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Home My WebLink AboutPermit Electrical 1995-12-13 (2) v-- SpaFIELD " The following project as submltted t;as tho folio' zoning. end dOOG not require specific land use upproval. _ [) Zoning rf f2. 225 FIFTH STREET - . t . L . SPRINGFIELD, OREGON 97477 Daie J:;}.. 13, ~ INSPECTION REQUEST: n6-g~rlzodSlgnetuN ~. OFFICE: 726-3759 r 3. 1. LOCATIOli OF INSTALLATION /1 2- '2- ))M L/j,)c ,Iw/' e: LEGAL DESCRIPTION /7-"") Z,7'),L JOB DESCRIPTION ' ~,tJr"~ ~~ 5::~ '? ~ / ,. '..~/J.d /,r-' Permits are non-transferable and expire if york is not started yithin 180 days of issuance or if york is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ololners Name.7~./ k~~ //~~. Address /122.. })~c} A#J~ Phone ~ -~7 City ~~ P;} , . OIINER INSTALLATION " The installation is being made on property I ololn Yhich is not intended for sale, lease or rent. I Owners Signature: X /l+I-'U:z-J-:l, CLOP/.. ~---~------~------------------------- DATE: /2.-S-<;,T RECEIPT II: 19'i1./~ RECEIVED BY: /~ ELECTRICAL PERKIT APPLICATION City Job Number 9 s/gSJ COMPLETE FEE SCHEDULE BELOV A. Ney Residential-Single or Multi-Family per dlolelling unit. Service Included: Items Cost Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular. 'Dllelling Service or Feeder $ 85.00 $ 15.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to, 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 c. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 $ 55.00 $ 80.00 see "Bit above Branch Circuits " Ney, Alteration or Extension Per Panel One Circuit V--$ 35.00 ::<~..... Each Additional Circuit or loIith Service or Feeder Permi t ,$ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE -<S';:C " 5% State Surcharge ~ /.1'"7.5' 3% Administrative Fee /.eJ.r TOTAL "< '7.&0 , SPRINGFIELD ~OB NUMBER :7" S/!3 SS- . RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 225 Fifth Street Springfield, Oregon 97477 r:;:o r I ~ I7'Il f' ;; I 4. Y'7 Y 7 -::. V (/ .~~ '----,L TAX LOT: ~ 7~ . //175lQ./ /Or e , 27 "22- 7LOCATION OF PROPOSED WORK: /7,e, "S l Jt' r p'iSSESSORS MAP: LLOT: BLOCK: SUBDIVISION' OWNER: m())?1 as ,ffDo)brt"s ADDRESS: '-I 1'2.. 7 VIA ~ / -1'14 ~ ffv{", CITY: Sf/ , '7 -t: I' Ie{ DESCRIBE WORK: Re/usmU &- UA-LJ(1"'r' PHONF.7C/b-6007 Sfr_'yl!-eJf Ot1f,__97 Y7 '7 STATF' rJr? ZIP: 97 (/7 7 ., , A)~A/,d?, ~4!.;r'>t'.7'. u7 /f??4-'7'-~;', NEW REMODEL ADDITION DEMOLISH OTHER, CONST. CONTRACTOR' CONTRACTOR'S NAME GENERA' ' f _ PLUMBING: -, /')a:;L)~ MECHANICAL' /h,U.AJ~ ELECTRICA' . I'lUJA ~Plt' ADDRESS EXPIRES '.-:- PHONE - OFFICE USE - QUAD AREA: LAND USE: FLOOD PLAIN' .. . OF BLDGS: . OF UNITS' ZONING CODE:_ OCCY GROUP' CONSTR. TYPE: . OF aDRMS: . OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER' RANGE: _ SQUARE FOOTAGE: To request an Inspection, you must call 726.3769. ThIs Is a 24 hour recording. AI/Inspections requested before 7:00 a,m. will be made the sarno working day. Inspections requested after 7:00 a.m. will be made the following work day. . 'REQUIRED INSPECTIONS t\7f Rough Mechanical -.:._ prior to ~cover. , -...... MFlnal Plumbing - When all ~Plumblng w9rk Is complete, o Temporary Electric f'9'(Rough Electrical - Prior to '-... ~cover. o Site Inspection - To be made after excavation, but prior to setting forms. ~ Final Electrical - When all ~Iectrlcar work Is complete, o Undarslab Plumblng/Electrlca" Mechanical - Prior to cover. 'l\7( FInal Mechanical - When all ~ mechanical work Is complete. . o Electrical Service - Must be approved to obtain permanent electrical power. o Footing - After trenches are excavated. f"'S(( Final Building - When all ~qulred Inspections have been approved and building Is . completed. o Fireplace - Prior to facing materials and framing Insp. ~ramlng - Prior to cover. o Masonry - Steel location, bond ,beams, grouting, DOther o Foundation - After forms are erected but prior to concrete placement. ". 