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Home My WebLink AboutPermit Electrical 2003-9-24 , lY J9Uqlo/W 1.}f!(j~ct as submitted has the following 225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · F~br~Th1lJcfrftYab'#s~not require specific land use ELECTRICAL PERMIT APPLICATION / -"'" approval." Cb~ City Job Number WW\ Wo'.] --009 82 Date -1;Idj!0-5 I"ate, Zonmg O(-7ft)-O'::) 1. LOCA110N OFINSTALLA.TiON, 3.gClM.PLEl'E FE!}~~,~I;[lIJlJJMful}hLOl1f eJ<IA"j, zGL/ r: ~ ':> 1- "W7""--',_ ''._.. ,'" .'_ '7..\ C. ,.' T~ll}l>orarY~~l"vk~s o6~'{reers \%~eS i ~X\\~ Installation~t4~W ~~Hon 20~~~ \~r'lleS8 ~~,~; ~;,~~f) '0;0 \O~1~1.~ni~~~~<1~j\~ rc 1:.tJJSJ \ /\2..~'\ r~: ~ij't1 '1:~~600i\~ -, ~~~@ :~ \ ..' ,,'J,\JJfJ f2>.-t,,,~~W~0\ '\,'t * .' "''?\~!J~\i . \\:1\1 \l ~ $j~ \J1f, - 1.1::-1-' !"-v'~\'~,-{J' .- )).0; . r~~" '\, (' .~ tor 1(1: ~v 1- 1'4~1\\~; _ " ~ ~ ,,,'is''''-'''.' " (}0jf. "'v ~'(?~ ., or NJ'U> \ ';J@'"<J''''{; 51 ~ " ~'" ,~ ens ion Per Panel o l:I c~\\\\\~~'\~"l'~ ,\~r)' I ~\t>eEm-d\~~d" 1 C" .th '0$'II ~)'.N\u ItlOna IrcUlt or WI Service or Feeder Permit LEGAL DESCRIPTION i703Z-S' ~Y JOB DESCRIPTION oz~oO A~b .:i- C(~,~ 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. CONTRACTOR INSTALLATION ONLY ..e.->. :..:....:. ,,; ,'< ~", '~>~ '>.-'+a.';;"A m "'~""< Electrical Contractor Address City Phone f6fy Supervisor License Number ,J j' D Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name ~jj (J t,., Address d-6 4€ J City ~/~held ;JtA-W ~ J~ Phone ~lfl- 9 /4-1~18 '. ,.,1 OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. rnturej 1/ (/?f./ Inspection Request: 726-3769 '.Jk.6., ,""';';"', .,-"':' " _ :::,';',_", A.New Residential,:- Sin~le()r lVlulti-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 "'-'-' - .,....... - . < ......... ,',.,. ^ B.CServi~esorFeede~s ~,lnstanation, Alterations or Relocation: E.':'ki~,;,;,.< _'<',/~-:" - .,;,dZl-h'A :.,~,.. 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 $ 63.00 $ 75.00 $125.00 $163.00 $375,00 $ 50.00 $ 50.00 $ 69,00 $100.00 $ 43,00 $ 3.00 L{3 E.1Vlisc~iianeo~~'(Serv~~./fe,e, d~t,.n~~ded)-Each Installation "., ".......,'."", ,."..,,\~\t \r';'\\~;P~Q\'.. .\~"eP 0' ~~ t"'~ '" ?t.\\~\\\ -()? $ 50.00 , ,e '~tIf~Udi~\~fl.n'k~\ ,~\)a~\:.\) 'r $ 50,00 \V\\SWnmeif~~1v1R~i~~al $ 25,00 .. \ \\.~\\)\ \' , cD \Ji\ . lW T\.iWli!~~r;;:.dIDAQ.~~rcial $ 45.00 CG:;\l\\'! \j\}.' "p.....-. .---.. MinimIi\ 'iWecfric Permit Inspection Fee i~+ Surcharges 1\' , "'..".. ,.... ".;C'" . 4.:'sVBTOTALOFABOVE P-f ) 7% State Surcharge '3/) Ii )-U 10% Administrative Fee -, TOTAL ~Z~ Shared DIive(T: )/Building FonTIsfElectrical Pennit Application 1-03.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00982 ISSUED: 09/29/2003 APPLIED: 09/29/2003 EXPIRES: 03/29/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2648 J ST ASSESSOR'S PARCEL NO.: 1703254402800 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install gas furnace Owner: JOSHUA HAWK Address: 2648 J ST SPRINGFIELD OR 97477 Phone Number: 541-914-2218 I CONTRACTOR INFORMATION' Contractor Type Electrical Mechanical Contractor OWNER OWNER License Expiration Date Phone VN ~~v I BUILDING INFORMATIONJ<eS ,!O ~\X\\'! ~eO: CdO(\ ~\O(\ # of Stories: 0(\ \e.~ e O~0 :(e Se\ ."Mlt Size: Heigh\t~~U'J \~ ~\}\aS ~ gC5'2:Si ~t 1st Floor: .....UP\O)!1~~\0 ~"oS0 1{\ 0 ~a ~U\~alt 2nd Floor: , ~"\'rt\v~ ~et. 0 \"~O\}~es 0' ~ ~e9"~~ 5~asement: \o\\o,*ans~ ~ >f{j.JJO\ . ~ CO'Q . \'(\0 \0 ~\\\~' it Garage/Carport O\\~~~;vt~Yh: 0'0\9-\ ~o\e.~\\\'I ~Ol\\ Sq Ft Other: ~ O~~~I ~ ~9-'J e(\\et'_t\O(\ ~ rl:~~1\ Impervious Surface Area: , C'... 0 ..0 0 ,..,.fW'!!J c 1),.'2; ~-~.' ,~~ ~ J'h~' I DEVE - . i,ll\l'l~y~A:TlON I (\uf.'\ Ge~''''' Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: REQUIRED PARKING # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: ~Q~~ \r \\\t. ~Q\ , . u _ _ ~ I :'i~W\t. t..\\~ 1\\\ \S PUBL~~P { E~' \\\\S r Q~t.\) rG~ \~~\~O~\l~ n 0\\ \S ~"~~~walk Type: f:>..\J' q~Ct:v n\Q\). , CQ~W\\.. \)f:>..'{ 'rt.\-l DownspoutslDrains: f:>..