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Home My WebLink AboutPermit Electrical 2003-5-16 '1 ~~03 S.l/ lX\ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION 200 Amps or less V' O~W Amps to 400 Amps \~ \~'t. ~ ~~ Amps to 600 Amps . \.. 't.'j..~\~'c. 't.~~\\ \S ~601 Amps to 1000 Amps City . . f..,\C~'P~~6b~~';.\\ \~\S ~ Q~'t.\) fa Over 1000 AmpsNolts \"I~~s ~t.~ 'i;.\) \J~\.}\:. ~'O~~\J Reconn~ct Only \" 'lC\\\\t f"\\\ \S T S' F d Supervisor License N~\!i\>W ...~ r~'9 ~"'l\\C\\)' C. emporary ervlces or. . ee . ers CO~~%\'{ '(\,. Installation, Alteration or Relocation Expiration Date r.~tl~V "'.'0- Over 600 Amps or 1000 Volts see "B" above. I ~ -..., D. Branch Circuits U\O New Alteration or El'-tens,joH'2p'!~P<e,n'eY .e'lJ'll ,e4~ ~Of\ u '0' One C5't~ibO\ \. \'(\e ate te se\ '0 _-J. ..._ ~ \ \v\'-\' ~ed '0'1 t\)\eS a; 'r/fJ?/0V /J /J t7) - ~n t;.' ~g~@gtioI1ifl(@~tu~\'?~~ u\es b:; C Owners Name <<' / /.--r /l;J /;/ k.c ~ \0\\0'-J'J {~!;erxtc_e~PFJ:.e~et\-Re'Mtits 0\ \'(\e {'-,,~ $ 3.00 1 _ -........ ~'ce\\O\ .$),\~Qv\. r;O?\/O 'tP,\e\-"'-~, n Address ~ c;;/? 4/1 y/J.2?#:/1 CO'\.\ \ \E.9'5~lISCell&~ltquS\tS&~ei~~fee(f~,\\~n'cllided) -Each Installation C7 --/ c,..' " . , , '-' ~ If' ~ - \'{\ P\ '{ ou 1't\a'J ~e{ . \~ $\\\\\'1 ~ City S;f~ Phone':::;--/ 7 - ?<?~~O'\\<<\I!TI'p'gl~~0lQOf\ ~'?!2~'2.?/J,f>,). $ 50.00 . '"-- -. /' ca,);ig::JrfltjlItl~~ kiAhfu\'g()~' ,. $ 50.00 U" \\.. ' o,e\ ,-<> OWNER INSTALLATION "(\ Limife@EnergyIResidential $ 25.00 The installation is being made on property I own Limited Energy/Commercial $ 45,00 which is not intended for sale, lease or rent. City Job Number CO VIA ZOO J ~ 0037 Z LOCATION OF INSTALLATION 1. .69!/ ./j;'t),CE/?'~-:1/7). c.r-EGAL DESCRIPTION i7D3~31Lf Date oose>o JOB DESCRIPTION JOD ~p 5~G. / J . c-I'eu...~ ('S. f Permits are non-transferable and expire if work is not stmted within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address Constr, Contr. Number Expiration Date Signature of Supervising Electtician Owners Signature: tf-) p@~/7 ~ ~ V - ~, ~ U;JC-L:.-- Inspection Request: 726-3769 5/16/03 I C6~MPLETE FEE SCHEDuIE BELOW 3. 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 Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19,00 $50.00 Services or Feeders -Installation, Alterations or Relocation: B. I b) $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 $ 43.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBl'OTALOFABOVE. 72- 5Dl( 7ZD ~'f 24 7% State Surcharge 10% Administrative Fee TOTAL I r Shared Drive(T:)/Building Fonns/Eleclrical Pennit Application I.03.doc Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2003-00372 ISSUED: 05/16/2003 APPLIED: 05/13/2003 EXPIRES: 11/16/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 690 ANDERSON LN ASSESSOR'S PARCEL NO.: 1703331400300 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Electric furnace and heat pump installation Owner: OGLE JODY R & DANIEL G Address: 690 ANDERSON LN SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Owner Contractor OWNER HOME COMFORT HEATING & AIR OGLE JODY R & DANIEL G License Expiration Date Phone 84164 06/2512003 541-345-2838 I /,.~\,: I BUILD'tt~IN~RMATION I ~ \ \ \<0 ,l. # of Buildings: -cx\~Y..~[{~10{ts'i1 Primary Occupancy Group.: R~\.. Y..~ \\\<0 ~ ~~ of Structure Secondary Occupancy Gr~. ~ <0" ~~ "\ ~~ pe of Heat: Primary Constructi~~~\'~~~\ ~ \<0 ~~ Water Type: Secondary construcli'~~~e:~\15:..\) \) ()~ ~()\). Range Type: # of Bedrooms: ~\'0'\:j ~~'.J~ ~ ~Y...~ Energy Path: ~ ()~~ ~ \)f. \. \ ....lQ ~~ I DEVELOPMENT INFORMATION' Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: SETBACKS REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: S '.Iou \? '1.1 u\~e \)\\\\'Cl % of Lot Coverag~:\a..\N ~e6~e~0~ e\ \O~\ .t,j(e9P \'(\e ~~e s ,00".. ~.n\~. ."r\ '0'.1 ,,\\eS """ a~2 .....' I PU.~L're'1M:~Ro~k'~~H~:Nii.)~~'(\ O~~~e ~u\e~; .. \O\\u" . ~ v~ nO"\v'. f'I\eS? _\QP'(\O., ~ .~. C'3-\\O nO"'v ..... CO", ~Jdewal~.:r..yJl.ell ~O\\,\ g'6~'v ;0\'3-\\' ~e'. \,\ \V NO\\'\\'J O~~....I . \ ((\~'.1 0 ~Ie~' ~~O \ \~D.(j~nsp'oiuts/Drains: \~ ,ov eW ~ V" t,)A~" oo90. . ~ \'(\e C o~e~O O,'2>?