HomeMy WebLinkAboutPermit Electrical 2004-1-26
2. CONTRAcrOR INSTALLATION ONLY B. Sen'iees or Feeders .. ,
.. 7'/. ~ p/J ~ Installation, Alterations or
Electrical" C?n.t~~lctor.:~'_~ ~ Relocation: . ,~'''~'<;' , . 'r) iu,. '(.:' . ;: \ I
Addressta?/~/ ~~>. 200ampsorless~' ~\"',.,." :::.; ';.$,6~,00_'
~'!,;.;.: ,',' . '7z,c/c'iitoO' "', 20] amps 10 400 illlips' . "' "';::';;,~$7):09 ----':-c-.
Cil)' '::;"'dif:~. :Phone /' ,(57-.",;:',:'::, . 401 amps to.600 amps~'<~,. _/, .. ,. $]2),00,
,If " '"'.',1 ' /i 'r)-' c'.. ,....:' . ,""60] amps 10 JOOOanlps' ';.";;;~'$163,OO~<'
Supervisprt':ic~il~cjNun;ber '7,Vb',t,:"o'S'i_-',-:- '., . ',':,ci'"',",Q"er 1000 aryti)s(~t~lis.:~.' ;' "";'~..:~ . ,:$j,75.00' . L; .
t::,~\:,.,,{-;''-';t'';'''ih' :,<,--,..,.,:,:.-~!. ,- ,.,:,:'>( R'econneClbnlY;~ \,'. -. ':'+~$,~5d.o6 ,'-'
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"~~' ,,'" 1\:~:EXpIratlOn Date /O/(J7~. '''-''''/,:'^,~':'',-.~ ."\'>-- '.~~' "'., , ~ .:200.:unps or les.s ',::' ~:: ':.'~/~'" " .<~ ~ ~~~9.00 ',~
':,~:':<:~':" .. . I ~ -'''<0.::.'_:' _:'., ..;:.~ 20.1 ampsto 40~ apljis; . _~;:'". ): ~ .$69.00 ~
. "S ~',"';: Sign'ltLlre of SUJlervising Ele<;!.{~i'~ '.' -""Ovef40110600 amg~. "..:.'(." ::_'; , '~:' $100,00
.':"(~'!:".'.'...':.. :.'LfJ.'. ";....::..".. . . ~ ~~ Over 600 am psor.:!o,OOlyolts:ee ... -, .,. '- -
,,_,. '. .' "..'~~/". (.""~~ "B"obove .\o.;Jf"d-":~., .,c ;.' '.
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'..,."Owners Nam. e. - ~ . ... . New AIlerouon o!,ExlenslOn Ref Panel ,
. ,\:, .' 'n' i.},.~'3.: ~,3l'(':';;.;":~ ,:' ,<t" ~ ~0 o~;sVJ if it ,:","
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Ci.)~: '\ ,@'Phonc ~ \ l..5~ ~gae{r~,~\i@'~lfgri;;7l~9~:riT\ Servife -" tJ. ctJ
~t::5 .:k> .:&5 <. I. cl'. ,,: ~~ orF~ea~.rPe'Jl\lt~P >:-v,{''' -L $ 3,00 J.)..
, OW:N~ ~S ty.;LATION .' v-<:- ,~0'" 00 r::,,,;jf 0" r:5? ('0'
The itilit~lratio~S being made on ~ ML,&llaneOlis (S~n'i8!/f.fcder not inclndcd)
)~. ~~'A:- ~-lll,. ,,-'V-Xl \..1....
property Q~'n which is not intended , ' ~O ,~Q;f CiiE<~h'~~~~liq!, .
for sale, leose or rent. . .~ ~ $I'.ump or \mgatlOn
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:,.-225 FIFTH STREET.. : '~oi,~~" EL.CALPERMIT APPLICATION ..,
'". SPRINGFIELD OREGON 9747~0/)'(\~h . .. r. '.;" '/\" > ' , NY\f"i'
I ' INSPECTION REQUEST:' 7g,~~0:::: _" Cii)' Joh Numhcl'_'::.s ni\1ltl-'1 ; r1. V\.l . _
'OFFICE' 726-3759. ....".. 'f).~~"."J I. i'.' ':.:',.' " "'~'
. . . . ..~0"'~ ~ \~' 1 .. ,01" ('. . l "',,, . ',' '-';.
