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Home My WebLink AboutPermit Electrical 2006-12-12 ZON LD~ INITIALS NM DATE Idll?/O<47. SOURCE rYYllps p2-J~~ \ 7.,/11-/ 'LdJ6 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 . ELECTRICAL PERMIT APPLICATION City Job Number COIA/1 2006-0 159/ Date Over 600 Amps or 1000 Volts see "B" above. D. ' Branch Circuits N ~.c ..",L.. ..,," dJ CNBf'Alteration or Extension Per Panel THIS~~p;.it \ $ 43.00 Cf :J AUTHficy~''t!ddit$MALq:~,..or with b '-:> / I COMM~eUlJe@rlJNrJrFfMMIRE IF Tit 1, $ 3.00 '(--=d//Ao1h~ ENCED 0 " THIS PERRA," t l1'ORK .5.f- A NY F1J 9 M,lf~W'~6Ss4~Nr1B",~~(f~r' 'ldlS'Nt'Jted) -Each Installation ERlOD /YED FOR Phone 7Cfb ~51 (;, Z Pump or irrigation' $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~SUBTOTAL?l!~~?VE'" l.{ 7 8% State Surcharge "> ~, 10% Administrative Fee 4 c;:e..> 5% Technology Fee 2.4)' 1. LOCATION OF INSTALLATION: \ q l.{ S H. <.;t LEGAL DESCRIPTION: /7 ()S 3' 61 z... 044<J a JOB DESCRIPTION: AdJ..~~ c;rclAi-\-s tor \-\vAc >yskt11 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' Electrical Contractor Address City Phone Sop,,,;,o, U"o" Numbe, .J ~ Y Expiration Date 0 / Con"'. Cootr. Nom"'" / Expiration Date / Signature of Supervising Electrician Owners Name" r c::vV<\.... If Address 194~- S?;:~ City OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners ~ature.:. ......-; " ~ - ~\ (-JjvJ Inspection Request: 726-3769 3. CO.MPLETE FEE SCHEDULE BELOW A. i New Residential- Single or Multi-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. Services or Feeders -Installation, Alterations or Relocation: / 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 6.dt~~.Jtt:>It9P'p' Amps $163.00 NlR.YPi41<6CD1_~W8bl90'lldW fF~qU/(: $375.00 ,~ygffim~fi~m ad by the Or. 6~ Yf$I$(/jC9l0 ~~~~l e'~~=~U:~t calfOn@ ~hlS un COPDtaiS if! ~A 952-001 'l41/iib!hl~r~~i~i~o~~IWjg~oW"D~ rUles ~ 200 A~iWEJF~sOr~fJon Utility AJ.~/~?hOYie5'(J.oo 201 Amps to 400 lriYJo-332_234~'4'l'icati$1i9.00 401 Amps to 600 Amps . $100.00 TOTAL to 7J- Shared Dnve(T:)/Building Forms/Electrical Pennit Application 8-06.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1945 H ST ASSESSOR'S PARCEL NO.: 1703361204400 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01591 ISSUED: 12/12/2006 APPLIED: 12/12/2006 EXPIRES: 06/12/2007 VALUE: Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install hvac system I BUILDING INFORMfF~' ~ ~;;.O ~. # of Stories: ~ ~ ~~ ~~. ~ Lot Size: R-3 Height of Stru~u~ ~& ~Q ~\SI ~ Sq Ft 1st Floor: Type ofHe~ ~~. ~ r:e ~a c;il~'O Sq Ft 2nd Floor: VB Water Type: ~6e::! ~~ c:;. ~ CV &~ ~ ~q Ft Basement: Range Type: ()~'O ~& ~ 7~ &~ ~~~t Garage/Carport A'.. Energy Path: <i>.., ~~ 0&.., ~~ V-o ~ ~~J. Other: /: "'0\ Sprinkled Buildir?~.&Q~ ~ ~ Od'C9<!tu1i3,.t Load: .. 0.-, ".# /^ A' _ ^ ~ ;4 " S'l, '0 '~~J>~~itOPMENT INFORM~~\ ~&. ~ V~\SI e~.~U' ~~,~ '-4. ~:\ ~:~\S'o ~~'& ~~QJJIREDPARKING ?~ 8 '''l'A 't? ~. & ~ ~ \2 ~~ ~, ~ ~ ~ YlverlayDist: ~~~~'&~~C9 ~)~~:c o ~ ~~eetTreesRqd: ~o~.~~~~~~capped: ~..t-..o ~ _'~~ Drive Rqd: ~ ~ o~ &\SI ~ofupact: ~ -(f>Ol<<60;~.l>coverage: ~~o & ~$ ~~~r~ " IPUBLIC~~~~ENTSI ~ ~ ~ Sidewalk Type: Y'~ ~ 70 ~ ~ ~ Downspouts/Drains: /' Owner: TREVOR ROLLMAN Address: 1945 H ST SPRINGFIELD OR 97477 Contractor Type Electrical Mechanical Contractor OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Phone Number: 541-746-5168 I CONTRACTOR INFORMATION I License Expiration Date Phone Pal!: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 Tvpe of Construction Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Appliance Vent Boiler/Comp Up To 100,000 btu Furnace - up to 100,000 btu Gas Outlets 1-4 Minimum/Adjustment Mechanical Total Amount Paid CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2006-01591 ISSUED: 12/12/2006 APPLIED: 12/12/2006 EXPIRES: 06/12/2007 VALUE: I Valuation Description I $ 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 $9.40 $4.70 $7.52 $43.00 $6.00 $6.00 $12.00 $12.00 $4.00 $11.00 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 12/12/06 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 2200600000000001687 $125.62 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. ~eouire<U'nsnections . 