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HomeMy WebLinkAboutPermit Electrical 2005-6-17 "'~'C ~o v ~'li-'V\'O- .~eO 6~~ ~" . I "'- .~e'; 0..,>" ,; " C., ", J 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726'f3689 , ELECTRICAL PERMIT APPLICATION ,r City Job Number COt-<< WO I.-f - 00 !::>~ ~ Date 6 -I 7 - 0 ~. .. ... '<.':'0-' . < ' . ~. '""':<" -"..^'~-. '.,.., 1. ~,~~S~!!P~q~lIY:~I1f0!!OlJ_,~:':.J(i 3. ~ q.. \ ~ .... J ~J-...... '" N LEGAL DESCRIPTION I 7033.3 J c.:r ~ \ ~ A- .l.."T-o.(.. S .>".J 0 0 700 :h ';.' :.:.,.':::: .;;;'::;:;,....~:;... ::--.. ":n .'~,:,":.:.,.. of" . _ , _ _ . '_~:" ....,;;.,-~"..,..,-:~~_. . .......~ ".... A. :,:N.e~:.~~~iden ti~!:-Si~~le; .~EJ\t!~;l ti-Fa Illily ~er dw~i!in~ ur.it. Service Included JOB DESCRIPTION IAlfLe- C; 1._/ /p gtA^JL ~ILce 'T' 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. 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 J <:::> (, 7- 31 $ 19.00 $50.00 ..J,.--,.....-....-";.~.-:..n::,.......-.,."..'t^' t ~. '.' ,.. .' . '.p'" ...., . . -" ,- ;;: B. ,S.e~~.ice.s ,Q!' .Fee~ers-II1stallatioI1, Alterations or Relocation: ~;;....::,,_: :;;;;;'::tt"_,,._5:::,.::,,~:<_... ..6.-NX:;::"':,...,A:~' :~dji~Jk...:::).;)~;:"~.:""4L~_,;.':-,,, ., ~o,;::'_0,"":"_" '0::-... .~..M~_ ^_,_.~, .';", 200 Amps or less AI I eN I luN: Or~ep'A; {~qW~u to ol.l~w ~ules adoPJ~!~ P~oQo~~*Ulp'Jtility /~Vlrfh"'Ql'Vj ,Center. nos rul~~. m-~ !~t~ forth in OAR 952-001-olW6 ttmYd9~"~m~001. ~1)<?0 v':\IJ may obPci'iff d8a~~tire<>H~les by calling the cent~c~Qt)lg~ ~telephone number for the or.f?:,SJ.~ O.........r:l....JJ....tHtty...:N.O.....ti..fiQa. ti..o.n....~ ~-;:.^''' ....... ".-'"'' Center f51~6~~S't~'2'~~~ices o~Fee'de~s ,,' . 2. .CONI'RACTOF-~sT4L,LAPQNQ1JI;r::d ',.. _~, ..,;-"._..__--,--" ___W.o. ._._,n~< ...e>.~~_" ,.' ,.. .,;....::. ..~_A.::.;;_~._...;-..;:;;~'--...,~,__ .:--,:....,~....,..^.~~ Electrical Contractor Address City Phone $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Expiration Date Installation, Alteration or Relocation / 200 Amps or less $ 50.00 Constr. Contr. N7:ber '.; ;----;-~ ~"; 201 Amps to 400 Amps $ 69.00 h.U r ,\l;~, 40LAmP~,t;o600..Amps $100.00 Expiration Dat THIS PERMIT SHALL EXPIRt 11- 1 Ht VVUMI\ Signature o:Zpemsmg Elecmcian~~i:~:~~t~D U;~~R AT~1~f~1~~~~I'j~fl[B"a~ove jU] AI~Y 180 DAY PERiOD. New Alteration or Extension Per Panel Owners Name 0}IJ~4.4.1/ ~.., Address ~ ~MlI\... L. City ~ Phone OWNER INSTALLATION One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 , '~:::~:,~~"~'~.'" '-'k'! '.<,<~ 4'.'> (;,y-~ _.::..-;.''"'_..~,';.~~"'- ~,:-';~r-" .-.~ ~--:': ~-. . ~... - . ~.~" "~ . E. Miscellaneous.(Se~iceJfeeder not included) ~Each Installation l~..'.:._.>~,,~_'.-w, ~.,:;'._.;;"':-':"''';__--....<:...-....t~,: _-:.-...~~~.. ~~""":"_"" ...~..,~:-:'..:. ~_N_''''_'~:~''__ _~m;"___ . _,_~" ". _ ._. . Pump or irrigation $ 50.00 Sign/Outlme Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: .--) ,<1 / // , / j;/ / f.... . / /,; t' )1--<::" _' 11 L-t"---= -'- . , - /1/ Inspection Request: 726-3769 ~"..-'::t>"~ ~ '^'-"'~ ". "'f"'''''' . '~''':;-;''-- ;----:">>~'-";'~""":..,:";'...-':: ,~~....-,,~ 4. . S~~~?-~10~AfO~ 7% State Surcharge 10% Administrative Fee TOTAL \4i~ /1.(1{ 10 0 \( /'11.(0 /b '[f.t8 Shared Drive(T:)/Building Forms/Electrical Permit Application I-03.doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2004-00565 ISSUED: 12/02/2004 APPLIED: 05/12/2004 EXPIRES: 12/16/2005 VALUE: $ 124,850.