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Home My WebLink AboutPermit Electrical 2006-1-12 '--',.., ',~~~;~\\O\-,:i\'\;J ". ,<\ "'8~ t. 'use 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7r~~b~~.!WSJ~~~':?ec\\\C iiJ,~~.#,>, . ELECTRICAL PERMIT APPLICATION '\\"E')c\\O,~\\~IJ~oeSf\O\le4., · ~ City Job Number Ce>,(:,,~ -z..Oc>S ,- CJ::) \ 35 ,;;,o:'~~~~e t ~ ~~~~,---" 1. LOCATION OF INSTALLATION 3. COMPLEl'Ee.;~E S~EB}fi-~-,.., oatS n\.\lle --'- o Sigl'''' \.!t\"lOliZ8 A. New Residenti~ - Single or Multi-Family per dwelling unit. If.]~' l{ I .) S-t- LEGAL DESCRIPTION ,,"1 D~ '34: ~\ o~ lOa JOB DESCRIPTION :L(~, 1./ Ode 2t2/J ~~ t:.e I 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 INSl'ALLA.TION ONLY -:0~ y...""- ~\)~\J\ . ,<;."\ ,.-( \S <;.~~'<-~~~~~ <';'\J~ ,~fh~~..<;\A\S r-(\~ ~,'?'v ~ \. ~v- \~~. ..t..\\ CO ~\)~ ~~~ ~~~ (,;,,~~' ~'0 ~,S . Supervisor ~'(~&~~~\) ~ r.~\J\) ~\~ &,~\J ~ ,<V' Expiration Da~~\\~~ o..\) \)'If. \r ;:\ ,- ~~ Constr. Contr. Number Electrical Contractor Address City Expiration Date Signature of Supervising Electrician AP' / I Owners Name .~_eL/'/ {.iAMWI' '11'.\ ( I ..-<' J Address 'J () (' Lv J <; +- r . (', / / L J / City ::>P/tvl~ f.f(11I Phone 7'77-~()39 I OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Q;:;~ ~-~- Inspection Request: 726-3769 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. 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 AmpsNolts Reconnect Only ~ 6' ?, () Q $ 63.00 $ 75,00 $125,00 $163.00 $375.00 $ 50.00 C. Temporary Services.orFeeders ",.'. ' Installation, Alteration or RelQ..cation , ", ,\ 200 Amps or less )' - ' 201 Amps to 400 Amps' .' .40'1 Amps to 600 Amps ,.' ,: ,," $ 50.00 $ 69.00 $100.00 r . ,,' "" Over 600 Amps orlOOOVoltssee."B" above. J? Bra~ch Circuits . ' . New Alteration or EX,tension Per Panel One Circuit ' , ,Each Additiona:I Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. l\-liscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OF ABOVE f.9 ~ ,O() :; ,0 c.... Co.~o 74:-,;"'~ ~ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/Elecuical Penn it Application I-03,doc 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: COM2005-00135 ISSUED: 01112/2006 APPLIED: 02/02/2005 EXPIRES: 07/12/2006 VALUE: $ 9,775.00 . SITE ADDRESS: 205 W J ST ASSESSOR'S PARCEL NO.: 1703341103100 I CONTRACTOR INFORMATION I Contractor ~\,)~~\ License OWNER \~Y..- ~\,) OWNER S:. ~ ~\ \'0 ~ OWNER Y..-~\~ ~Y..-~~Y..-\) ~\S ; OW:~~ \~ ".\\)\S ~\f\;)"\\~~~~ ';'\)~'0\S ~,<>\" I BUILDING INFORMAllUN I \' ~S ~ ~'LX; \) \,)~ ~\)\). , # of Units: \'0 :\~\) ~c,x; ~ ~Y..-~ , Primary OccupaJroe~ ~~IN\ \)'f. U Secondary Occup~~~M6p: , Primary Constructidh~ype VN Secondary Construction Type: " # of Bedrooms: PROJECT DESCRIPTION: Garage - Owner: TERRY CUMMINGS .. Address: 39157 EASTON LN SPRINGFIELD OR 97478 Contractor Type General Electrical Mechanical Plumbing Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 ," 9.00 0.00 Street Improvements: . Storm Sewer Available: , Special Instruction: Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential Phone Number: 541-747-5639 Expiration Date Phone # of Stories: \.0 Lot Size: Height of Structure "IO\). .-,:~,\ Sq Ft 1st Floor: s') ,'~'\ '$' Type of Heat: ~,,\e 0<0 v K. \o{. ,,~q Ft 2nd Floor: Water Type: ~ {.e~{.e~ ~e se :l;\J\J ~~ Ft Basement: Range Type: 'f:' \'0- '\('e es'O- <;0 C!J~ 0,esSq Ft Garage/Carport Energy PA~bt;)P c\ "0'\ e {.~ O"r"':0e {.v- oSq Ft Other: Spri~ltt~i1l1i~gP<:i o$.'f' d'l~a ~e'<: ,S).C'6.pant Load: "d..)'\ - ,,?S 1 ,Y\{.$:>,S ^ \.e ;.\\V I DEY-EU<;~MENJ'uiNi<JciRmTi@N:~:\ ~~~. . ~u' ~v' },)'-' 0'$' ~ v ,'l,":> \0 .;~\v'O- C!J'J'7; 0-'\ ~e{.' Q:,00 ~'O'7; ~0\er.l'a~ Dim ve'-" O{.e o.\)\Y I l' "V' ,y\'e "e \.,v '#IStl\eet Trees Rqd: ,c- o ()~- . <'.'9 ~O' :\. (J Paved.,Driv\_e.R:gd:~e: v. ~_)- ('<Jc" % of Lot,Coverage: \.'~. 