HomeMy WebLinkAboutPermit Electrical 2004-7-26
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION .oj
City Job Number CoWl20olt--ool(J'{ Date 7 /2r;,/tI~
........ ..' .' , . E t' / / .
1. LOCAI10N OF INSTALLATION 3. COllfPLETE'FEE SCHEDuLE BEtOl17
& Z<t fiJJl-111ou/'u"
LEGAL DESCRIPTION 1'70~/:S
R.oJ-ocA-m-Jv'1 E rc 1<. 07 9tJD
JOB DESCRIPTION
Be/a~ /UtY~
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. C~NJ;RACt<ZR ~~I!ST~LI1.!I9I!'()NLY
Electrical Contractor
SeLF
Address
J
/
City
Phone
Supervisor License Number
Expiration Date
I
Constr. Contr. Number
Expiration Di
Signatur'SuperviSing Electrician
02~~~tWl/s.~~~
I' I
Address (02.4- 'Ii Ai A-wlc.d..{ .L..I-i.
City <:;P-(lJ
Phone 7 4 '1 - b '1 L 7
OWNER INSTALLA nON
ATTENTION: Oregon law requires you to
The i~f~~Iatl(1-1W~~~emW BY tw@~~gWIUMlityh
is not IRt.eWUe&rorAare,,"I'eas~Rr..r.ent.uleS are s"'t forth
Notification ~enLer. I u::;~ T v
~et. k-:001-0010 through OAR 952-001-
Ow aU may ubt~in copies o~ rules by
. ter (N te: thE t hone
- number TOr me ur YU~ h; .
Center is 1-800-332-2344).
Inspection Request: 726-3769
SPlVtUr-.JOrFl1:'ZLO
.. ....
A. ~ew R~sidentia1-S~.n~~e.orMulti-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
$50.00
B. ..Services or Feeders-Installation, Alterations or Relocation:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
v-$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
b3
,CCo ~\' ./' . ',",.::' "',". " _. .0 '<. .'.'~ . '"<:,
C. '" Temporary Services or Fee(lers
. .. ^...., ,:.... >,"_~. '_ '--;.._':.', ,..'-.. .......,:,.._.l.:L.. .
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps .
$ 50.00
$ 69.00
$100.00
Ov.er 600 ~ps or 1000 Volts see "B" above.
D.BraJlch Circuits
'v'
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
b
~
': -' '<
E. ..' l\lisceUaneolls (Service/feeder not mcluded)-Each Installation
",-,_,;.., ..w;","'. ,......... __J ....
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited EnergylCommercial $ 45.00 .
Minimu~lftrJt~E'Permit Inspection Fee is $45.0Q.t's~f(harges
........'. :Utl,S. . PERMI.T..... S. H...A...... LL.......E. XP.......1R....E...../IF...JH.EWPI 8 00
4.~uMjmewt~6'.M~HISPERMlllS NOT ~ {,
. .~ G )MMEfiCED OR IS' ABANDONED FOR A tj]
7 Yo A.~tJl ~~r61n1ff PERIOD. 7- D
10% Administrative Fee f:/;l 0 _
TOTAL ~O. 73
Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03.doc
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-00434
ISSUED: 07/26/2004
APPLIED: 04/16/2004
EXPIRES: 01126/2005
VALUE: $ 15,523.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 624 TINAMOU LN
ASSESSOR 'S PARCEL NO.: 1703221309900
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Addition to existing SFR - L.R. extension
Owner: SANDRA BRYAN
Address: 624 TINAMOU LN SPRINGFIELD OR 97477
Phone Number: 541-747-6927
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Mechanical
Plumbing
Contractor
OWNER
OWNER
OWNER
License
Expiration Date Phone
I BUILDING INFORMATION.
# 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: Forced Air Gas
Water Type:
Range Type:
Energy Path: Path 1
Sprinkled Building: nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
168
R-3
I DEVELOPMENT INFORMATION'
Front yard 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:
20.40
0.00
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction: Storm to existing
Sidewalk Type:
Downspouts/Drains:
Notes:
A.fTcNf!UH:Uregon laW requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
;n OAR 952-001-0010 through OAR 952-001.
0090. You may obtain copies of tile rules b~
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Page 1 of3
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00434
ISSUED: 07126/2004
APPLIED: 04/16/2004
EXPIRES: 01126/2005
VALUE: $ 15,523.00
~S:;GF.I:J;t liJi. ....... . . :...
WAr. A~.
. Ai ..