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 891 Anderson Ln ASSESSOR'S PARCEL NO.: 1703331100700 Springfield TYPE OF Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence (Same as 863 Anderson Ln. - Com2003-00890) Called on 11-16-2004 to notify contractor that plans are about to expire. # of Units: 1 # of Stories: Primary Occupancy Group: R-3 Height of Secondary Occupancy U-l Type of Heat: P'rimary Construction Type VN Water Type: K Secondary Construction 'neE: \~~ng~\%rIMPR # of Bedrooms: MU Pt.RM\1 S\3f\ll t.XP st~~~~rf4lltNOl 1\--\\S \IcO \.n~Ot.R 1\--\\ Wfin~~OR ^\\TI-HjR L _ Ir I\QC:lNlfUNt 'CON\MH~Ct~ ~~pi~~y ~LOPMENT 11~~UKMATION I f\N'{ '\ 80 Of\ . 23.00 ~-Overlay Dist: 5.00 . . .._#Btreet Trees Paved Drive Rqd: 15.00 % of Lot C~rage: A':rrENTION:~on law requ'res you. . " J I . .. h, ........ r\rDng,n Utllltv fOllOW rUIt:l~ CI vt'....- cr. - . '.r. ....... 'f' t'on Centet T.~~e'SIMPR9~NmNTSI Notllca I ~ L 001 ' Street in OAR 952-o01-oD10}~_.n ~~he v~les bY' Sidewalk Type: 'naD You may obtairrtlU~~ 0 , Stor~ Sewer A~ailatO~ .. enter:~ol€r.sth.etelePh~~a Downspouts/Drains Special Instruction: cag~~ ~~Ivat~ 8. ,~,ItlW&fIo8AlG,JI along Anderson Lane. number for (tie u\.e, . ) f.,t ' Notes: .:. Center is 1.~00-332-2344 .. ~.~' , Owner: n.M. JOHNSON Address: 1825 KINGSLEY ROAD #29 . EUGENE, OR 97401 I CONTRACTOR m~uKMAHul~ . Contractor Type " . General . . Electrical Mechanical : Plumbing Contractor BENSON DEVELOPMENT CO LLC OWNER CHITTIM ENTERPRISES I INC THOMAS ANTHONY RYDER License 143021 47396 159425 I BUILDING INFORMA TIONI 2 25.00 Forced Air Gas Gas Gas Path 1 n/a ) Front yard Setback: . Side 1 Setback: Side 2 Setback: , Rearyard Setback: .' Solar Setbacks: .1 of 4 Residential Phone Number: 541-338-8143 Expiration Date 05/15/2008 Phone 541-688-8897 03/08/2007 05/12/2006 541-461-2101 541-343-0975 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 846 400 9 Yes 13.60 REQUIRED PARKING , Total: 2 Handicapped: Compact: 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: COM2004-00565 ISSUED: 12/02/2004 . APPLIED: 05/12/2004 EXPIRES: 12/16/2005 VALUE: $ 124,850.00 I Valuation Description I Dwellinl!s Garaee Type of Construction V Wood Frame Garaee $ Per Sq F:t or multiplier $92.40 $24.30 Square Footage or Bid Amount 1,246.00 400.00 Value Date Calculated Description Total Value of Project $115,130.40 $9,720.00 $124,850.40 05/12/2004 05/12/2004 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Same As $100.00 5/12/04 1200400000000000728 -Mechanical Issuance Fee- $10.00 12/2/04 1200400000000001680 + 10% Administrative Fee .$98.49 12/2/04 1200400000000001680 + 7% State Surcharge $68.94 12/2/04 1200400000000001680 2 Baths One or Two Family $254.00 12/2/04 1200400000000001680 Addressing Assignment $31.00 12/2/04 1200400000000001680 Air Handling Unit Up to 10,000 $8.00 12/2/04 1200400000000001680 Building Permit $646.90 12/2/04 1200400000000001680 Dryer Vent $6.00 12/2/04 1200400000000001680 Exhaust Hoods $9.00 12/2/04 1200400000000001680 Furnace - up to 100,000 btu $12.00 12/2/04 1200400000000001680 Gas Fireplace $15.00 12/2/04 1200400000000001680 Gas Outlets 1-4 $4.00 12/2/04 1200400000000001680 Heat Pump $12.00 12/2/04 1200400000000001680 Plan Review - Planning $71.00 12/2/04 1200400000000001680 Sanitary Sewer - Improvement $344.20 12/2/04 1200400000000001680 Sanitary Sewer - Reimbursement $452.80 12/2/04 1200400000000001680 SDC MWMC Administration $10.00 12/2/04 