~'{ '\ lQQ % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paj!e 1 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00982 ISSUED: 09/29/2003 APPLIED: 09/2912003 EXPIRES: 03/29/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $10.00 9/29/03 1200200000000002226 + 10% Administrative Fee $9.00 9/29/03 1200200000000002226 + 7% State Surcharge $6.30 9/29/03 1200200000000002226 Add, Alter, Extend Circ $43.00 9/29/03 1200200000000002226 Appliance Vent $6.00 9/29/03 1200200000000002226 Furnace - up to 100,000 btu $12.00 ' 9/29/03 1200200000000002226 Gas Outlets 1-4 $4.00 9/29/03 1200200000000002226 Minimum/Adjustment Electrical $2.00 9/29/03 1200200000000002226 Minimum/ Adj ustment Mechanical $23.00 9/29/03 1200200000000002226 Total Amount Paid $115.30 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. ! lJeouiredJnsnections . 1 Gas 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. . 2 Rough Mechanical: Prior to Cover 3 Final Me,chanical: When all mechanical work is complete. 4 Rough Electric: Prior to Cover 5 Final Electric: When all electrical work is complete. Pa2e 2 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2003-00982 ISSUED: 09/29/2003 APPLIED: 09/29/2003 EXPIRES: 03/29/2004 VALUE: 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 6mc(ux~ cr~if~ '5 ~ . Owner or Contractors Signature Pal?;e 3 of 3 '/ Date . . I Constru~tion 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 #: CoW' ZC>~ / -c.1O c;crZ S 5+ Zb'-( y- --p~ Date: 9 -27-03 Address: IssJ.led by: Statement: ,1~formationNotice 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 requiredfor 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 wiUbe filed with thepermit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or3B: ~1. ~2. I own, reside ill; 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 ,~B. I will be myown general contractor. If I 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. . j ,I hereby'certifythat the 'above 'Information is correct and that Thave read and do understand the Information No~ope~' Owneryabout Construction Responsibilities on the reverse side of this fo~m./ ~ ~/-L-, , . ~k;2q/03 V (i~a;ure of permit applicant) , ,.' / (Date) , ' (White copy, to issuing agency permit file, pink f;OPY'~O applicant.) Property_owner. doc 03/11/03 '. ) Acting as Y our 'Own General Contractor?' , , INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction ContractorsBoard in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct anew home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employe,r 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 or improvement of a residential structure. As, the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you mus~ wit~hold 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 a State Business ID number, call the Busine~s ~f?~ationCenter 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' Compensation Law, and must obtain workers' compensation insur~nce for your empJoyees. ,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. .~ther Responsibilities~nd: Areas of Concer~s Code Compliance: As thepennit holder for this project; you are responsible for resolving ~ny 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: Make, sure you have ~~fficient time ,to supervise y()llJ:, ~mp}oy~es. Expertise: Make sure you have the skills to act as your own general co~tractor, to coordi~ate the work of rough-in and finish trades, and to notify building officials.as the'approphate 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 Sireet Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 COM2003-00982 Payments: Type of Payment Check Receipt #: 1200200000000002226 Description Furnace - up to 100,000 btu Appliance Vent Gas Outlets 1-4 Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend Circ Minimum! Adjustment Electrical + 7% State Surcharge + 10% Administrative Fee Received By djb Check Number Batch Number Authorization Number Paid By JOSHUA HAWK 000181 003247 City of Springfield Official Receipt Development Services Department Public Works Department Date: 09/29/2003 2:30:08PM . Amount Paid 12.00 6.00 4.00 23.00 10.00 43.00 2.00 6.30 9.00 $115.30 Item Total: How Received In Person Payment Total: Amount Paid $115.30 $115.30