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Home My WebLink AboutPermit Electrical 2005-8-9 1. LOCATION OF INSTALLATION s-b 7 7 t::- ~+- LEGAL DESCRIPTION i 70 z,--s -~( Lf JOB DESCRIPTION AJ~ Z o lfOOU c ( r LeA. \'" j-S Permits are non-transferable 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 ,.,r 7 /,"- . /' City Phone Supervisor License Number Expiration Date Constr. Contr, Number Expiration Date Signature ?f Supervising Electrician Owners Name ",S~'P.\\I.U.A ~ Locyu,.o..u $'Q-^-'~i Address b-(jqq '2(, 6-V- City 50> l'-~ Ct-ro1J Phone ') ~ -JDdv) OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: -S\r.oit,,; ~ _ S>~ J~ Inspection Request: 726-3769 .~"r eV" 'o.:$' "'() r "'~ .~~e ?i-~ ~ v'I. ,~~~. (\0 3. 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: New Alteration or Extension Per Panel { One Circuit Each Additional Circuit or with Service or Feeder Permit $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 ( $ 43.00 $ 3,00 f{S J 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps ,\ \0 -..\r,.\. Over 1000 Amps/Vol~\\\~eS '~\S(\\\\~ \_ ~e'\ ,.,\ t n\' Reconnect O~\X'2\.N ,c,erjJ cg\~\ (),r\O.> ~,-\e" rA\e. o~'k\jv ~<~\\C1\~~~~~~~\~~~~~~~es '01 ~:.\ \ \. '. v \:,(0 . ..:,(0\$\ 0 0\ \\,\e y,o(le lnsfa~t,~~:~H~~ftMf~~,~t~~~\\o(\ ~'-, ",::,,-$''-' , .,',.-.\\(~v\' ,\,~\\e. ~'. \,~o....\ 200~~drr~~t ~.v \J\\\S~ '.. ~ c':\. $ 50.00 20if'A, ""., 'n,~ <1&W'\O.A.wM~ ({o2,-'2.;J"< .. $ 69,00 _;" "'~,~)".~t\.-~J.~(,<,~",; \' 40r'Am~SJ~'809,t\dWsv $100.00 l/ ,..'\_~'.,,;\ '--' ,.,,\...e~ \ \-0-v'er 6()(1i\mps or 1000 Volts see "B" above. D. Branch Circuits E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 4. SUBTOTAL OF ABOVE Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ifb 7% State Surcharge 10% Administrative Fee TOTAL r-:> -. Z ~? L{ 60 53 !L Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03.doc Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5699 E ST :,. ASSESSOR'S PARCEL NO.: 1702331404000 ,,"(\V'.. 1"'. '\or .,/' CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-01070 ISSUED: 08/08/2005 APPLIED: 08/08/2005 EXPIRES: 02108/2006 VALUE: Springfield TYPE OF Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Heat pump and air handler Owner: LARRY SENKEL Address: 5699 E ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: R-3 ~. Secondary Occupancy Yrimary Construction Type VN Secondary Construction # of Bedrooms: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: " Description Type of Construction . Phone Number: 541-726-9721 I CONTRACTOR INFORMATION I oU \0 . u\teS'I \.\X\X\\'I ~"e.1l~6te~~~tjt\'ft Date Phone ...\t"\~'. Oteg r\ b'l \"e ,,,s ate :~t).()O'\" ~lJ ~ _. V'_S~' ~/ Op...\'" ~- 'O'f I BUILIltNG~ ON tou9n ~e tu\eS 'O\~": ~o(\ ~O ,eS 0\ ~ ~ot\e # ~i\"~~~z~O'\ o'O\a.\t\ CO~e', \ne 'f\~e~~ot\ Hei'(b~ 'lou {(\a'l t\\et. ~~o UX\X\\'1 ~o t 1st Floor: TYP~~i1~9 \"e Ce Ote9ot\ ~~Z.2~ t 2nd Floor: Water ~~bet \ot \ne \5 ,\,~OO' Sq Ft Basement: Range ~ ce(\\et. Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled n/a Occupant Load: I DEVELOPMENT INFORMATION. REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: ./, I IPUBLIC IMPROVEMENTS I c \\\'t. \N\j~~ . ... ~\~'t. \~ :\ \'2> ~ \C'i:. Sldewal~~p.~: e ?'t.~~\ (\~ 11.\ \)1 . /1\' '2>\\ ",0..:.\\\\;:> t>.\'t.\J tV \"<a \e ?'t.?fio'WnsmfutS/lJrdins\)O\'t \\\;:> O~\l't.D \J;~ \'2> f\ut\\'< f\\S\\-\ ~'t.~C't.\J 't.~\O\J', .. COW; CO\) Df\"{ ? , C\~"{ '\ I Valuation Description I $ Per Sq Ft or multiplier .' Square Footage or Bid Amount Value Date Calculated . 1 of 2 '. Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid J Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $4.60 $3.22 $43.00 $3.00 8/8/05 8/8/05 8/8/05 8/8/05 Total Amou nt $53.82 I Plan Reviews I CITY OF SPRINGFIELD:' Building/Combination Permit PERMIT NO: COM2005-01070 ISSUED: 08/08/2005 APPLIED: 08/08/2005 EXPIRES: 02/08/2006 VALUE: Receipt Number 1200500000000001152 1200500000000001152 1200500000000001152 1200500000000001152 To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. Rough Electric: Prior to Cover Final Electric: 'Vhen 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 certity 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 OCCUP ANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certity 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 inspections are requested at the proper time, that each address is readable from the street, that the permit card is locatetl at the front ofthe property, and the approved set of plans wiD remain on the site at all times during construction. ~5 \0 Q ~,c;-o ",-:if { 2S ~ -e6 Owner or Contractor~ SilnatureDate " 2 of 2 ;li!,,,,_. .~,,*?. Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 . . Phone: 503-378-462i Web Address: www.ccb.state.or.us Permit #: COyV\Z;':)cfJ 0 (O '70 Address: 5b 7' ~ t.- Issued by: 'h 1? st- Date: "6/8'"/0 S- f Statement: Info. mation 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. Tftis statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under 9RS 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: @: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. D 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 X 3B. I will be my own gel1eral co~tractor. If! 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 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 above information is correct and that I have read and do 'understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. S~l J 0 I ~^ V cA. <g, -~ -8~~ (Signature pfpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 A(Ctniilg -~sj'\'_.our'6wn General'Contra(Ctor? .,..,: ~ . '\ \ ':) ,-' .."' - - . ' .,'-' ..' - U\IIfFORMATION)NOTICE TO PROPERTY bWNERS', . . ~\.' \.: AB9~1' CONSTRl)lCTION RESIPONSIBIUTUES ". ;'. . , 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. ! J If you are acting ~s your own contractor'to construct a new home or make a substantial improvein~nt to: an existing structure, you can prevent many problems'by being aware of the following responsibilities and concerns. ~ ., Employer Responsibilities . _ '.f . You will, ,in most instances"be ruled to be an. "employer" and the contractors you contract with will be "employees" if you ~se contractors not lipensed with the Construction 'Contractors Board to do .labor in constructing oT to assist in the construction or ilUpLovement ofa residen?al stnicturc;:~ As the ellnpBorer, you.must comp~y vritb ~h.e following: . _ _ . .. : i .' Oregon's Withholding Tax Law: As an employer, you must withhold:income tries frorrl 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 503-3784988. Unemployment Insurance Tax: As an employer;:you: are- required to pay a tax for unemployment insurance PUrpO'SeB\ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. .- The Oregon Business Identification Number (BIN) i~ a combined number for. both'- Oregon WithhQlding arid' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the appropriate forms. . Workers' Comp(msation Insurance: 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 emp16yees is injured on the job. For more information, call the Workers' Compensation DIVision at the Departrrient of Consumer and Business Services at 503-947-7815. U.S. IntemaI Revenue Service: As an employer, you must withhold' federal income tax trom empl6yees' wages~ 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 1-800-829..493~0f'visit their web site at www.irs.lwv. " '.'\ - .', Other ReSpOll1lsibilities and Areas 00{ CQncerns '" : Code Compliance: As the pennit holder for this project, you are responsible for resolving anyfailure to meet code requirements that may be brought to your attention through inspections. .' "c' . ", Liability and Property Damage Insurance:" Contact ybur insUrance agent to see if you have adequate' insurance' coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctUres, fire or work that must be redone. . ~. -. '\ .", . J \." ", \, \ J' f 4 "'-..- .~~ ,- I '..; ", , ; .{ _.f' ~.' ,.I._-"1....~ -,' . i I .. _.~ \~ I ~ } ~.1ul '; '.. A'v- - . , . 'f,,' . - - "'):' .,'.' Time: Make sure you have sufficient time to supervise your employees~ -. ". JExn>ertilse: Make sure you have th~ skills to act as your oWI{generalcontr~btor: to coo~ainate 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. . i' .- Property_owner. doc 06-01-04 .. """ . ""'2'25 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone rity of Springfield Official Receipt ~velopment Services Department Public Works Department RECEIPT #: 1200500000000001152 Date: 08/08/2005 lO:48:34AM Job/Journal Number COM2005-0 1 070 COM2005-0 1 070 COM2005-0 1 070 COM2005-0 1 070 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Payments: Type of Payment , CreditCard Paid By SHELLEY SENKEL Item Total: Check Number Authorization Received By Batch Number Number How Received djb 104732 In Person Payment Total: Amount Due 3.22 4.60 43.00 3,00 $53.82 Amount Paid , ~ '~',\J.; ... ;::It r~ $53.82 ,. $53.82 ';if ., ~,'>1"I,\...... ~,,-,.... . ~'..,,:: 'jq 8/8/2005 I of I