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Home My WebLink AboutPermit Electrical 2004-9-23 / ;".' ' ':' 'Ciiy OF Si,~dNtJFIELI:f::OREGbN,";".'ry',' ,( . ,;.' " '. _ , ' <. <.. ' ~ '~.~ ".,';A, ~\ _I' ' SPRINQFiELD m..~Y'"~~ 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CtM-lJ4 ~ O/I~f r~c--~-~'-"'~~':'1'n1r~' __. ,', """"--'--:'~-:-'r~;t",'"""'':T'''J 1. ~~~Z2f~Tj?~;::,~ 3. - ,--.. - LEGAL DESCRIPTION JOB DESCRIPTION 2- cfAl CU / rs fltJ..lf.;J. . Permits are non-transferable and expire if work is .' not started within 180 days of issuance or if work is Suspended for 180 days. ~ _:'~_""'_'.~,:. .-,_ .." ,;' '. _,,:;-'-:"t}"irF':;7. .V',"',,/. ,:,:_~.,._-.<._,. -;' "~'.7P;? "CONTRACTOR'INSiALiiATiONPNLyi' 2. fh:,"'i.i-_'_'n."l\.;;;~1'dTh~~"._-:"c;'''''_~-*''';'lX,~.jiYl'~i\,,,.:.i',,,,~'3-,:j:1-'l'j';;';';-:::i~tt~ Electrical Contractor Address City Supervisor Lice7nse Numb Expiration Date Constrt-tOS . ber . JHI PERMIJ SHALL EXPIRE IF THE WORK EXPlra~'12 i'tfR:2:::3 ~18::R JHlg PEDJ'!: !2 ~'QT Signanfle1lti!;:,p~JiQg:Jfleb\h~~NDONED FOR ANY 180 DAY PERIOD. OwnersName:5fl~~..,~ L.il/~f':L Address ~~::-'Co ~~RJ\ t)ll. City stiLl\ Phone ..,1/1,-11 y 'l OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~~~r--1'~~.-) Inspection Request: 726-3769 Date /~ 1/&~ /.. "$ . 1''''"- --. ....._.r"'r...-- ~_."'""....,w".. d~~.I'~~?:i.,"n...,.,pt~l'.'''-..--.''''..''~.- ~.-.~~-~. .'.''''.''''^.rrrasi'. i(;o.MfJ;i:IE'Ej;;i::S~~~g~lfEr:PWi;i'K{'i;~".:i~~q;'i.~J':TI~ ,--,-,-->w,-~,-,-~ov.~I);"""~.b-"~.;....."---,;""",,,,,,-'-;;.h.;'--$---'''-''~-'''''''~-'-' 1.1/ C' 0; "'0' D . 0.. "Ole, F.")'-'),:;Z'7Y':i-,~':i'it>jt":i1.::;:-" -, ~.;~t6't'';t:,':'(r1,~o1:'>>!~;}::tt-:~-J). - -,,~.t'0,t',:;\.:1ti-J;'~_::-Y~:'i'\'-m~'>;':'\",-iiD'.;1 A. \i.Ne,'!;~e,~!lI,en!~Ro.~I, le,o~ulti:f~~"~~jv~I!!ngJ!!,it:'~,i~ W~""'_'-i-' _....~~~, -'i-.?;..._~~",l:ZW-.... -"4-'---'9'4~"'''It:' -""-'-~. ---- . . Service Included "O'.$:' c::l''''' "'/}$O'I,,,,,, <9,,<> r ~ V ~ "IF,. 11,$ tVr$ $1 O~" '0'<. "- 'l;, "'V., "'If> "- 0 $:9 ~ 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufac!' d Home or Modular Dwelling Service or Feeder l~= ~.7tf~._.- .--." r'l'- B. ,:~s;;~~;f~~s 1;'r<zF~0d~~~'+~InstaYi:ii~~~.'AW~r1i'ti~-iis 'b~;'Reirihatr6ri~;;~'1.1 ~,."",,-;,..<k~"L<. ;,',~:;1, ~/._\t';S""',"''''~ """-,."".;40,..,:',., _':h.J\\G.->;';r~'" "~Y~'';;i~Jtr.tj,__,-''-3''t<,,'3;i; 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps Over 600 or 1000 D. $ 50.00 $ 69.00 $100.00 New Alteration or Extension Per Panel One Circuit V $ 43.00 Each Additional Circuit or with J Service or Feeder Permit $ 3.00 .-;t3 "3 fi:j-';"::t~:<i'~;,.<,>td ~.:!;:t";:f"t:'ti'''2;~Tv!::'$\='",:~''?Rrr;:rrL1m;%'~~??--::i>-:;''-''<':1'--"-> -,,_.' )r',-:.~ E. ' .Miscellaneous (ServIce/feeder. not mcluded) .,:Eacn Installation, ~-,"'-r', .....'~.._.."".. .........,__"_...'_~,, ." ~;;,.;~r.\ .c. .......--'.....,.,'"-.9, ,., .,-,.-...... ."';"'-"''''''--.''''''"'f..::.;L).C,~''__t;:j Pump or irrigation . . ~ Signlo~1\~ Oregon la., reEjUlrB.'t../l UQ tl. cled by tt'.c Or\lgO'l'I'Cft Y LimitedoJllevg~~~&~?iar Those r"lp~ arEli~Oorth . . ~ifl!t!W!fl) Center. " . . Lnmt.\{l QA,R'tl5'~~lff!6~? thrn' ~~: ~~=:Ob~ Mmunu~ ~~'flS~~&~:" S"4I~1g "h~'If~harges · ~~~lZ- '~*''";;If:~ 10% Administrative Fee y.tt. D TOTAL ;")1 . ~2... Shared Drive(T:)/Building FonnsJEtectrical Pennit Application I-D3.doc . . Ll1 i' OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01164 ISSUED: 09/23/2004 APPLIED: 09/21/2004 EXPIRES: 03/23/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2536 DEBRA DR ASSESSOR'S PARCEL NO.: 1703234402900 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPnON: Heat pump & air handler, including ductwork Alteration Residential Owner: SHARON LILLEGREEN Address: 2536 DEBRA DR SPRINGFIELELD OR 97478 Phone Number: 746-1147 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Contractor OWNER PACIFIC AIR COMFORT INC License Expiration