391 REQUIRED PARKING Yes 11.50 Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: Fully Improved Yes Curbside 5' Curb and Gutter - , Notes: Storm drainage tied into existing system (curb face) Paee 1 of3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00135 ISSUED: 01112/2006 APPLIED: . 02/02/2005 EXPIRES: 07/12/2006 VALUE: $ 9,775.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax :,541-726-3769 Inspection Line I Valuation Descriotion I Garaee TVJ}e of Construction Garaee $ Per Sq Ft or multiplier $25.00 Square Footage or Bid Amount 391.00 Value Date Calculated Description Total Value of Project $9,775.00 $9,775.00 02/02/2005 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential ' $69.81 2/2/05 1200500000000000136 + 10% Administrative Fee $15.24 3/2/05 3200500000000000078 + 7% State Surcharge $10.67 3/2/05 3200500000000000078 Garage/Carport $107.40 3/2/05 3200500000000000078 , Plan Review Minor - Planning $59.00 3/2/05 3200500000000000078 I" SDC Sanitary/Storm Admin $10.71 3/2/05 3200500000000000078 Storm Drainage Impervious Area $214.21 3/2/05 3200500000000000078 Storm Sewer - 1st 50 Feet $45.00 3/2/05 3200500000000000078 -Mechanical Issuance Fee- $10.00 3/14/05 2200500000000000289 + 10% Administrative Fee $8.70 , 3/14/05 2200500000000000289 + 7% State Surcharge $6.09 3/14/05 2200500000000000289 Dryer Vent $6.00 3/14/05 2200500000000000289 Fixture' $42.00 ' 3/14/05 2200500000000000289 Minimum/Adjustment Mechanical $33.00 3/14/05 2200500000000000289 Vent Fan $6.00 3/14/05 2200500000000000289 + 10% Administrative Fee $6.30 1/12/06 2200600000000000054 + 8% State Surcharge $5.04 1/12/06 2200600000000000054 Perm Serv/Fdr 200 amps or less $63.00 1/12/06 2200600000000000054 Total Amount Paid $718.17 I Plan Reviews , w, Initial Review 02/03/2005 02/03/2005 APP SKG Plannine Review 02/03/2005 02/23/2005 APP TAJ Public Works Review 02/03/2005 02/04/2005 APP CAS Storm drainage piped to curb face 2/4/2005 CAS Structural Review 02/03/2005 03/01/2005 APP DLM See documents for Plan Review comments 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. Paee 2 of3 If: ~ J: CITY OF SPRINGFIELD,' Building/Combination Permit PERMIT NO: COM2005-00135 ISSUED: 01/12/2006 . APPLIED: 02/02/2005 EXPIRES: '07/12/2006 VALUE: $ 9,775.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Reauired InsoeCtions I :Foundation: After forms are erected but prior to concrete placement. . Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Storm Sewer Line: Prior to mling trench. Underslab Plumbing: Prior to filling the trench and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Undertloor Mechanical. Prior to insulation or decking and including required testing. , 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, that each address is readable from the street, t7at e permit card is located at the front of the property, and the approved set of plans will remain on the site at all times duro construction. I?e.. ,/:,7 ~ . /_ 12 - oJ' . Owne~ ~r Contr~cto:S SignatP - Date Pal!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 #: a:>~~S-~ \.~S z.6S W, ~ ~I .j~~ Date: \ - \ '2...- 0 b Address: Issued by: Statement: Informati9n 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. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: Itt-' 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 flh 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 ofthe name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information , Notic e to Property Olwne, rs about Construction Responsibilities on the reverse side ofthis form~ /I ~ " ~ ~zJ ~ ~ ___________ H"Z-- Db -- ~ (Sign~ure of permit applicant) '(Date) (White copy to issuing agency permit file, pink copy to applicant.) , ' Property- owner. doc 06-01-04 Acting as "\ our Own GeneratContract.or?: ,INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . :l~. , 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 YDU are acting as YDur Dwn c(mtractDr to' CDnstruct a new hDme Dr make a substantial improvement