The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2004-1-6 " 225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · F~:,{5i~b7+'~2~fi~~CI as submitted has tile toll owing ELECTRICAL PERMIT APPLICATION ..OIII~ and does not require speci'fic land use /0' . c.')pi'Oval -" 0 CityJobNumber w Wlz..oc'i-OOC,,~ Date /- b-bL( . . i....V~c... -. Zonrng .._.~._---,'_..."n__-_._.._-c-" ~ ,,-vi -Of" ___--4_-, ~~J\,.-f 1. LOCA110N OF INSTALLA110N - 100 IS; M\(/L LEGAL DESCRIPTION 180Z0.33Lf JOB DESCRIPTION ~\ ~ r (0 S+. ~/1'!Sf; rId 0(297Lj7!J OOI~ A'b~ Z- c ( <Z.cv-. ~ 1- <:; Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number .Jv' . ~ t;J Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician OwnersName ~1(1.c"-- 1-\. L.elY\\e.\/ :Jt'. I Address ( () b I s:-- M. i <.u. 7:rl- . City $'?{locf.; e\o\ 612.. Phone ci4":6 --zt>1 '() . ...J OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ;z??; ~)- /' V" i.-/~ Inspection Request: 726-3769 3. CO~MPLETE FEECSCHEDfff:Ef:tEf;()W' .",Uu,OrlZbQ Slgl~2.~l.lI€ _.._ ..,...___..,.. A. New Residential - Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C. Temporarv Services or Feeders . 1t\'t \NO?~ l1. ~\~Ji.tjon: Alt~~leIfW?iafo~~\~f\ \5 N01 ~~q~~}1G~01e~~Dtn 1\,\\5 ?~\~ tOR $ 50.00 ~H~~4~\40'O~~ p.BF\ND $ 69.00 'C~\~~~r~??twe\). $100.00 ~~~~\A}rlps or 1000 Volts see "B" above. D. Branch Circuits . t to eo ,,'0"" \.ll{S'" J 'n\~ New ~te~ation or ~~~W~~ ~91Ta!\~n U\\\~"1 \ One ClrcJt\bN.,.OCag rt '0'1 \ne Of ~~l;'tr.OO Lf >- l\~~~diii<w~.t;O\~\'U\a~ ... p. 9S2..oo .7f' t~ ~\~ee~~.g~l'tt \n'fOUg~~O'o fP7 'it\Ca\\O\\O,\~otr\~' . "",o,,e E, \o\)r~~~us. (~t ' .. 4~~~}~F~,n..&lj$'Hl Installation \ ~ ~a:y ". t4.0\'ffi~1o""'" . 90. 'IoU. centa~..", U\\\\$l tJ,\ Pb~g .rurW~M!dnh"" O'(a~()\' ~f1?~'l~A ' '$ 50.00 ~a.\ I ..Ant \1 .'" 9 ('1.(\-' . Sig~<a~\~21;.~!1)g:" ~ ' $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ../~. 4. SUBTOTAL OF ABOVE ~~.,..w", .. 0:..4 \ (.l ,I t; ~(.... 7% State Surcharge . ~ ...,v- ..,.\ ~./' ~... ,1/., 10% Administrative Fee ''/'IlJJ<-''V do () '')'" U;'~111 C'" TOTAL \0/1,;; -;~:\ ~~ ~y __u_ '.. SI"red Dri,<(TVB,;"'" F'M,IEI~t. 'rrS~7]'~S' ---......., 410 ??L ...:> '-(60 1~ .~Wi~ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00015 ISSUED: 01106/2004 APPLIED: 01106/2004 EXPIRES: 07/06/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6015 MICA ST ASSESSOR'S PARCEL NO.: 1802033400135 TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install heat pump Owner: MARK LEMLEY Address: 6015 MICA ST SPRINGFIELD OR 97478 Phone Number: 541-343-2010 I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 SETBACKS ..\0 I DEVELOPMENll~1}9N , _..,\\::1 ~e'" \'lJ....... 0' ~e 'D . J:P .O\e~~~~~~ e; ~ ~~~\1t~ \ ~\O~. ~\@~t!:fP"'.l_~S\~<D.~~e' 0(\0 ~<C.~ ~e'O 9-~efft\~~~'P~~' ~.9~ 0.\\0(\ ~ 1'tI ,~ e0' ~ ",Q'\ 0 J.. r;.Q9'11. .,^0 \! O~,\G :\\0 . 0(\ "..\:lIll 0 ~\-,I1\~~.el'a \0 .~\c9-\'\ &7,...pO:J 0<o\'IJ. ~O U\~\~brbr"" , ~o~,c.g ~ ~0-:..,J"'t~'_;,^~ ...:r"'l \ rJlJO::~~~VEMENTS I \) c~\'II., .,..~ ~'O.e r'-'" (\~ REQUIRED PARKING Total: Handicapped: Compact: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Description Type of Construction Downspouts/Drains: Co 'NQ~~ t. \f 1\-\~ 01 l\01\C~~~\\ S\\~ll E{~~ Pt~~\\i~: 1\\\S ~t.O\"1t.\) \)~\)t~ I\Q~~\)O~tO . \ ,"{\-\lIn L- n,n \<; t\U .....\.,\ ~~tU v.I I Valuation DescriPG~t~Q Qf\'i ~t.~\QQ. ~\~ $ Per Sq Ft Square Footage or multiplier or Bid Amount Value Date Calculated Notes: Total Value of Project Pae:e 1 of 2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00015 ISSUED: 01/0612004 APPLIED: 01/06/2004 EXPIRES: 07/06/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L Fees Paid I 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 1/6/04 1/6/04 1/6/04 1/6/04 Receipt Number 1200400000000000012 1200400000000000012 1200400000000000012 1200400000000000012 Total Amount Paid $53.82 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. I Reouired Insoections I 1 Rough Electric: Prior to Cover 2 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 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 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. ~u-/7/. 4-')~ r;i/-/JI,-oLj Owner or Contractors Signature S/' Date Pa1!e 2 of 2 .. 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..o ylll'Z..C -( - 000/ -S- Address: b6/ S- m I LA s., Issued by: Ib ~ Date: I - b -0 Lf '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. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: fit. ~ 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners ~t Constrnction Responsibilities on the reverse side of tbis fonn. ~ Z(q,~< . 0!-06-0'/ (Signature of permit-1f"}9pliCant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 03/11/03 .. Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES 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. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed \'lith the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you 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 a State Business ill number, call the Business Information Center at 503-986-2200. 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~ Workers' Compensation Insnrance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensatiol?- insurance for your' employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for an claim costs if one of your employees 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. 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 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns Code Compliance: As the pennit 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 Property Damage Insurance: Contact your insurance agent to see if you have 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. " Time: Make sure)'ouhave sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your o\'vn general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the apprcipFiate 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 03/11103 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-000 15 COM2004-000 15 COM2004-000 15 COM2004-000 15 Payments: Type of Payment CreditCard Receipt #: 1200400000000000012 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Received By djb Check Number Batch Number Authorization Number Paid By MARK LEMLEY 000268 636826 City of Springfield Official Receipl Development Services Department ~ ' Public Works Department Date: 01/06/2004 11:03:26AM Amount Paid Item Total: 3.22 4.60 43.00 3.00 $53.82 How Received In Person Payment Total: Amount Paid $53.82 $53.82 ;""-SlPRINQf.'I!m,JI) ~' i . . ,. ,"... "."~"~~'-', . .........._"" " ,- .-.., .. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00015 ISSUED: 01106/2004 APPLIED: 01106/2004 EXPIRES: 07/06/2004 VALUE: ~~ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6015 MICA ST ASSESSOR'S PARCEL NO.: 1802033400135 TYPE OF WORK: Heatin~ System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install heat pump Owner: MARK LEMLEY Address: 6015 MICA ST SPRINGFIELD OR 97478 Phone Number: 541-343-2010 '/-;> I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER . License Expiration Date Phone BUILDING INFORMATION' # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: .....~ rt Garage/Carport Energy Path: O':~~ Qther: ~ ~ ~~ ~p~..~ious Surface Area: ; C"\ " ;C? l' t;-... ",0 .;;: ~~- I DEVELOPMENT INFORMATION rt'~0~ ~0 ":JOj<oq; ~0C:J ~ ~A::._~""'~ ~ 00 0C:J'lf-t' 0"'~~@REDPARKING ~ ~. ~ ,"~ ~ ~ 0 .;s' ~ ~ Frontyard Setback: # ~ ~ Overlay Dist: 0<:- 'Q~ 0'" ~ d- .....~0 ~l: , Side 1 Setback: !J. -f:? <<. ~ # Street Trees Rqd: ~0~.....00 ,<:-0C:J ~ooS '~0C:J ~0 ~<H~dicapped: Side 2 Setback: .......,<<J i!' ~ Paved Drive Rqd~9 ,..oq ~~ \::).;s' (Joq 0~'~~ ~mpact: ~ ~ ~ ..p" qrV ~0 ~".~ rS~..;s. %-" Rearyard Setback: if ~ ~~~. ,% of Lot CO~~l~ 0....... s:s ~~ ~ ~ r>-,r{J./ Solar Setback~: t:::. -& ~ ~ A<</ ,oS ~(J C\::):.. d> ~0"" 0~O (::.\:"" <t.- ~ r- <0:~ A ' _~.\o :r. ~~.'" 'fJ' f" ~. Q..~<? 87 -A.'J."v I PUBLIC IMPR~Jt~~~0V~0, .,c..... $;:1 ~ s:::>~ ~"'?: J ~ ~ ~.( Street Imp~~I<.~~ s::::, ~ ....0 ~. ~<:-~ ~...si{le'\valk Type: ~~~ ~~J( Storm Sewer ~~~: ~ v ~4f:' Downspouts/Drains: Special Instruction~ <:' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 VN SETBACKS Notes: I Valuation Description I '~, Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00015 ISSUED: 01106/2004 APPLIED: 01106/2004 EXPIRES: 07/06/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $4.60 $3.22 $43.00 $3.00 $0.30 $0.21 $3.00 1/6/04 1/6/04 1/6/04 1/6/04 1/8/04 1/8/04 1/8/04 Receipt Number 1200400000000000012 1200400000000000012 1200400000000000012 1200400000000000012 1200400000000000025 1200400000000000025 1200400000000000025 Total Amount Paid $57.33 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. I Reouired Insoections I 1 Rough Electric: Prior to Cover 2 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 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 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 Pa2e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-000 15 COM2004-00015 COM2004-000 15 Payments: Type of Payment Cash Receipt #: 1200400000000000025 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Ea Add Paid By MARK LEMLEY Received By djb Check Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department Public Works Department Date: 01/08/2004 1l:24:03AM Amount Paid 0.21 0.30 3.00 $3.51 Item Total: How Received In Person Payment Total: Amount Paid $3.51 $3.51