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. 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. Pa2e 2 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01591 ISSUED: 12/12/2006 APPLIED: 12/12/2006 EXPIRES: 06/12/2007 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~ 11., 117-/06 . . Owner or Contractors Signature Date Pa2e 3 of3 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 #: UJM 20'0 ..::>. - 0/ ')9 / .S+- /9L( S- Jf -:J::>~ Date: /Z/;z.-/OG I Address: Issued by: 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 perinit 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: ~-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 ins1:rl;lct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR -(" 3B. I ~i11 be my own general contractor. , If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, lwill 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 Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~(2A- --. t'l-/tt/t>(, (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property- owner. doc 06-01-04 A~!nID1g ~~ "')t @~rt._OWinr GelllleJr.~1 ~~)nTI~t:rj!ctor;? " . '. J ,. t ' , '. .. ~ . ,_ ." - INFORMATioN NOTICE TO.PROPERTY oWNERS ' .' ." ABO~T. CONSTRlUCTION, RESPONSIBIliTIES _~_ .~ ~ 'I , "~ .. i . '. .~ \ .. , NOTE: This Information Notice to Property Owners about Construction Responsibiiities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legis/ature. 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 be~ng aware of the folloWing responsibiliJies and concerns. Employer Respoll1lsibilities . " . . '. .'.. " .. You will; in most,in~tances, be ruleq to be an '~employer" a,nd the contractors you contract with.will1;>e"employees" if , you use contract~rs not licensed witl~ -the Construction Contractors Board to do labor in c~mstructingor toa~~ist in the construction or improvement of. a resi4ential structure. As the .e)Mp'loyell", you must comp~y with the foRlowi~g: - .' . ~ ,\..... . - . Oll"egolll'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'Reverllie at 503.:378-4988. . ' . . UnnempBoymelllt XnsuJrall1lce Tax: As an employer, you are required to pay a tax for unemployment insurance purposJ~..- 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 ~ot~ Orego~ Wi~olding and Unemployment Insurance Tax. To file for a BIN, can 503-945-8091 or www.dor.state.or.us/formsnav.htmll. for the appropriate forms. . . Workers' Compensation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law, and must obtain worke~s' compensation insurance.for yo~ 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 emplQyees 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 JRevcnme 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 their web site atw"\l.o-Woirs.lIov. Other llesponsibilities all1ld Area~ of Co~~er]ills 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 attenti~n through inspe,ctions, " Liability and Property Damage IlIlsuJralIlce: Contact yo~r insurance agent to' s~e if you have ad~quate insunmce coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or -{\.\ . work that must be red<:!l~.' , "'... .':". . ":, Time: Make sure you have sufficient time to supervise your employees. . ~ ". .. 1 . , " Expertise: Make sure you have the skills to act as your own generaic'ontiactor, 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 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone C;~' of Springfield Official Receipt 1 .:lopment Services Department Public Works Department Job/Journal Number COM2006-01591 COM2006-01591 COM2006-01591 COM2006-0 1591 COM2006-0 1591 COM2006-01591 COM2006-01591 COM2006-01591 COM2006-0 1591 COM2006-0 1591 COM2006-01591 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Date: 12/12/2006 2200600000000001687 Description Furnace - up to 100,000 btu Boiler/Camp Up To 100,000 btu Appliance Vent Gas Outlets 1-4 Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By TREVOR ROLLMAN Item Total: Check Number Authorization Received By Batch Number Number How Received djb 223047 In Person Payment Total: Page 1 of 1 1:43:42PM Amount Due 12.00 .12.00 6.00 4.00 11.00 10.00 43.00 6.00 4.70 7.52 9.40 $125.62 Amount Paid $125.62 $125.62 12/12/2006