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Home My WebLink AboutPermit Correspondence 2006-11-27 (2) NDV-27-2006 10:03 From:AMERICAN EAGLE ELEC 6862275 . . To: 5417263689 P.2/2 ;Ml1crican Eagt~ . 7;'~ EleClric (541) 686-1999 cce 153834 ELECTRICAL CONTRACTORS LLC \\-27-2006 Lisa Hopper City of Springfield Elc:ctrieal P<::mlils 225 Fillh Street Springlield, OR <)7477 Ms Hoppe,r Cast wcek [ pulled a Pt:rrl,iL Ii" u hot tub installation at 3382 Game Farm Road. pennit nU111bcI' COM20060 14R5 whieh the Oaniels were hiring me to do, Thcy have now ucciue,d Lo do the work themselves and will apple li>r their own pemit. So will you please refund American Eagle Fleelrie the 52,89 cost of this pennit. Thank you, Ray May 111 ~a~~ eDio tlu1" 3\Jl~ tfC/o Mt\\ \ (\ " (;Y \CO~O ~ ~~~ 3.lJ) . .:II ~loD AMERICAN EAGLE EIEC. U.C "087 WE~T 11TH, EUGENE OR PH. 686-1~)9 FAX 6B6-2275 .--' , -' CITY OF SPRINGFIELD, OREGON ~ ~ ::,~,V! A!.. DATE III 3OIO(/), ~ SOURCE~. fYS(>2.I.~ Date //-JO - 0 b 225 FIFTII STREET. SPRtNGFIELD. OR 97477 . PII:(54t)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number C.oIN\ ?OO b - D ( S" ( a, I. LOCATION OF INSTALLATION: :3 38 'Z... GMe-t=M.W\ 3. COMPLETE FEE SCHEDULE BELOW LEGAL DESCRIPTION: \ 703 Z.'Z\L A. New Residential- Single or Multi-Family per dwelling unit. DI/CO 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 JOB DESCRIPTION: AJ! C.\"'-C.\.,~+ -P~ M.l..~ $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days, $50.00 2. ~ CONrRACTORINSTALLATIONONLY B. Services or Feeders -Installation, Alterations or Relocation: . " $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50,00 City Phone 200 Amps or less 201 Amps,to,400 Amps t,o., ,.. 401 Amps 10 600 Amps 'r, . 60 I Amps to ,I ~OO Amps Over 1000 AmpsNolts 'Reconnect Only. . !11' Electrical Contractor Address Supervisor License Number ~(~ Expiration Date _ \.1 U '__'_.. ~. ~~..t-.....__."':_ ~ ~.~''''' .~ C. , Temporar'~~ Seryic'~s'orFeeder:s;,~ .. .. - .-. - ._, - .'-_. ..........."""" Constr. Contr, Number Installation, Alteratioibr Relo~atiirr ,- ' 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps $ 50,00 $ 69.00 $100,00 Expiration Date cl!9;/CE: 7ver _600 Amps or 1000 Volts see "B" above, . THIS PERJt:nranch- Circui~..~ ,.,' _. .__ AU TH 0 R I Z ED Ne~~\re, I "'t!(51IlY~- ,rension Per Panel / COM!1EN 61tl!!illr~irHI<: Pc: . THE WORI( $ 43,00 ANY 18 CEOElE/1/~ddi\i~'l~l CirgitlbT~"'OT '- . 0 DAY f> i "r'ttee'il:;\{P,~ 'jy Owners Name _'b:ANf;:" ~M/~1c... ~ijJ~,. _ __''"_. ~OR~ __ Address 331' Z G-,4-u.( E:~ A$1'lJA..-\ E, I Miscellal~"o.~s ,<Se~ce/feeder not inclu~ed) _-EaCh Installation Si>Ph Phone 9gt;- D ~~b l{'] Signature of Supervising Electrician $ 3.00 City Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidentiaJ $ 25.00 Limited Energy/Commercial $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ".. . - ,:-.,.- - -. -- - .. -"'~. - OWNER INSTALLATION The installation is being made on prOPertJI own hich is not intended for sale, leas~t. ) ~rs Signatur~ . r; 'Y )/t~ - e>. t.l/J7 Inspection Request: 726-3769 TOTAL (f) -:J bC> tp~ ~zr :s~3'r 4, ' SUBTOTAL OF ABOVE l.._ :....:...~ ...u__ .._._._.--......:..._ 8% State Surcharge 10% Administrative Fee 5% Technology Fee Shared Drive(T:)lBuilding FonnsIElectrical Pennit Application 8-06.doc -ilA:.BU!' ~ . .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01519 ISSUED: 11/30/2006 APPLIED: 11/30/2006 EXPIRES: 05/30/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3382 GAME FARM RD ASSESSOR'S PARCEL NO.: 1703221201700 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Add 1 circnit for hot tnb Owner: DIANE DANIELS Address: 3382 GAME FARM RD SPRINGFIELD OR 97477 Phone Number: 541-988-0936 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: , ; >" . .Sq Ft 2nd Floor: Water Type: " ','" - I""" ~q Ft Basement: 'Range Type: ,'.. ,,,- _~,'t L:.~q Ft Garage/Carport Energy Path:' ,.. " , ',' ~ ~q Ft Other: Sprinkled BUildiIig: G'..," ~ ~:nia " ,Occupant Load: ...., 1 .~ ~ _.... .....;:) ". R-3 Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: . .' . 