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Home My WebLink AboutPermit Electrical 2005-10-25 " ;'(,ilowmg project ~~ PjS .th~lowing """., and does no~lxrft~~&Wf:id~use :\i""'iZ~"t:tJ "'.., . nino n 1.aL(?&a2-u1~' i;i~~G~1t ..........., 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726~3689 ELECTRICAL PERMIT APPLICATION~".~' City Job Number CO\,,-r., 7.-O~::;-O~--:':.."2.":l Date IO-'A5-OS I V\ \:) \ tI\. t/I'/\c; new u '(' c..ud- I Permits are non-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or $5000 Suspended for 180 days. *" Feeder . 2. CONTRACTOR INSTALLA110N ONLY,~ ~~~'\ Services or Feeders -Installation, Alterations or Relocation: ~ ,\'\'~ '\-;) Electrical Contractor .9-~ ~,Q.,~ <<..\j<(:.200 Amps or less $ 63.00 x,{3."s <:<.'(.,'~v.,<V 201 Amps to 400 Amps $ 75.00 . 't-..\"\" a '\~ ~~\S 40 I Amps to 600 Amps $125.00 X" ~' ~~. 'S;:, ~ C;) ~\j s ~ 601 Amps to 1000 Amps $163.00 :({'~ ...~~ \) \j<:(.. '\ ,~~. Over 1000 AmpsNolt('-O. $375.00 \:~t;J ~ '< v ~'\; '<:<..~ ~v.,'(' - Reconnect Only -f~'j~~\ ~~ $ 50.00 '\~ '::0,\y:-~~~\J <v~ ~!(<:.~l?J~.'r{\,.:o\[;,\05'.f:j~:-l Supervisor License Num~r\)~ ,,<o~ c. TempOJ;a.r.y ,s~r-vil:~s % jEeegfl'9 '-.) ~ 'I 't(:: .,.'2;"0.1 _~:; ~... ,,~~;J ~~. ?) "'?-~ ,/'" ",' .,~:, r:,'"?" 0'-';,0'-" (, Expiration Date Ins~aHation,Ane.~~~()n''9J'l~Joc~~'n . ~_' . r/~~ .~, r;',J ,-.,~.Jj _ 0' ~._r;\-'~<f/> . 2~0.Amps,0~~~~ss f/''-.' .:\? "~~i'P $ 50.00 ,201 Kmi?~,~o ~Q9-JAmps,,;:\" ,'l~' $ 69.00 40 f- An1P~. t(j~'600*~p.~ "~'; ;C:J'" $100.00 '" .'~ ,C'~ I"',',. ......,....'0...' r:' :J'I'" Over 600 Amps Qr1009~Volts see "B" above. . ., D. Branch Circ~it-s . 1. LOCATION OF INSTALLATION )bo tU. H- s\. LEGAL DESCRIPTION ~l O~ .-~~ ~~ O~~Oc) JOB DESCRIPTION Address City Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name\(e.loe(C.CA L~C\. rc. k Address d--IoO LA.) Ii sr City ~r,~.c;eld Phone ,3b-3Q<?1 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. 311:;", VW1 ~ VWbAc I " :-. - ~ Inspection Request: 726-3769 3. COMPLETE FEE SCHEDULE BELOl1l A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof . .. _..l.._:..",., h"s: tl$lOl.l!OOing -....rj use $ 19.00 New Alteration or Extension Per Panel One Circuit x: Each Additional Circuit or with Service or Feeder Penn it $ 43.00 $ 3.00 L( 5 . CO E. l\liscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OF ABOVE Y 3 lei) (t\~) .6;\ 3.01 <~.lt", y,?JO .~\S,(') SO.? / 5'Z.bS' 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/ElectI;cal Pennit Application I-D3.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01329 ISSUED: 10/24/2005 APPLIED: 09/2812005 EXPIRES: 04/24/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 260 W H ST ASSESSOR'S PARCEL NO.: 1703341104900 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install new furnace Phone Number: 541-736-3981 Owner: REBECCA LAMARCHE Address: 260 W H ST SPRINGFIELD OR 97477 I CONT~~OR INFORMATION I ~ S) '. Contractor '\~<v ~ ~ License OWNER ~ ~c.~"-- ' ~~ ASSOCIATED~~~~~IR CONDITIO 106275 . ~~\.,\., ~ '\~~LDING INFORMATION' , ~. ~ s ~<v~ ~ # of Units: " ,\.fV"Y9:..~ ~ '0 ~ {:> ~'\). # of Stories: '\.0 Lot Size: Primary occupan~~~~ ~'\.~ x,W~<V~ Height of Structure ~o\;> #"~ \\,Sq Ft 1st Floor: Secondary Occupan~~ ~\J ~ ~ Type of Heat: . ~e~ ~..;s \0/$ ~q Ft 2nd Floor: Primary Construction ~'e~~~ ~ <;J~N Water Type: eo...;y. e~O ~e'\.a,:<)~t Basement: Secondary Construction '6P~ ,~ Range Type: ,,'b-~ ~ e O~ s ~~ <?>~ ~e'8~t Garage/Carport # of Bedrooms: ~ Energy Path: ,,0'" A >is' ,~e O~ \\,e ~ ~\$(~t,\Other: Sprinkled ~q.uding? o~e -,0.q; n/;) ~ V.e~ .~tt)ipant Load: ,. ,,'\."'..('<." ,0 ',r's _ ~ _,,~'1 ~,- AV..o ",". ..,,, .",- ~...... I DEVELO~lYIE~;r'IN.@?)~A,1OO~b~'\ rJx~' ~..(,..v ,0' ~ v- l0'\'~ ~'\.()o. ~ ~ a,:'(; \>': ,o~ ~ (')5::5 ~,o e" ~o f}:)'?J Q.~e~~~y>ujJJ~' ~'b-"" 0<0~ O,e <;o\::)C0r # ,~trht.j"reWRl1dP ,^0 r_ '\' "". l'\l " -~ ~. ',J Pav~,d~~i;vt~qd~\O' ~0' % of IJ<(it g6~$Jlge,u0" ",..:s Contractor Type Electrical Mechanical Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Expiration Date Phone 08/31/2006 541-683-2590 REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: Pae:e 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Type of Construction Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Furnace - up to 100,000 btu Minimum/Adjustment Mechanical + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Total Amount Paid CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01329 ISSUED: 10/2412005 APPLIED: 09/28/2005 EXPIRES: 04/24/2006 VALUE: I Valuation Descriution ~ $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Amount Paid Date Paid Receipt Number $10.00 10/1 0/05 2200500000000001406 $4.50 10/10/05 2200500000000001406 $3.15 10/10/05 2200500000000001406 $12.00 10/1 0/05 2200500000000001406 $33.00 10/10/05 2200500000000001406 $4.50 10/24/05 2200500000000001485 $3.15 10/24/05 2200500000000001485 $43.00 10/24/05 2200500000000001485 $2.00 10/24/05 2200500000000001485 $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 I 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. Paee 2 of3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-01329 ISSUED: 10/24/2005 APPLIED: 09/28/2005 EXPIRES: 04/24/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. \\J~o-, -?WlbAL- lb- :J4c~ Owner or Contractors Signature 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 #: COt4~, nS --0 l'3 L 9 Address: '7-<CO W" tA <S;.\: , 'Issued by:' .J~?' Date: \.0 r- 'Z...<\- ....oS statement:'lnformation Noti.ce 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 ORS701.010(7), need not.sui?mit this statement. This statement will befi(ed with the permit. , , . Fill in the appropriate blames and'initial boxes 1 and 2, and eitl}er box 3A or 3B: (ID,: 1 '4/:' .. tf2. 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. o 3A. My general contract()r is (Name) , (CCB #) I will instruct my general contractor that all sub~on~actors who work on, the structure rimst be licensed with the Construction ContI:actors Board. . , . 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. .~91 +~rU lo~)\ -O~ (Signature of permit applicant) (Date) (White copy' to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 ActiIig"~s ~-'\<<?ur (~wnGeneral.Contractor? I . ~' .~) '_ . _ . _.. .", . _ ~ _. '~'",; ~ ~ _ " _ . .., " .' INfORMATION NOTICE: TO :PROPERTY OWNERS " '" . . ABOUT CONSTRUCTION RESPONSIBILITIES . ,. 'h~ fNO;~~-;hi~ Information Notice to Property Owners about Construction Resp~n~ib;liii;;; was deve/ope-;;b;;~~'t L~onstruction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Lf;gislature. . -<; ~ -\. -' . " If you are acting as your own contractQr to construct a new home or make a'substantial improvement to an existing structure, you can prevent many problems'6fbeing:aware of the foI1owingresponsibilities and concerns. Employer Respo~sibUities . . . . . You will; most instances,: be IVIed to bean '~employer" and the contractors you contract with will be "employees" if you.use' con,tractors not lice~sed with thc'Con,struction Contractors Board to. do labor in constructing or to ~ssist in the construction or improvement '~f a~esi4~tia1.structure. A~, ~~e ~~p~~;yc:r, you comply wit~ the following: Oregon's Tax Law: As an employer, you must ~ithhold income 'taxes frortt ~mployee ~ages at 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, can the Departmertt of Revenue at 503m3784988.. ,< Unemployment Insurance Tax: As an employer~'you are required to'pay a tax forurtemployment purposes on wages of employees. For more information, call the Oregon Employment Department at 50l..947-1488~ The Business Identification (BIN) a combined number. for, both Oregon Withholding ( . . . . . Unemployment Insurance Tax. To file for a BIN, call' 503-945-8091 or www.dor.state.or.us/fonnsnav.htmlt for appropriate forms. Workers'Co~pensation Insurance: As an employ~r: ~ci~'a~e subject to the Oregon Workers' Compensation Law, and must.obl:a;.in workers' comp(;nsation i~surance for :;:our emp1l?yees. . you fail to obtain workers' compensation insurance, YOlf touldbe' subject to 'penalties and be liabie fOr ;111' clrtim'costs if one of your' employees is injured on the job. For more in:fonnation, call Workers' Compen~ation 'DIvision; . the Depmtment of Consumer and Business Services at 503-947-7815. Internal Revenue You for the tax IRS at 1.:800-8294933 or As an employer, you must with~oId' federal tax even didn't actually withhold tax. For a their web site atwivw.irs.l!ov., wages. .> and. project~ you are for any ;,," coverage accidents and omissions such as that must , to see if over spray, water or ..I.. sure you have to your employee~; . ">. .' . ..' ;'j . L.. and 1) or agency at PO j, ,;.. ".. . ..";' '~';, 06~O 1-04 225 Fifth Street Springfield, Oregon 97477 , 541-726-3759 Phone iiirF4'i r<{ty of Springfield Official Receipt ~velopment Services Department Public Works Department RECEIpT #: 2200500000000001485 Date: 10/24/2005 1l:17:24AM Job/Journal Number COM2005-0 1329 COM2005-0 1329 COM2005-0 1329 COM2005-0 1329 Description Add, Alter, Extend Circ Minimum! Adjustment Electrical + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By CreditCard REBECCA LAMARCHE Item Total: Check Number Authorization Received By Batch Number Number How Received Jmp 171198 In Person Payment Total: Amount Due 43.00 2.00 3.15 4.50 $52.65 Amount Paid $52.65 $52.65 "I' :f '.)~ 10/24/2005 Page 1 of 1