0 Wail/Ceiling Insulation - Prior to cover. o Underground Plumbing - Prior to filling trench. ~rYWall - Prior to taping.: " , - -~ - ~ ,'. tJ Wood Stovo - After l~sta,,~ilon. , MOBILE HOME INSPECTIONS o Underlloor Plumbing/Mechanical , - Prior to Insulation or decking. o Blocking and Set.Up - When all blocking Is complete. o Post and 8eam - Prior to floor Insulation or decking, , o Insert - After fireplace approval and Installation of unit. o Floor Insulatio~ - Prior to decking. o Plumbing Connections - When homo has been connected to water and Sewer. o Curbcut & Approach - After forms are erected but prior to placement of concrete. o Sanllary Sewer - Prior to filling trench. o Electrical Connection - When blocking, set-up, and plumbing Inspections have been approved and the home Is connected to the service panel. o Sidewalk & Driveway - After excavation Is complete. forms and sub.base material In place. o Storm Sewer - Prior to filling trench. . O Wator Line - Prior ,to filling trench. .~ Rough Plumbing - Prior to ~over. o Fence - When completed. o Final - After all required InspectIons are approved and porchos, sklrtlng, decks, and venting have been Installed. D Street Trees - When all required trees are planted. ... \~:; . " ,I;,:\. '" -.' '".it"" ,;:.,,'. ",' _j : ; . i:,_~ .." ,. '"i,'; '" " \, \ I . '1'" .. . I .S TI;lE PROPOSED WORK iN THE. HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? II yes, this application must be signed and approved by the Historical ~.oordinator prior to permit issuance. Setbacks HSE GAR ACC I P.L. IN Is Iw' IE "\ BUILDING PERMIT ITEM SO. FT. ~~SO FT ~ VALUE \ , Main - - " ..... , . " Garage ......... "",) \. '" Carport #/.- If'..?IiiL , ,/1;,J.LJ , Total Value /5~ ) . 2.-0 -,Lr;... :LO SYSTEMS DEVELOPMENT CHARGE (SDC) Building Permit Fee Slato Surcharge ,71" T,-rf" Total Fee (A) (B) PLUMBING PERMIT ITEM Fixtures 4- Residential Bath(s) N' Sanitary S!3wer FT. Water FT. Storm Sewer FT, Mobile Home Plumbing Permit Stato Surcharge 2. <;>0;- /,....0 Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Ven t Fan N' FEE 48~O ( ?,~-... ---- ..s c :----"3-: ..-- ~ ~ 2.0 Wood StovellnsertlFlreplace Unll Dryer Vent .n?/A';, Mechanical Permit J. ):"0 / t:) 60 /,2.D '"? /' ;!.,o --- ---~, Issuance State Surcharge (7~-I'if (D) Total Permit MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk II Curbcul II Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding cleGtrlcal) (A, B, C, D, and E Combined) {'2>5:~ . APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMI:T . , This permit is'granted on the exp~ess con-dltion th'ai the said construction shall, In all respects, conform to the Ordinance adopted by the City ',of Sprl';gflel~, Including the De....elopment Code, regulating the con~tructl()n a\ld use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plan Check Fee' , Date Paid: Receipt Number- Received By: AI/A Plans R6vlewed By Date Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS By signature, I state and agree, that I have carefully examined the completed appllcallon and do hereby carll fy that all Information hereon Is true and correct, and Ilurther certify that any and all work pcrf<?rmed shall be done In accordance with the Ordinances of the City of Sprlnglleld, and the Laws of the State of Oregon pertaining to the work described herein, and tliat NO OCCUPANCY will be made of any structure without pennission of the Building Safety DivisIon. J further certify that only contractors and employees who arc In compliance with ORS 701.055 will be used on this project. I further agreo to ensure thai 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 tho approved set of plans wltl remain on the site at all times during construction. Signature Date I, VALIDATION: RECEIPT NUMBER /9g/t2; ; .i~~/!, r /2-:< ,~o .~ .~ DATE PAIr> AMOUNT RECEIVED RECEIVED BY Permit #: . CJ5/g,S\' //2 2 ~A.tPf.Ot ,~. MAl- L~--" Date: /'l.. - / - S' \- '""\..../ < . Address: Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4), requires residential construction permit appli- cants who are not registered 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 registration 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: ~ ~ D I. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A, My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR & 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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. ()~f1k-f). W~ ~/L--- (Signature of permit applicant) /1--/~ r;s (Date) (White copy to issuing agency permit file, pink copy to applicant) . . , . , ". Information Notice to Property Owners " About Construction Responsibilities ..... "_/", I ., "," .' , Note,: ThJs lnformation'Notic~ to Property Owners about Construction Responsibilities , was developed by the Cons(ruction Contractors Board in accordance with ORS 701,055(5). 