The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2005-9-15 ..:.J,.;;~~VD! ~D:-' ":~f;tJ~.:; lY\ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689- :"'9,~\l:.iftil .L;O;~rt.---' ~ ELECTRICAL PERMIT APPLICATION . I>i~J7 '-- CityJobNumbeWI/72oG>S-O/~5;Z Date 9/15/0 5 , 1. LOCATION OFINSTALLATION /2{)-:J 35 3_$ 07~;:GP€f 9700 LEGAL DESCRIPTION r;,rG/ ~If/~ JOB DESCRIPTION 5fA-::> , Permits are non-transferable and expire if work is ,r not started within 180 days of issuance or if work is Suspended for 180 days. 2. CON'['RACTOR INSTALLATIqNJPLY ~triCal Contractor / Addr~ / ~ ~hone City suP""~or~~ EXPi~~"Date ~ co~str. Contr. Number ~ \ Expiration Date Signature of Supervising Electrician Owners Name ~~ ~~ Address :5X"?OcJ t41>t5L;>~p ~ 1L- - If 1- City ~ Phone 717-G)3'cO OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~TJ4r Inspection Request: 726-3769 3. COMPLETE FEE SCHEDuLE BELOlV A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq, ft. orless $106,00 Each additional 500 sq, ft, or portion thereof $ 19,00 Each Marfu-i~;;tia1Ft~.t09regon law requires yo~ ~o Modular ~1Hrlgl!f{NitgJtWed by the Oregon UtilIty Feeder :\cLi"(icaticr: Cent~r. Tho~A l'ules areOOlilOrth in CA0 052-001-001 O}hrough OAR 952-001- B. . S~rv~~J'J. ~~~taletj~ifMffiI1dh~Jl~~lhcation: .. . c~!ll;l-r"i 1"1",0 c6nf6r 'Note: tilete!ephone G.I I .~....'-' v v. \ 200 AmP~rlm-tr '[ar the Oregon Utility N~t6im'dion 201 Amps to 400 ~Plter is 1-800-332-234~)~5.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375,00 Reconnect Only $ 5'0,00 C. Temporary Senicesor Feeders -,- ,,-. - - ,-,.) , . -. Installation, AIteratidri or' Rel6catforl '.: :-;, ,I: I I ~ i 'c J I 200 Amps o riess" q~ u," :c:; "~I-'.i'~\:L::)i~foo SU. 201 Ainps'to400 }\ilip{LJ.IJJ. $ 69,00 401 Amps to 600 Amps $100,00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits ~Ji) New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43,00 '(p, aU 2-- $ 3,00 E. :Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OF ABOVE 6(P,cJC> 3-9~ ,I)' . & c) ItS-. &~ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/Electrica\ Pennit Application I-03.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6967 Main Street ASSESSOR'S PARCEL NO.: 1702353309700 ":..r .~,.,ltrtV' r . CITy~ObF~~Ri~GF~I-J Building/Combination Permit PERMIT NO: COM2005-01252 ISSUED: 09/15/2005 APPLIED: 09/1312005 EXPIRES: 03/15/2006 VALUE: $ 125,432.00 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence, Lot 4, Redwood Lane Subdivision Owner: Address: BOB GREEN 38704 UPPER CAMP CREEK ROAD SPRINGFIELD OR 97478 Contractor Type General Electrical Contractor ADAIR HOMES INC OWNER , # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 VB 3 Residential ATTENTION: Ore~bQrle.'Numl>.eres ~4l1J.14J7-0300 ~oi!ovv rule~ adopted by the Oregon Utility Notification Center. Those rules are set forth In UAH ~:JL-UU I-UU I U Ulfuuyr I Ur\n ~;:u:.-uu.. I CONTRACTOR INFUKlUfA NONTfY obtain copies of the rules by calling the center. (Note: the telephone mJoitelIser th eEXP!PrtUJJii1J) atetifi cBli'ollle 593 Center is 1-8W19.l!OOb344). 503-645-1156 I BUILDING INFORMATION I # 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: 1 16.00 Electric Electric Electric Path 1 n/a 1,192 400 I DEVELOPMENT INFORMATION' REQUIRED PARKING ... j .- j ,,' (. I, j L I\I,~ . Overlay Dist:-' ' L I, L CI'..- :if iF T!-rtotal' , . '--. ., !),.' I." _ '. -,' ! .' '\...: ,_ ,. .. ~/ j .; \ #StreetTre_e~l{qd,: .' () _.J.:," !(lIu r'i:iil,'II.~ltn~i~apped: Paved Drive Rqd:, " '-LI-: \:. ", j,~'..\ i~U'\!i" iJ Compact: %ofLotCovedge:)/':' j'L1,J:'r} - 1\"'11 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: Sidewalk Type: Downspouts/Drains: Pa!!e 1 of 3 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-01252 ISSUED: 09/15/2005 APPLIED: 09/13/2005 EXPIRES: 03/15/2006 VALUE: $ 125,432.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I DweIlinl!s Garal!e Tvpe of Construction V Wood Frame Garal!e $ Per Sq Ft or multiplier $96.00 $25.00 Square Footage or Bid Amount 1,192.00 440.00 Value Date Calculated Description Total Value of Project $114,432.00 $11,000.00 $125,432.00 09/13/2005 09/13/2005 ~ Fee Description Plan Review Same As + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $100.00 9/13/05 2200500000000001262 $5.60 9/15/05 3200500000000000560 $3.92 9/15/05 3200500000000000560 $6.00 9/15/05 3200500000000000560 $50.00 9/15/05 3200500000000000560 Total Amount Paid $165.52 I Plan Reviews' Initial Review Planninl! Review Public Works Review Structural Review 09/14/2005 09/14/2005 09/14/2005 09/14/2005 09/14/2005 APP LLH 09/14/2005 APP LLH Plans reviewed and approved by Rebai Tamerhoulet, Sate of Oregon Plans Examiner under Master Plan Review Program. State Plan Review Number 2005-00181 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.Jl.eouiredJnSD~ctions I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor foundation inspection. 