Date Phone 39237 03/25/2006 541-672-9510 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMAnON I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: I PUBLIC IMPROVEMENTS' ATTENTION: Oregon law requires you to fo"6hI~~led by the Oregon Utility Notlfti~t'n~W1t JhQse rules are set forth In OAR 952';o01.oofti'mrough OAR 952-001- 0090. You may obtain copies of the rules by calling the center. {Note: the telephone number for the Oregon Utility Notification \lenter 18 l-tlUlNiU-""....I. Storm Sewer Available: Special Instructio'R01\CE: f.XP\Rf. IF lHE WORK ERMli SHI\LL PERMll IS NOl Notes: iHIS PORlIED UNDER lHIS DONED FOR I\U1H_ , en nl\. IS {>.B{>.N IjUNIl".J1.: - :1 PERIOU AN'f 180 D~ I Valuation Descriotion I $ Per Sq Ft Square Footage or multiplier or Bid Amount Description Type of Construction Value Date Calculated Paeelof2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Air Handling Unit Up to 10,000 Heat Pump Minimum/Adjustment Mechanical + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01l64 ISSUED: 09/23/2004 APPLIED: 09/21/2004 EXPIRES: 03/23/2005 VALUE: Total Value of Project F~~s Pair! I Amount Paid Date Paid Receipt Number 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 2200400000000001192 2200400000000001192 2200400000000001192 2200400000000001192 $10.00 $4.50 $3.15 $8.00 $12.00 $25.00 $4.60 $3.22 $43.00 $3.00 9/21/04 9/21104 9/21104 9/21104 9/21104 9/21104 9/23/04 9/23/04 9123/04 9/23/04 $1l6.47 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 R~miLil'~r! Tn~\1m;!~ Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover 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, tbat 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. l~.A<"'_ t\ .J...~O~..L______ ~Signatu~e' ~ q- ~1.- 04 Date Pa2e 2 of2 . Perrnit#: ~ho 1/6-f Address:2~?~ ~~ ~ Issued by: ~ Date:. mkd -----< ./r. I / I (I). . . \. ..f ", ,,' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Saiem OR 97309-5052 Phone: 503.378-4621 Web Address: www.ceb.state.or.ns 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 aptUVtU;ate blanks and initial boxes I 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. 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. ~3B. OR~ I will be my own ~elitlfl11 contractor. 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. ~ ~\.~ ._ ~ . q- !Z~- OC{ ~ (Signature\Jfperml (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 ., , , . - .... :...::.~~ ,\.,.. '",\\ ',,>,-\ .,.:,-:~....,r~YT"t-. rr n cc. <I- " .,. A\1~]'n;ru~~~:I(iliurr''0Wllll \UJ~IID~Ji21 aDml!.lf~~0lJlf t ", ~~~, ~...,. - " "",~ l'.....trlln"O~lIlfil'~G'\l.MOT~CE "iTO P~OPERTY OWilJERS 'L-~~.'~ A~~p...i,=C~~TRucr~ON RESPONSII8~L1T!!ES , '} 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. Emjpllilbyer JRe!iljpilbITnsfibfillfi1bies 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 wi~h ~l1e following: Oregon's Witbholrling 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. , , 1Uce;:nploymen~ lloscTaoce Tax: As an employer, you are required to pay a tax for unemployment insurance purpose~< 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 lIfltl Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. WOlr[{ers' COI!lpensa~ion 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 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. """~" - . . ~ ...':!::tt. _ V.S. llnternal lllevenue Service: As an employer, you must withhold federal income tax from employees' wages':" You will be liablc 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 www.irs.l!Ov. ((J)1b(flIl" !R(fl$J!DO!ID$iilbiftn51U(fl$ 2l!ID<dl AIT'(fl21$ Oll Ce!ID~(flIl"!ID$ Co12e 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. lLiclli[ity and Property llkmage TIosUJraoce: 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 redone. ... ) ~ . 0 I ' ~..C' _I;:'" ~ _,~ , __~_ .1I1} ..:l:::- ,'- . I r.; <,;..-"" I --..--..~.t,.::;;\.) 