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 areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. 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 more information, call the Oregon Dept. of Revenue at 945-8091. 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 Division at the Department of Human Resources at 378-3524. Workers' compensation 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 may be subject to penalties and will be liable for all 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 945-7888. 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 more information. call the Internal Revenue Service at 1-800-829-1040, . OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirem~nts. 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 re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, , f \ ..1' ,'. :.- ~_ . If you have additional questions, write or call the Construction Contractors Board,(pO Box 14140; Salem;O~,97309-5052, 503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.prn4 1/94 IIIr' ATTACHMENT B CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET . . JOB NO. 17/85G NAME OR COMPANY: 7 j.,I,lI.-.J 'f-S " () oiM ~ f,..{ftd.t:a? JAw? /0;;.1...)":' .4...1<...-/ , ' LOCATION' /I?' ") . . -.- .: I DEVELOPMENT TYPE: :"),,c.../f'.. AJ~d (1f1;z; .ffAiW @"'L/?7C'A7-4:J BUILDING SIZE: LOT SIZE SQ. Ft. 1. STORM ORAINAGF, IMPERVIOUS SQ. FT. 2, SANITARY SFWFR-r.ITY NO, OF PFU'S '7 (See Reverse) ; X $0.21 PER SQ, FT. $ X $43,43 PER PFU $ 3.9 1. tr/ .' 3. IBANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $437,93 $ X X $437,93 $ X X $437.93 $ 4, SANITARY SFWFR-MWMr. NO. OF PFU'S x $18.75 PER PFU + $10 MWMC ADMIN.FEE $ (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ TOTAl -MWMr. sor.. $ SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ 5, AnMTNTSTATTIIF FFF'. BASE CHARGE (SUBTOTAL ABOVE) X .05 .. $ /'). 2.tI ~.~ wR1liiv Troy MeA 11 i ster SDC Coordinator Date: 11.!t3!Q r TOTAl SOr. $ 3/9.2/ "..,. FIXTURE UNI~ CALCULailON TABLE: Number of New Fixte X Unit Equivalent = Fixture Unit~ (NOTE: For remodels, calculate onl""'e ~ additional fixtures) NUMBER OF UNIT FIXTURE FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS Bathtub,.....,..,..........",.....,.,.,..,.,.............,.,...",.,.."." . Drinking Fountain....... ... ................. ........., .........,...... Floor Drain..... .....,...,...................... ........................... Interceptors For Grease/Oil/Solids/Etc................. Interceptors For Sand/Auto Wash/Etc.................. laundry Tub/Clotheswasher................................... Clotheswasher - 3 Or More...................................., Mobile Home Park Trap (1 Per Trailer).................. Receptor For Refrigerator/Water Station/Etc........ Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single StalL..............................................., Shower, Gang................................... ............... ........ Sink: Bar, Commercial. Residential Kitchen........................ Urinal, Stall/Wall"...,....... .......................................... Wash Basin/lavatory. Single,................................. Toilet. Public Installation....................................,... Toilet, Private.............................................,:........ Miscellaneous: J 2 1 2 3 6 2 6 6 1 3 2 1/Head 2 2 1 6 4 2.. I J J 4. TOTAL FIXTURE UNITS = 7 CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table, calculate credits separates, Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 1980 1981 1982 1983 1984 1985 1986 $3.47 3,39 3.33 3.21 3.06 2.92 2.74 2.46 1987 1988 1989 1990 1991 1992 1993 1994 $2.13 1.76 1.35 0.95 0.58 0.41 0,29 0.14 i' I II Credit for Parcel or land Only If Applicable Improvement (if after annexation date), X $ (Rate X Assessed Value) X $ (Rate X Assessed Value) = = CREDIT TOTAL = $ RUNOFF COEFFICIENTS FOR STORM DRAINAGE (For Estimating Purposes Only) Resldenti."I.:~..~.:................... 0.4 Commerical......................... 0.9 IndustriaL........................... 0 5 GovernmentaL..................... 0.5 , " '~',' IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT