (Signature of permit applicant) (Date) (White copy to issuing agency permitfile, pink copy to applicant.) I" Property _ owner. doc 06-01-04 ."';' .. Acting' a's' . INFORMATION PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Contractor? '. . \ \ ,_ __,m -, NOTE: This Information Notice to Property about Construction Responsibilities was developed by the Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature, If you are acting as your own contractor to construct a ~ew , structure, you can prevent many problems by or a 'substantial improvement to an existing following responsibilities and concerns. You will, in most instances, be ruled to be an you use contractors not licensed with the Construction construction or improyement of a residential contractors you contract with will be "employees" if Board to do lab()f in constructing or to assist in the you must comply.with the following: Oregon's Tax Law: As an employer, you must income taxes from employee wages at the time employees are paid. You will be liable for tax ,even you don't actually withhold the tax from your employees. For more infonnation, call the Revenue at 503-378-4988. - Unemployment Tax: As an employer, on the wages of all employees. For more to pay a tax for unemployment insurance purposeS ~. Employment Department at 503-947-1488. 'A'. . ~ The Oregon Identification Number UnemploYment Insurance Tax. To file for a BIN, appropriate fonus, number for both. Oregon Withholding and or wvvw.dor.state.or.us/fonnsnav.htmll for the Imm:rance: As an compensation ins~ance subjectto penalties and call the Workers' you are subject to the Oregon Workers' Compensation Law, YO'\.lr you fail to obtain workers' compensation if one of your employee's is injured on the at the Department of Consumer arid Business Worke:rs' an.d must obtain . insurance, you could job. For more Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, You will be for the tax payment even if you IRS at 1-800-829-4933 or'visit their web site at federal income tax from employees' wag~s: <' . .... the tax. For a Federal EIN number, call the .' are resolving any failure to meet code Code As requirements that may holder for brought to your 'Insurance: such as to see if you have adequate insurance over spray, water damage from pipe punctures, fire or _ Time: Make sure you time to supervise your SUl"e you the skills to act as your mVI1 to notify building officials as the to coordinate the work of rough-in so they can perfonu the required inspections. questions call the Construction OR 97309-5052. 06-01-04 (503-378-4621) or 'wTite the agency at PO 225 ,Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00942 COM2007-00942 COM2007-00942 COM2007-00942 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Temp Power 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By KEN THOMAS City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000000831 Date: 06/27/2007 Item Total: Check Number Authorization Received By Batch Number Number How Receiyed djb 153602 In Person Payment Total: Page 1 of 1 2:33:05PM Amount Due 50.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 6/27/2007