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. Pal!e 2 of 3 r-~~H,',~~J5I~~ ~,,,.,",, f , ~ Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-01252 ISSUED: 09/15/2005 APPLIED: 09/1312005 I EXPIRES: 03/15/2006 VALUE: $ 125,432.00 225 Fifth Street, Springfield, OR .i. 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbin\g: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Final Electric: When all electrical work is compl~te. 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 ofany 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. Owner or Contractors Signature Date Pa!!e 3 of 3 .' . . , , . . , . . .' ... .. . , . ' 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 #:Gdln 2..(. .J.e:; - 0/;). 5 L Address: i2QU7 !ntLt W Issued by: iJ ,/1:J;2t.htt/i-o Date: Q/;6/0S I . Statement: Info. mation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is requirefI for residential building, electrical, mechanical and plumbing permits, Licensed architect and engineer applicants, exempt from licensing under ORS701. 010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~. I own, reside in, or will reside in the completed structure. D 2. 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 I2d" 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 of the contractor. . I hereby certify that the above information is correct and that! have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. QJ:J: A (Signature of permit applicant) j -/ .s--:Q'S (Date) (White copy to issuing agency permit file, pink copy to. applicant.) PropertLowner,doc 06-01-04 Acting as \',dur Own General Contractor? \' I ~ ,- INFORMA TION,NOTICE TO PROPERTY OWNE~S ABOUT CONSTRUCTION RESPONSIBILITIES , ~.,; \ .. ~ . .' I 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. r J If you are acting as your own contractor to construct a ~ew home or make a substantial improvement to'im existing. structure, you can prevent many problems by being aware ofthe following responsibilities and concerns. ~mployer Responsibilities :i'i - ,", You will, in most instances, he,ruled to be an "~mployer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contr:act,ors Boar~ j9 do labor in constructing or to assist in the construction or improvement of a residential structUre. As .th~ employer, you ~ust comply with the following: . " . ..... . . '. \. .., . . . "f . 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, calf the Department of Rever me at 503~378-4988. ' . Unemployment Insurance Tax: As an employer, you are required to pay a tax fot u:O:c.111ployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. - . I" ~ . , 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/fonnsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mu~t obtain w~rkers' compensation,insura!!ce 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 empl.oyees 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 theirweb site at Wv,.w.irS,l!0v., . . , Other Responsibiliiies ;t~d Areas' of Concerns Code 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. ". '. ,) . . "." .,1 ",.;. . ",- '. .. Liability and Property Damage Insurance: . ContaCt: yo~r irisllrance 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: Make sure you 'have sufficienttirne to supervise your employees. Expertise; Make sure you ii~ve'th~ skills to ~dt' as' y6ur' owrt 'g~ne~al contractoi, t6 c'oordinate 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 Spripgfield, Oregon 97477 541-726-3759 Phone ~ity of Springfield Official Receipt l';:velopment Services Department " Public Works Department RECEIPT #: 3200500000000000560 Date: 09/15/2005 11:50:07AM Job/Journal Number COM2005-01252 COM2005-01252 COM2005-0 1252 .: COM2005-01252 Description Temp Power 200 amps or less Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge Payments: Type of Payment Paid By CreditCard ROBERT W. GREEN ,,' Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 033762 033762 In Person Payment Total: Amount Due 50.00 6.00 5.60 3.92 $65.52 Amount Paid $65.52 $65.52 ( ;1 .. , - , . ~ '. .,..j" 9/1 5/2005 Page 1 of 1