>~'Z C~\\\~ \O~ \'(\e. '\ ,~a ~'Oe~ ~e\ \5 ~U c.en Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Inst.ruction: Notes: Pal!e 1 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00372 ISSUED: 05/16/2003 APPLIED: 05/1312003 EXPIRES: 11/16/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriution I Description Tvpe of Construction $ Per Sq Ft Square Foota2e Value Date Calculated Total Value of Project ~ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $10.00 5/13/03 2200200000000000840 + 10% Administrative Fee $4.50 5/13/03 2200200000000000840 + 7% State Surcharge $3.15 5/13/03 2200200000000000840 Air Handling Unit Up to 10,000 $8.00 5/13/03 2200200000000000840 Furnace - up to 100,000 btu $12.00 5/13/03 2200200000000000840 Heat Pump $12.00 5/13/03 2200200000000000840 Minimum! Adjustment Mechanical $13.00 5/13/03 2200200000000000840 + 10% Administrative Fee $7.20 5/16/03 1200200000000001226 + 7% State Surcharge $5.04 5/16/03 1200200000000001226 Add, Alter, Extend Circ Ea Add $9.00 5/16/03 1200200000000001226 Perm Serv/Fdr 200 amps or less $63.00 5/16/03 1200200000000001226 Total Amount Paid $146.89 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. . L..ReouirerUnsnections I 1 Rough Mechanical: Prior to Cover 2 Final Mechanical: When all mechanical work is complete. 3 Rough Electric: Prior to Cover 4 Electric Service: Approval required prior to utility company energizing service. 5 Final Electric: When all electrical work is complete. Pa2e 2 of3 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2003-00372 ISSUED: 05/16/2003 APPLIED: 05/13/2003 EXPIRES: 11/16/2003 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. Owner or Contractors Signature Date Paee 3 of 3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00372 COM2003-00372 COM2003-00372 COM2003-00372 Payments: Type of Payment Check 5/16/2003 Receipt #: 1200200000000001226 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By DANS PAINTING AND CONSTR 1O:42:14AM Received By djb Check Number Page 1 of 1 City of Springfield. Development Services Department Public Works Department Official Receipt. Date: 05/16/2003 Item Total: Amount Paid 63.00 9.00 5.04 7.20 $84.24 Confirm No Amount Paid 84.24 $84.24 How Received In Person Payment Total: cReccipt.rpt 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 Address: Permit#: COWl z..oO:3'f_:. o637Z A ~J~c-.. Date: Sf ~/o""(' h70 ))d' 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 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: ~1. W2. 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 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 WSB. I will be my own general contractor. IfI hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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 ofthe 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 sideofthis form. 47 p'/V1_ ~~ ,~--~-z;(? (Signature ofpermit~plic~ (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 03/11/03 ... ~ . " Acting as Your 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 Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your OWTI 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. Employer 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 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 a State Business ID number, call the Business Information Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of an employees. For more inforniation,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 obt;1in 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 costs if one of your employees is injured on the job. For more information, can 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. Other Responsibilities and Areas of Concerns 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. 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.overspray, water damage from pipe punctures, fire or work that must be redone. Time: l'1a~e s}ITe you have sufficient time to supervise your employees'.t Expertise: 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 UpplUpnate 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 03/1 I/03