1200400000000001680 SDC MWMC Improvement $214.23 12/2/04 1200400000000001680 SDC MWMC Reimbursement $314.63 12/2/04 1200400000000001680 SDC Sanitary/Storm Admin $84.55 12/2/04 1200400000000001680 SDC Transpo Admin $55.26 12/2/04 1200400000000001680 SDC Transpo Improvement $727.42 12/2/04 1200400000000001680 SDC Transpo Reimbursement $164.89 12/2/04 1200400000000001680 Storm Drainage ImperVious Area $568.08 12/2/04 1200400000000001680 Vent Fan $18.00 12/2/04 1200400000000001680 Willamalane Single Family $1,000.00 12/2/04 1200400000000001680 + 10% Administrative Fee $14.40 6/17/05 1200500000000000855 + 7% State Surcharge $10.08 6/17/05 1200500000000000855 Penalty Fee - BWOP Electrical $144.00 6/17/05 1200500000000000855 Residence Wiring 1000 Sq Ft $106.00 6/17/05 1200500000000000855 Residence Wiring Ea Addtl 500 $38.00 6/17/05 1200500000000000855 Total Amount $5,612,87 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00565 ISSUED: 12/02/2004 APPLIED: 05/12/2004 EXPIRES: 12/16/2005 VALUE: '$ 124,850.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Initial Review I Plan Reviews I 05/12/2004 OK RJB 04/27/2005 10 LLH 05/12/2004 04/27/2005 Plannine Review 05/12/2004 06/21/2004 DONE TAJ Public Works Review 05/12/2004 06/02/2004 APP VRJ Structural Review 05/12/2004 06/03/2004 APP RJB Address changed from 925 to 891. See attached documents or address file. Change effective immediately. Needs over the counter LDAP. Annexation effective 6/7/04. 9 street trees required: 5 on Anderson; 4 on Kellogg. Improvement agreement for street and storm sewer required prior to issuance of building permit, Survey is writing up the agreement and will be ready in the next few days. Storm sewer to private storm along Anderson. Same as plan. 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. I Reouired Insoections I Erosion/Grading Inspection: After all erosion measures are in place. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. " , Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before coveriIig sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. ' Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. 3 of 4 ~~.~~I,t!~~"~f;" ~ ~ ~ CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00565 ISSUED: 12/02/2004 APPLIED: 05/12/2004 EXPIRES: 12/16/2005 VALUE: $ 124,850.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to fIlling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 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 Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Drywell: Engineered Drywell is Required. Provide the City with a copy of the DEQ application to keep on file. - 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 a~;j};;t~c~~. (-/7-00 Owner or Contractors Signature ~6f~ Date 4 of 4 .' , , . , . . -. ." 00 ." O. .0 . 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 #: CO/itf\ -z..o-o" ~ - 00 Sb ~ g9-! ~dOiLs;.o- ~ tJ Date: fo-/7-0 r- Address: Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare 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 file4 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. ~. 3A. My general contractor is"1Se7II~o-rI 'J:x:;Vt:;l..OPVVI t;NT' c...<..:> L-LL (Name) 1l-f30Z.