'Q I DEVELOPMENTINFORMAT'ION .,,,,,,:- "" '., ..:::::at:on , .' . . ~ ,~ . ...", "1' '.-!..2~'}1.~). Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I P.UBtI~ilMPROVEMENTS I THIS PERMIT SHALL EXPIRE IFS,a[wiilmype: AUTHORIZED UNDER THIS PERb'.J*rlfptm~Drains: COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Notes: I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of 2 . .ITY OF Srt<ll'liuNf.,LD . Building/Combination Permit PERMIT NO: COM2006-01519 ISSUED: 11/30/2006 APPLIED: II/30/2006 EXPIRES: 05/30/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Valne of Project F....s P3WJ Fee Description + 100/0 Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $4.50 $2.25 $3.60 $43.00 $2.00 11/30/06 11/30/06 11/30/06 11/30/06 t t/30/06 1200600000000001701 1200600000000001701 1200600000000001701 t200600000000001701 1200600000000001701 Total Amount Paid $55.35 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. IRml'~ 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, 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 tim;D~:~~:trUNamJ' II hot, .I' f Owner or Contractors Signature Date Paee 2 of2 ~. ... Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us -' . , \. ./ " " " ." Pennit#: c...OVV'7__6 - 0/)/9 Address: s3lSZ r..,..,4VV\c h1/Z-vV\. ~~ Date: If Ircj~ b Issued by: f 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 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 befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ..h- 1. ~2, I own, reside in, or will reside in the completed structure. o 3A. My general contractor is I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. / / /) Jtr ~ame) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR g 3B. I will be my own general contractor. If! 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 I have read and do understand the Information Notice to, Property Owners about Construction Responsibilities on the reverse side ofthis form. V/flAU-- ~~/JmuJ , 11/30 /01 (Signature of permit applicant) f (D'ate) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 AdnIIDg ~~ I1lllIr (Q)WIID cG~IID~Ir~n (C'IID~Ir~~~@Ir? INFO~MATION NOTICE 10 PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES '.. 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 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 being aware of the following responsibilities and concerns. lEmJllllll!)yer JRe~JllImn~nJ]}nllntne~ 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 tbe following: 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, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. 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/formsnav.htmll for the appl up'" ~ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim eosts 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 R.evenue Service: As an employer, you must withhold federal income tax from employees' wagei'--- 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 at \vVlw.irs.{!ov. O~lhllell" IReSjploII1ls1i]))1ill1i~1ies amll All"eas olT COIIn<eeIl"II1IS 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, Liailility 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 sufficient time to supervise your employees. lEl1pert1se: Make sure you have the skills to act as your own general contractor, 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. rfyou 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 Fiftb Street Springfield, Oregon 97477 541-726-3759 Pbone "'~AJNOF1"'" , . _.,",..','_9'" ", Wit,' . , : c~ ~ ,~.,.._'.._{ ",-,-.'-'.,.-.. ..-'" Ci~f Springfield Official Receipt D.opment Services Department Public Works Department Job/Journal Number COM2006-0 1519 COM2006-0 1519 COM2006-0 1519 COM2006-0 1519 COM2006-0 1519 Payments: Type of Payment Check cRccciot 1 RECEIPT #: 1200600000000001701 Date: 11/30/2006 Description + 5% Technology Fee. + 8% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Paid By DIANE DANIELS Item Total: <":heck Number Authorization Received By Batch Number Number How Received djb 4063 In Person Payment Total: Page 1 of I 8:58:44AM Amount Due 2.25 3,60 4,50 43.00 2.00 $55.35 Amount Paid $55,35 $55.35 11/30/2006