'-. ~_...," .".v__,..__,' .__...._._~..", ' ;
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description I
Description
$ Per Sq Ft
or multiplier
$92.40
Square Footage
or Bid Amount
168.00
Dwellinl!s
Tvpe of Construction
V Wood Frame
Total Value of Project
~
Value
Date Calculated
$15,523.20
$15,523.20
04/16/2004
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $100.23 4/16/04 1200400000000000491
-Mechanical Issuance Fee- $10.00 7/26/04 2200400000000000971
Add, Alter, Extend Circ Ea Add $6.00 7/26/04 2200400000000000971
Building Permit $154.20 7/26/04 2200400000000000971
Copies - Ea Addtl @ 50 Cnts Ea $4.50 7/26/04 2200400000000000971
Copy 6th @ 75 cents $0.75 7/26/04 2200400000000000971
Not Covered Mechanical $45.00 7/26/04. 2200400000000000971
Perm ServIFdr 200 amps or less $63.00 7/26/04 2200400000000000971
Plan Review - Planning $71.00 7/26/04 2200400000000000971
Plan ReviewIResidential Hourly $45.00 7/26/04 2200400000000000971
SDC SanitarylStorm Admin $2.44 7/26/04 2200400000000000971
Storm Drainage Impervious Area $48.72 7/26/04 2200400000000000971
Storm Sewer - 1st 50 Feet $45.00 7/26/04 2200400000000000971
Total Amount Paid
$595.84
Initial Review
Initial Review
Planninl! Review
I Plan Reviews I
04/16/2004 APP
07/13/2004 APP
04/29/2004 APP
RJB
SKG
TAJ
04/16/2004
07/13/2004
04119/2004
Structural Review
04/19/2004
04/27/2004 WE
TCM
Structural Review
07/13/2004
07/26/2004 APP
DLM
Pal!e 2 of 3
Revised drawing
Setbacks are not shown on plot plan
and it's not drawn to scale, but
based on the addition in relation to
the existing house, it more than
meets setback miniums.
Sent letter to owner regarding
additional required information.
Received revised plans and
structural calcs 7/9/2004 Review
completed 7/22/04, still need Lane
Co approval for septic
clearances. dIm
~~J;G,~~ D~"..'J'...'
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_.._.......~MM ._.._+~ _._.__., _ .
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00434
ISSUED: 07/26/2004
APPLIED: 04/16/2004
EXPIRES: 01126/2005
VALUE: $ 15,523.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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.
l Reouired Insoections I
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or decking.
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underfloor Drain: Prior to cover or placement of concrete.
Storm Sewer Line: Prior to filling trench.
Vnderfloor Mechanical. Prior to insulation or decking and including required testing.
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 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.
~ ~ ,>>----
)
.
..
~~, 0<-1-
Owner or Contractors Signature
Date
Pae:e 3 of 3
CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN(~ORKSHEET
JOURNAL OR JOB NUMBER: Com 2004-00434
NAME OR COMPANY: Sandra Bryan
LOCATION: 624 Tinamou Lane
TAX LOT NUMBER: 17032213 t1 9900 .
DEVELOPMENT TYPE: SFD Addition
NEW DWELLING UNITS 0 BUILDING SIZE (SF; O' LOT SIZE (SF):
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. CHARGE
I 168.00 I $0.290 = $48.72 ,
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. x COST PER S.F. . x' DISCOUNTRATE I DISCOUNT