to an existing structure, YDU can prevent'many problerris by being aware Dfthe.fDllowing respDnsibilities and CDncerns. Employer R~sponsibilities . , -'- Y DU will, in mDst instances, be ruled to' be. an "employer" a,nd the cDntractDrs YDU cDntract wit~ will be "empID):'ees" if YDU use cDntractDrs nDt licensed with the CDnstructiDn CDntractDrs. BDard to' dDlabDr in constructing Dr to' assist in the cDnstructiDn Dr i~prDvement Df a resident~ai structure. ,As th~employer, you must comply' with the ~ollowing: Oregon's Withholding Tax Law: As an emplDyer, YDU must WithhollincDme taxes from emplDyee wages at the time emplDyees are paid. Y DU will be liable fDr the tax payments even if YDU dDn't actually WithhDld the tax frDm YDur emplDyees. FDr mDre infDrmatiDn, call,the Department DfRevenue at 503-378-4988. . Unemployment Insurance Tax: As an emplDyer;YDu are required to' pay a tax fDrW1c,UlpIDyment insurance purpDses Dn the wages Df all emplDyees. FDr mDre infDrmatiDn, call the OregDn EmplDyment Department at 503-947-1488. " The OregDn Business IdentificatiDn Number (BIN) is a cDmbined number fDr bDth, OregDn WithhDldingand UnemplDyment Insurance Tax. TO' file fDr a BIN, call 503-945-8091 Dr WWW.dDr.state.Dr.us/fDrmsoav.htmll fDr the apprDpriate fDrms. Workers' Compensation Insurance: As an emplDyer; YDU m-e subject to' the OregDn WDrkers' CVUlpensatiDn Law, and must Dbtain wDrkers' cDmpensatiDn insurance fDr YDur emplDyees. IfYDU fail to' Dbtain wDrkers' cDmpensatiDn insurance, YDU cDuld'be subject to' penalties and be'liable fDr all claim'cDsts if DneDfyour emplDyees isinjured'Dn the jDb. FDr mDre infDrmatiDn, call the WDrkers' CDmpensatiDn DivisiDn at theDepartm~t of Cansumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an emplDyer, YDU must withhold federal incDme tax fram'etnpIDyees' wages< Yau will be liable fDr the tax payment even ifYDU didn't actually WithhDld the tax. FDr a Federal EIN number, call the IRS at l-800-829-14933ar visit their web site anvvv'W.irs.gDv: , . Other' Responsibilitie~ and Are3:~ of Concerns Code Compliance: As the permit halder fDr this prDject, yau are responsible fDr resalving any failure to: meet code requirements that may be brought to' YDur attentiDn thrDugh inspectiDns. .... . _ ',' '.. . -r ' . .,- . . . _,..: .' h . 'Liability and Property Damage Insurance: C~ntact 'yauf'insurance"agent tD'~ee ifyau have'adequate insurance cDverage far accidents and Dmissians such as falling tools, paint aver spray, water damage fram pipe pW1ctures, fire ar wDrk that must be redane. I 'I Time: Make sure YDU have sufficient time to' supervise YDur emplDyees. ;- .. ~ -:,' . . _" : ... I " ..' - t -.'; \ ,'.. " ", ~. ...... _ . Expertise: Make sure YDU have the skills.tD act as'YDur own geneiarcontractDr, to cDDrdinate thewDrk Dfraugh-in and finish trades, and to' nDtify building Dfficials as the appropriate times sa they can perfDrm the required inspectiDns. Ifyau have additianal questiDns call the Canstructian CantractDrs BDard (503-378-4621) ar write the agency at PO Bax 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 . 225 Fifth Street Springfield, Oregon 97477 . 541-726-3759 Phone \ , ' Job/Journal Number COM2005-00 135 COM2005-00 135 COM2005-00 135 Payments: Type of Payment Check 'i j ".;, ,..: ill' :( j. l; 'f , ;.t 1 (It ;.r ~ f i , si. ,( 1/12/2006 RECEIPT #: Description Perm ServlFdr 200 amps or less + 8% State Surcharge' + 10% Administrative Fee Paid By MARANDA D STACKHOUSE ~LJ,'~~.~,~~~,~ji.,,' '. '" j.... WIlt, "'. ' ~ '. ~ ~. .._--..,.'.-~-l ", _rl, "_'!!f~""~~..-<. ....~..~-,f'.. ....,'! 2200600000000000054 Check Number Received By . Batch Number Jmp Page 1 of 1 ""~ty of Springfield Official Receipt .tvelopment Services Department Public Works Department Date: 01/12/2006 Item Total: Authorization Number How Received 1081 In Person Payment Total: lO:55:40AM Amount Due 63.00 5.04 6.30 $74.34 Amount Paid $74.34 $74.34