{ (CCB #) I will instruct my ge~eral co~tractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 3B. I will 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, 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. l hereby certify that the above information is correct and that I have read and do understand the Information , Notice to Property ~wners about Construction Responsibilities on the reverse side of this form. J ' JIri! . ) /; 'J . j ;I -' ~ . i~ ~'/7i 1/...... . (Signat~i of permit applicant) (White copy to issuing agency permit file, pink copy to applicant.) t~~s- Property _ owner. doc 06-01-04 Actin'g' a~ 'Yo'tit'.OwD"GeneralContractor? ; , . " .l .'. " ".,' - ~NFORMATION NOTICE 10 PROPERTY OWNERS' -', 'J . :- \ - ,,) ABOUT CONSTRUCTION' RESPONSIBILITIES c. If you are acting as your own c()ntracto; to construct a new home or make a substa~tial improvement to' an eXisting structure, you can prevent many -Problems by being aware oUhe following. responsibilities and concerns. Employer Responsibilitie~ You will, .in most instanc,es, be ruled to be an "employer" and the pontrl!ctors y~m ~ontract with ~ill b,e ~'einployees" if you use contractors not licensed with the Construction Contractors Board to 'do labor in constructing or to assist in the .,' . t ~ . I' construction or improvement of a residential structure. As the employ~r, you must comply with the following: Oregon's Withholding Tin Law: As an employer; you mu~t withhoid income taxes from employee wages at'the time employees are paid. You will b~ liable for th~ 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 -unc.mployment insurance purPose~: , " on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. .>, The Oregon Business Identification Number (B~ is a combined number for b()th: Oregon 'Wtthholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the approp~at~ f9tp:iS.. i \ ) }) c:; ,,~,"'.. >' :,..or \i, '..). ., .}:.T. " Workers' Compensation Insurance: As an employer, you' are subject to the Oregon Workers' C.llUpensation Law, and must obtain workers' compensation insurance for your empl?yees. If you fail to obtain workers' cvmpensation insurance, you could be subject to penalties and be liable for,all claim. c?s~s' if one of your employe~s is injure~ 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 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 IRSat,1-800-829-4933 or visit their web site at \~"W.irs.l!ov. Other Responsibilit!es .and Areas of CO.llcerns. . Code Compliance: As the permit holder for this project, you are responsible for resolving any' failure tc> meet code requirem~nts that ~y be brought to your ~ttention through iI?-spectio-r:~' Liability and Property Damage Insurance: Contact \~~rinsurance agent to see' if you'have~dequate 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 YOR,have sufficient time to supervise your employees. ,1 . : ...... ., ' . ~. " . .' , : ' . . ., . .. . ,~. ",. Expertise: Make sure you have -the skills to act as your oWn general coritractor,"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 Springfi~ld, Oregon 97477 541-716-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2004-00565 COM2004-00565 COM2004-00565 COM2004-00565 COM2004-00565 Payments: Type of Payment Check ) 6/17/2005 ') RECEIPT #: 1200500000000000855 Date: 06/17/2005 Description + 7% State Surcharge + 10% Administrative Fee Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Penalty Fee - BWOP Electrical Paid By WINONA JOHNSON Item Total: l:heck Number AuUtorization Received By Batch Number Number How Received djb 1268 In Person Payment Total: 1 of 1 10:34:16AM Amount Due 10.08 14.40' . 106.00 38.00 144.00 $312.48 Amount Paid $312.48 $312.48