00;> ~~ \ Tfr~2: Make sure you have sufficient time to supcrvise your employees. I i' - i I V ZJI:!2~~:~2: Mukc sure you have the skills to act as your own general contractor, to coordinate the work of rough-m and finish trade,. anli to notify bwlding officials as the appropriate times so they can perform the required inspections. If you havc udditional questions call the Construction Contractors Board (503-378-4621) or write the agency ut PO Box 14140. Salem, OR 97309-5052. Property _ owner.doc 06-0 1-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ....~.III~~._F.l~'_._..._...,.. . 1YM1 ~.j Jiiily of Springfield Official Receipt "elopment Services Department Public Works Department RECEIPT #: 2200400000000001192 Date: 09/23/2004 8:28:39AM Job/Journal Number COM2004-01164 COM2004-01164 COM2004-01164 COM2004-01164 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By Cash SHARON L1LLEGREN Item Total: Check Number Authorization Received By Batch Number Number How Received dim In Person Payment Total: Amount Due 43.00 3.00 3.22 4.60 $53.82 Amount Paid $53.82 $53.82 9/23/2004 Page I of I . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-0II64 ISSUED: 09/21/2004 APPLIED: 09/21/2004 EXPIRES: 03/21/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2536 DEBRA DR ASSESSOR'S PARCEL NO.: 1703234402900 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPnON: Heat pump & air handler, including ductwork Alteration Residential Owner: SHARON LILLEGREEN Address: 2536 DEBRA DR SPRINGFIELELD OR 97478 Phone Number: 746-1147 I CONTRACTORINFORMAnON I Contractor Type Mechanical Contractor PACIFIC AIR COMFORT INC License 39237 Expiration Date 03/25/2006 Phone 541-672-9510 BUILDING INFORMAnON I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: 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 REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Sidewalk Type: Storm Sewer Available: ATTENTIO~!lelMeomslDtafifS\lires you to Special Instruction: follow rules adopted by the Oregon Utility otificatlon Center. Those rules are set forth Notes: NOTICE: ~ OAR 952-001-0010 through OAR 952-001- ~~iH6~i~'~:ci 0~ci)E~ ~:~~~ ~~i;~:~~~&;escriD~i;;,~gt~~~~~;:.;n(~~~~r.~~IF~~~~?~:y COMMENCED OR IS ABANUlmcLJ run """ ber for the orego~~~1 i34~) Description ANY ~Q 00 ~JiruOOm $ Per Sq Ft Square Foot&g@nterIs1-80VI-' . 0 or multiplier or Bid Amount a ue Date Calculated Total Value of Project Paee 1 of2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Air Handling Unit Up to 10,000 Heat Pump Minimum/Adjustment Mechanical Total Amount Paid . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01164 ISSUED: 09/21/2004 APPLIED: 09/21/2004 EXPIRES: 03/2112005 VALUE: I Fl'l'~ tilW Amount Paid Date Paid Receipt Number 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 1200400000000001371 $10.00 $4.50 $3.15 $8.00 $12.00 $25.00 9/21104 9/21104 9/21104 9/21104 9/21/04 9/21104 $62.65 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 Reouirl'd TnSDl'ction\l Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical 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 tbe work described herein, and that NO OCCUPANCY will be made of any structure without permission of tbe 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 t~e front of the property, and the approved set of plans will remain on the site at all ~":;:;Ii~ &ruTh C{ / ~\ Owner or Contractors Signature Date I lOll t Pal1e 2 of2 . 225 il'ifth Street Springfield, Oregon 97477 541-726-3759 Phone . ~ ~y of Springfield Official Receipt .elopment Services Department Public Works Department RECEIPT #: 1200400000000001371 Date: 09/21/2004 1l:17:59AM Job/Journal Number COM2004-0 1164 COM2004-01164 COM2004-01164 COM2004-01164 COM2004-01164 COM2004-01164 Description Air Handling Unit Up to 10,000 Heat Pump Minimum! Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 8.00 12.00 25.00 10.00 3.15 4.50 $62.65 Amount Paid Check PACIFIC AIR COMFORT INC dim 8882 In Person Payment Total: $62.65 $62.65 9121/2004 Page I of I