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Home My WebLink AboutPermit 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'...' ~~" .: _.._.......~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 CZl ~ Q o u ~ IE-< CZl >-< o 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