0.00 $0.290 50% = I $0.00
o
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ga
ITEM 1 TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's x COST PER DFU
'0 $22.64
B. IMPROVEMENT COST:
NUMBER OF DFU's x COST PER DFU
o $17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,
3. TRANSPORTATION.
$48.72
$48.72
11070
= . $0.00 11091
=' , $0.00 1092
$0.00 . I
A. REIMBURSEMENT COST:
I ADT TRIP RATE l x NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR
, 9.57 0 $17.23 1.00 $0.00 1093
B. IMPROVEMENT COST:
ADT TRIP RATE x NUMBER OF UNITS x I COST PER TRIP x NEW TRIP FACTOR
9.57 0 I $76.01 1.00 $0.00 1094
ITEM 3 TOTAL - TRANSPORTATION SDC = , $0.00
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's x ICOST PER FEU
I 0 I $314.63 = $0.00 . 1054
B. IMPROVEMENT COST:
NUMBER ~FFEU'sl x COST PER FEU
$214.23 = , $0.00 1055
I
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 11054
MWMC ADMINISTRATIVE FEE $0.00 11056
ITEM 4 TOTAL - MWMC SANITARY SEWER SD< = , $0.00 I
SUBTOTAL (ADD ITEMS 1; 2, 3, &. 4) = , $48.72
5. ADMINISTRATIVE FEE:
I SUBTOTAL x ADM. FEE RATE CHARGE
I $48.72 5% $2.44
TOTAL SANITARY ADMINISTRATION FEE: I 2.44 11079
TOTAL TRANSPORTATION ADMINISTRATION FEE: I . $0.00 11078'
Virginia Jurasevich 4/23/2004 TOTAL SDC CHARGES =1 $51.16
PREPARED BY DATE
DRAINAGE FIXTURE UNIT (DFtJ) CALCULATION TABLE
NUMBER OF NEW-FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 0 0 3 = 0
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRYTUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 0 0 3 = 0
CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
RECEPTORFORREFRIG/WATER STATION /ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK/ DISHWASHER / ETC. 0 0 3 -. 0
.SHOWER, SINGLE STALL 0 0 2 = 0
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASINIDOUBLE LA V A TORY 0 0 2 = 0
SINK: SINGLE LA V ATORYIRESIDENTIAL BAR 0 0 1 - 0
URINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INSTALLATION 0 0 3 = 0
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
I
TOTAL DRAINAGE FIXTURE UNITS 0 I
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day I
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$I,OOO
ASSESSED VALUE
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
o
$5.04
$5.04
$4.95
$4.88
$4.75
$4:58
$4.41
$4.20
$3.88
$3.50
$3.07
$2.60
$2.14
$1.71
$1.52
$1.38
$1.19
$1.03
$0.87
$0.68
$0.46
$0.27
$0.09
$0.04
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE/WOO CREDIT RATE
$0.00 x $5.04 = I
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE/lOOO CREDIT RATE
$0.00 x $5.04
$0.00
o
TOTAL MWMC CREDIT
=
$0.00
'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 #: COf///fZOI.. l -- CJ 0 13 </
Address: bZL{ 'I '^ A M C> V\ W
ISSUedbY:~~ Date: 7/~~t:L
~, , I '
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.
Pill in the appropriate blanks and initial boxes l' and 2, and either box 3A or 3B:
--a . 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.
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.
OR
-----H 3B. I Will be my own general contractor.
. If I 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 ofthe 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. .
...~..
. ". ~
. ' . L~(C!A
- (Signature 'ofpermitapplicant)
i-l~-()cf
(Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property _ owner. doc 03/11/03
\> ?.. '.5.:.. ., .
~~tnlg.as Your Own General Contractor?
.. ".... ~'" "to, INFORMAllON NOTICE TO PROPERTY OWNERS
~~ ~ ,~~:;.... ':', . ABOtJ-T;:COt\J;S;rRUCTION RESPONSIBILITIES
'. . . \ . I .
NOTE: This Information Notice to Properly 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 with the Construction: Contractors Board to do labor in constructing or to assist in the
construction orimprovement of a residential structure. As the employer, you must.comply with the following:
Oregon's Withholding Tax Law: As an employer, you must withhold i~come 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 purpose~
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVIlll'ensation Law,
and must <?bt~in workers' compensa~ion 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.
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 Re,sponsibilities and Areas of Concerns
Code Compliance: . As thepennit 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 over spray, water damage from pipe punctures, fire or
work that must be redone. ' . .'
Time: M~~e s~e)'o~ ~av~~ s~fficient time to supervise your employees.
\
'_"~ oJ
")
. . .
. 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 03/11/03
225 Fifth Street
5pdngfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
COM2004-00434
Payments:
Type of Payment
Check
7/26/2004
r.ty of Springfield Official Receipt
lelopment Services Department
Public Works Department
RECEIPT #:
2200400000000000971
Date: 07/26/2004
9:30:57AM
Description
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Plan Review - Planning
Plan Review/Residential Hourly
Copy 6th @ 75 cents
Copies - Ea Addtl @ 50 Cnts Ea
Building Permit
Storm Sewer - 1 st 50 Feet
Not Covered Mechanical
-Mechanical Issuance Fee-
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Amount Due
2.44
48.72
71.00
45.00
0.75
4.50
154.20
45.00
45.00
10.00
63.00
6.00
$495.61
Paid By
STEVEN BANNING KUNKLE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
dIm
3303
In Person
Payment Total:
$495.61
$495.61
Page 1 of 1