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Home My WebLink AboutPermit Electrical 2004-10-18 ~~~~ 225~U'!nSTREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 .FAX:(5~l726-3689 ~ ~ ELECI'RlCAL PERMIT APPLICATION . ~.?o ,,,'OlIo.., ~ ~ City Job Number COWl 2-C 0 L( - 00"3 0 7 bate I 0 ~l"~~~...: ~8 tis "..~. "_"_'_.~~~_'___'''' ....."'>>"~.'. ~'_,.__...=.,. .'_.~,_J:. 1. -J,;OeATION,OHINSTAIJEATIOm;..,.,' .' 3. COMPI:Jj~Jj;1iE . ';B.=.'" 1920'-.'~r~Ncr.:JiL~.- , '-~-"'~-~0~.?60' . . ...."'" LEGAL DESCRIPTION A. ~6~ffi{_"'ill'~" 1703. Z 7 L.- \ 00 )0 0 Service'lnclUd~ "1' JOB DESCRIPTION 1000 sq. ft. or less ~ Each additional 500 sq. ft..or (A.. {J&{l..AQ,(--- >C~V \ Lc portion thereof' . Permits are non-transferable and expire if work is Each Manufact'd Home or ,. not started wilhin 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder ~..v.t~~"'-';"<"~-_""""~"'-lK..~''''---~'~''~ M'....~ ~~~~~~~~~~~~....:,1l~~I:;.lr\<<:~~ 2 .!j.ONFR:A:CTOIl>INST.A TJT!fI!PN10!'fJlY;' B. S"e~m%!eeileis"",IiiStallation:rAlterations'orJRerocation: E'lec;:;~~::.~;r .. ~i~~~~::;n ~~~~:~~;~~~~;f.U'=- "--~"'T:::~b ~ P.l , ~\~ adO?tB1hose 1\1\e!2@f~il.I9)lOO Amps S 75.00 Address \O\\~_'l^n centel. ';S ',,10\19" ~~~j:9'6OO Amps S125.OO ~~~9s2..o0,-v~~n cO?ies '6bl~qOOO AmPs S163.00 ~~,~ou f{\&.~ O..~~ ~~otB: \~~~slVolts S375.00 calling U\8 \iV' 'Olegon \.It\\\l<;J2l\'1~t Only . S 50.00 ~~l\:i&1-&O~~-~!!~!fi~~F~r~~~~~ S50.00 City Supervisor License Number Expiration Date . Installation, Alteration or Relocation 200 Ainps or less 201 Amps 10 400 Amps 401 Amps 10 600 Amps Over. 600 Amps or 1000 Volts see "B" above. D. rtB~~Cfr'clii~t~~;~~~"m~~~.Ji;1!lll" .i.t~...--.._~_..w'..._...-,,;"'~~~~_ New AlIeration'or Extension Per Panel One Circuil .' ~~ () . ( Each Additional Circu~ ~ ~~ Owners Name k::'.......1::, '7 '/'A<LWl t:::.^-7C--<L Service or,~~d~t~~~, \<;, ~ . S 3.00 := S::~ b::":;~_ ~~~..~:.. OWNER INST ALLA nON c,Cl~ \ 'O\i.~~ EnergylResidential S 25.00 The installation is being made on property I own which I>-~ Limited Energy/Commercial S 45.00 is not intended for sale, lease or rent MinImum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~b;;'~:A:'irOF14if(}vE~~~ / ;. ~~s..~~~~p;~~.~~bk."lIirib:"'o_ 0 fLff b-SO 7371 F i \) S 50.00 S 69.00 SIOO.OO Expiration Dale . Constr.Contr.Number Signature of Supervising Electrician S 43.00 ~ftJ;;~~ I 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Sh=d DrivdT:YBuildin. Fonn.slEleclricnl Permit Application )-03.doc . . Lu r OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2004-00307 ISSUED: 08/25/2004 APPLIED: 03/19/2004 EXPIRES: 04/12/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 920 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272100500 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Gas piping, furnace and air handler. Upgrade service New Residential Owner: RUBY PARMENTER Address: 920 DARLENE AVE SPRINGFIELD OR 97477 Phone Number: 541-726-9677 Contractor Type Electrical Mechanical I CON1:RACo;I;QRlINFORMA TION I N. I "'"' ATTENilO . U -,,- the Oregon "''''''I COItf.~qll\eS adO?te~:~se l\lles are Get 'llr~cense O~~~ation Center. h OA~ 9SZ,"lff; C(tM~Rll!fl,Olt-OO'?_\~I~~;s 01 the nJl!J~ l(~o 0090. '(O\l hml1cYJ::aUiIJDlNGIINFowirI0N.... \. \ e " 'UI " I ca\ Ing - ore~on "..," .- number lor the. 1 o"Sl8Ae&~!t!i)" .r. \erlS - ~'J R_yen Height of Structure Type of Heat: Water Type: Range Type: ,.'. Energy Path: Sprinkled Building: Expiration Date Phone 06127/2005 541-726-0100 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla , I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I puiii~i~RO\(EME~i~ ii'~~~~~; \~~~~ ~\J\\10R\ItU UOR IS '/>.\3/>.NO(SllfeQ..,rIQl;}ype: COMMt.NCOt./>.~ pt.RIOO. DownspoutslDralns: />.N'1180 REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation DescriDtion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Palle10f3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Alr Handling Unit Up to 10,000 Furnace - up to 100,000 btu Cas Outlets 1-4 Minimum/Adjustment Mechanical + 10% Administrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less Total Amount Paid . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00307 ISSUED: 08/25/2004 APPLIED: 03/19/2004 EXPIRES: 04/12/2005 VALUE: Total Value of Project Fpp< P~;<lJ Amount Paid Date Paid Receipt Number 1200400000000000350 1200400000000000350 1200400000000000350 1200400000000000350 1200400000000000350 1200400000000000350 1200400000000000350 1200400000000001465 1200400000000001465 1200400000000001465 $10.00 $4.50 $3.15 $8.00 $12.00 $4.00 $21.00 $6.30 . $4.41 $63.00 3/19/04 3/19/04 3/19/04 3/19/04 3/19/04 3/19/04 3/19/04 10/12104 10/12104 10/12104 $136.36 I Plan Reviews , 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 }?pmlir,ptl I~ Cas Service: After line Is installed and line has been connected to a minimum of one appliance Including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Electric Service: Approval required prior to utility company energizing service. Paee 2 of3 . . L11 i' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00307 ISSUED: 08/25/2004 APPLIED: 03/19/2004 EXPIRES: 04/12/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 he 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 slreet, 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 3 00 -; \, l ", .,' ". ..' . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Weh Address: www.ccb.state.or.us Pennit #: (OWl z-o tit - (:>0"3 0-, Issued by: '1 ZO ~.MLu...-7\{ E ~ '3 Dale: fO ~ I Z -0 '-( Address: 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 befiled with the permit. Fill in the app.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B: WI. ~ 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 Z 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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 ofthis form. x ~'A.. -A,/1 AA^ q 47fu )0 - jt:Z, -or '/ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) F._r..:J_owner.doc 06-01-04 ., . .. . _A~~nIIllg ~~ 1( @1lll1l" ~WIIll '<GleIIlllell"~ll Cl!}IIll~Il"~~~l!}Il"? .., - ) .. I . - . . 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 ReslPOIlllsilbil.ities 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 with 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 more information, call the Department of Revenue 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. .~ The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.hlmll for the app'" up", ;ate forms. 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 could be subject to penalties and be liable for all claim costs if one of your employt:es 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 1-800-829-4933 or visit their web site at ww\v.irs.!!ov. Otll1er JReslPolIRsill>fimfies anndl Areas oft" COItllcerll1ls Code Compliance: As the permit holder for this project, you are responsible for resolvirig any failure 10 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 over spray, water damage from pipe punctures, fire or work that must be redQne. , '- 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 06-01-04 225 Fifth Street Sprj~gfield, Oregon 97477 541-726-3759 Phone . ~ Wi:. . .ty of Springfield Official Receipt Wevelopment Services Department Public Works Department Job/Journal Number COM2004-00307 COM2004.00307 COM2004-00307 Payments: Type of Payment Cash Change Job/Journal Number COM2004-00307 COM2004-00307 COM2004-00307 Payments: Type of Payment Cash Change 10/1212004 RECEIPT #: 1200400000000001465 Date: 10/12/2004 Description Perm Serv/Fdr 200 amps or less + 7% Stale Surcharge + 10% AdminiSlralive Fee Paid By RUBY PARMENTER RUBY PARMENTER Item Total: Check Number Authorization Received By Balch Number Number How Received djb In Person djb In Person Payment Total: Descrlpllon Perm Serv/Fdr 200 amps or less + 7% Stale Surcharge + 10% Administralive Fee Paid By RUBY PARMENTER RUBY PARMENTER Item Tolal: Cbeck Number Authorization Received By Batch Number Nnmber How Received djb In Person djb In Person Payment Total: Page I of I 1l:31:33AM Amount Due 63.00 4.41 6.30 $73.71 Amounl PaId $80.00 ($6.29) $73.71 Amount Due 63.00 4.41 6.30 $73.71 Amounl Paid $80.00 ($6.29) $73.71