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Home My WebLink AboutPermit Electrical 2006-11-14 Date 'ZON /?1l>2 INITIALS IV ft1. " . .~, DATE //-1'-/- u~ , , " SOURCE~)~ / / - /7' - tJ{::; .-=~. \,' ~i~1D.D 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEl....IKlCAL fERlVHT _4PPUC.4T10lV City Job Number ('/~ . {J () 11~ 1. LOC4110N OF INSTAl.LAJI0N: I q ~ s- IJ. I h 'f!= 2f r~ (,,;f(;Y!/d LEGAL DESCRIPTION: --.) /703 ~S ~ Y 0 ~~O{) JOB DESCRll' l~: 0 (JrfhCf 100~ SoW r&.ntp 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. CONERAC1URINSTALl,A110N ONLY 3. C01l-fPLel1!. FEE SCHEDfJLE BEI..Dl-V 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 $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. Scnkes or l?Ct.~ders - lnstall:ttion, Alterations or Relocation: Electrical Contractor 200 Amps or less " 201 Amps to 400 Amps Address ~ 401 Amps to 600 Amps '" 01' ,,/ 601 Amps to 100~6mps City "- PhonJ'l ~:~'nIT rHALL EXPUVErlfolib\~~Q~lts >d11\tl ten ~ UNDER TH\~\;,rtf>'tMrp~NOT , AUTHORIZED U N ONEO fOR Supervisor License Numbe/ r. 0 M MEN C ED 0 R I S A ~ qJ emporaf) Sen.-ices Ot' feeders / ).~ 180 DAY ptRIOO. ~ Installation, Alteration or Relocation 200 Amps or less $ 50,00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps , $100.00 _ .. ~. , ,. ~, -' .;0 . I ,J " \ :6v~t600' AmP~ pT' 1000' Volts see "B" above. , . _.1" '.', . . ~'._' ." , " .' "J~. . ,D. ':'~r~lI.ch ('u<cu#s;, ({:. ,..... . ( .' ~ t. . ....- ,,- ".' ~ ,', ..J ',:- j' i ' , ... ,New. Alteration 'or Extension Per Panel \ . ,1-'; .-,~' I I '.' -_ . -.. ,--': ~"'f, .\.:,d~ "~ ( i',' ,. ;01l~Ciroiiit J,'.~~~.~,~,') . . "~'.': i;:., ~.; c "'''I _.\,.~- . , ~.F.ach *dditioiial,eiicuit,orwith 50 tiJ. '.' '. ...,,(", ;-':-:,' rS.ewice QfFeed~rpemiif'v . $ 3.00 e ' /'to . .' l~,.. " .::J"'" . ". - '\ \ r, OO!<.:.J..~ ':':' ',' '. ,.. . .""),::~)I~hJ' / t, ~, sh e+ . -."',, E. C '~1iscenil~~t;S (Ser'rice/feeder" not included) ":Each lnstallation Expiration Date Constr. eonLmber E~ate Signature of Supervising Electrician ";; Owners Name JJ!& f cv- nJ Address Jq 5-5 City:s.J)r-;~ OWNER INSTALLATION Phone 65'1- ()/ ?Lj' The installation is being made on property I own which ::~~e:l~~r#L - ~/ ! Inspection Request: 726-3769 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 43,00 tr'l 13-- Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/ResidentiaI $ 25,00 Limited Energy/Commercial ~~ ~45.00 Minimum Electric Permit Inspection FrS' $4~ + SurJ?Jles 0 4. SUjjJ.uTJ4L OF ABOVE ---- 4 ~ , 8% State Surcharge . ~'.:< s 10010 Administrative Fee 4 ~O 5% Technology Fee '3. , 1.1-0 TOTAL Shored Dri'o(TWwld;og 1'<>nmIE"'lriool .,J "",-2.,: :.(J6~'S 225 FiftlI Street Springfield, Oregon 97477 541-726-3759 Phone cir' "f Springfield Official Receipt Dl Jpment Services Department Public Works Department Job/Journal Number COM2006-00972 COM2006-00972 COM2006-00972 COM2006-00972 COM2006-00972 Payments: Type of Payment Check cReceiotl RECEIPT #: 2200600000000001574 Date: 11/14/2006 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By NEAL L. MOORE Item Total: Check Number Authorization Received By Batch Number Number How Received 4133 In Person Payment Total: nJm Page 1 of 1 10:13:4IAM Amount Due 43,00 2,00 2.25 3.60 4.50 $55.35 Amount Paid $55.35 $55.35 11/14/2006 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'#: C(j; .- ~iifJ 1'~7~ , ~ 5 'II..- Address: / "7 5 / ~ Issued by~,tlchttk Date: / 1-- ) </ .- O~ Statement: Information 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. 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 this statement. This statement will be filed with the permit. . Fil~ the appropriate blanks ,and initial boxes 1 and 2, and eIther box 3A or 3B: ~,1. I own, reside in, or will reside in the completed structure. o 2. 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 It! ',3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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 ~ wners about cons:~Jion Responsibilities on the reverse side of this form. I ~ }-/' j;' f1) (Jlr'r€- I ~.. It(- tff; -- (Signature ofPenrtir'rPlicant) .' . (Date) , (White copy to issuing agency permit file, pink copy to applicant.) ..... Property_owner. doc 06-01-04 , ,_ ,"'0 '0_' Acting as, I9..r Own 'General Contractor? .,INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION 'RESPONSIBILlTIES '- ' .' NOTE: This Information Notice to Property Owners about Construction Resp~nsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial illljJlovement to an existing structure, you can preventrnany problems by being aware of the following' responsibilities and concerns, Employer Responsibilities You will, in most instan~es, be ruled to be an "employer" and the contract9rs you,contract withwill be "employees" if you use contractors po.t licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction orjmprovemeni(~f a residential structure. As ~,~~ employer, you mu~t co.mpiy with the following: . . . .,' , ' Oregon's Withhoiding Tax Law: As an empioyer, you must withh~ld 'income taxes from efnployee wages at the time employees are paid. You will be liable for the tax payments evenif you don't actually withhold the tax from your employees. For more information, call the Department ofRevenue"at 503-378-4988." . . Unemployment Insurance Tax: As an employer, you '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. Th~ Oregon Business Identification Number (BIN) is a combined nwnber. 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 ~ppropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers'. comp~nsation insurance for your emplox~es, If you fail to obtain workers' compensation insurance, you could be subject to penalties arid be liable for all claim costs if one of your employees is injured on the job. For more information, can the Workers' Compensatio!1 Division at tne Depiutment 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' 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-'829-493'3 or visittheir web site at w\\l\vOirs.iwv;'- . ,Other Responsibilities and. ~Areas of,Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. , ,;~ . . .,. ". - ,-, , ' Liability and Prop'erty Damage Insurance: Contact YOUr insUrance ageIittosee if yml have adequate insurante coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be r~don~. ,'\ ~'i \ \ .~ ~ -' .~.. -- . 4 \ '\ . Time: Make sure you have sufficient time to supervise your employees.' " -,' '.. -, ' Expertise: Make sure you have the skills'to act as your own general contractor, to coordinate'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. Property _ owner.doc 06-01-04 Status Issued 2ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2006-00972 ISSUED: 08/07/2006 APPLIED: 08/01/2006 EXPIRES: 02/07/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1955 16TH ST ASSESSOR'S PARCEL NO.: 1703252402200 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install heat pump and air handler Owner:' NEAL MOORE Address: 196417TH ST SPRINGFIELD OR 97477 Phone Number: 541-654-0184 I CONTRACTOR INFORMA nON I Contractor Type Electrical Mechanical Contractor ARC ELECTRIC HOME COMFORT HEATING & AIR License 115113 84164 Expiration Date 07/29/2008 0612512007 Phone 541-741-0494 541-345-2838 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: . Lot Size: R-3 Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: VN Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkl'it!(fvO{ting: '\I~ n) \ \' n~at:YP\RftF'm~twOOlK DEVELOPMEN~\t~ ...,~ I U_'.' - THIS PERMIT IS NU I f'nMMENCED OR IS ABANDONED OOfQUlRED PARKING Overlay J:Jtst!' DAY PERIOD, Total: # Street ~ k&Q: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS 1_ ,I, -,'onon ia\~.J rE:qU\\2;S '10Ll.~:~ A\ Il::!\ll 10\,,:UI ":;:'! .,' "thA Oregon UtI LY , lef ~~S1YaIRI T-ype: ' '" re set fort follow ru ~ ",tor Those rule", a,~, ." Notiiication CDownsp'Quts~~Lajp.s;)AR 9:.>2-00 \. , OAR 952~001-00\Otll ,'" s of the rules b, III btain cOple 0090. You may 0 r Note: the tele.~ho~e Iling the cente . ( U"'I'lty Notlt;catlon ca Oregon \1 number for the, 8:10-332.-2344). center IS 1- ~. Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Air Handling Unit Up to 10,000 Heat Pump Minimum/Adjustment Mechanical + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Total Amount Paid 2ITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: cOM2006-00972 ISSUED: 08/07/2006 APPLIED: 08/0112006 EXPIRES: 02/07/2007 VALUE: I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Amount Paid Date Paid Receipt Number $10.00 $4.50 $5.50 $2.25 $2.75 $3.60 $4.40 $43.00 $12.00 $8.00 $12.00 $25.00 $4.50 $2.25 $3.60 $43.00 $2.00 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 8/7/06 11/14/06 11/14/06 11/14/06 11/14/06 11/14/06 1200600000000001208 1200600000000001208 3200600000000000419 1200600000000001208 3200600000000000419 1200600000000001208 3200600000000000419 3200600000000000419 3200600000000000419 1200600000000001208 1200600000000001208 1200600000000001208 2200600000000001574 2200600000000001574 2200600000000001574 2200600000000001574 2200600000000001574 $188.35 I Plan Reviews I 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 Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Paee 2 of3 :ITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: cOM2006-00972 ISSUED: 08/07/2006 APPLIED: 08/01/2006 EXPIRES: 02/07/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 inspections 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. Owner or Contractors Signature Date Paee 3 of 3