,'" .. '., ':i: '~"li~O ," ;:' ,.' ,.';,COMPLETEFEESCHEJ)ULEBELOW
:LLQJ:~TIt& TAL 10 ..c r,';>" ,.,,:,.f',
.- ~'11 ~~ ..~. '__.J 'A." Nc,,: Residential-Single or' .. ,." ..
.0'" ,o~ 1,0" Multi-Family Jlcr dwelling unit.
LEG~~~t.1ATION ~~ Scn'ice Included: Items Cost Sunl.'
. ~\~.t
v 0"
~~"o.~ 6~
Permits me I~OI~ranSfcrable and exp~ 0
if work is 1I0t started within 180 dol'S
ofissllance or if work is suspended for
] 80 days. '._"
..'
....',.
,r'
,',.
1000 sq.fl. or less
Each additional 500
sq, ft or portion
thereof
Each Monufd Home or
Modula, Dwelling
Service or Feeder
$]06,00
$ J9,00
~
,'.
1ft> ,cr>
$ 50,00
'r:-',
..'.
. Owners Signature:
$50,00
$50,00
$25.00
$45.00
\,
l\:linimum Electric Permit Inspection Fcc i~ 545.00 + Surch~~5cs
4. SUBTOTAL OF ABOVE I D~p"
7% State Surcharge ., ,'l,,~
S% Administrotivc Fcc \0,30
Lryj) .5~
TOTAL
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Co~stru~tion Contrac_s 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
Pe..:rut#: ~~ - dt?tJ17
Address:. $7~o /tJbA'~ er;
Issued by: .J tv\.? Date:C>'3.03,.-C>4:-
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 I 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.
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
rv( . PPI,l/NA/1/N4
~ 3B. I WIll be my own*,. .~l-(ontractor.
If I 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 of this form.
~ ~~ ~-3~~
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner.doc 03/11103
~~~~ - .~~);ttA ·
~~~\'-~~'f~~wnn G~nn~Ir~ll C~nn~Ir~~~~Ir?
INFORMATION NOTICE TO 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.
. !Employer JRespolllsilbmHes
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 ill 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 pu~e~,.
on the wages of all employees. For more information, 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 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 costs 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 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. il>,^"""~~~~ V
.._-~ v.,
Other JRespolllsilbiRJit:ies 31I1ld Areas oJ!' Com:erns
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 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,
.~-
- - - - -- - ~ (-
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 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 03/11/03
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SPRINGFIELD I'~
225 FIFTH STREET
SPRINGFIELD. OR 97477
(541) 726-3753
FAX (541) 726-3689
MANUFACTURED HOME LAND USE AGREEMENT
As required by the City of Springfield Development Code, I agree that with the approvjt of the attached
permits, one of the following manufactured homes will be placed at 7.7 ~n K ~c C-r:,
Springfield, Oregon, City Job Number CiIi#f:J/)!# -~7
~ Type I Manufactured Home, A multi-sectional (double wide or wider) unit with an enclosed
floor area of not less than 1,000 square feet, that has a nominal roof pitch of3 feet in height for each 12
feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to
have an exterior thennal envelope meeting perfonnance standards which reduce heat loss to levels
equivalent to the perfonnance standards required of single family dwellings constructed under the State
Specialty Codes.
_ Type II Manufactured Home, A unit of not less than 12 feet in width with an enclosed floor area
of not less than 500 square feet, that has a nominal roof pitch of 2 feet in height for each 12 feet in width
and that has no bare metal siding or roofmg,
The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6
percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the
home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of
the enclosing material exposed above grade.
I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60
days of the date of issuance of the manufactured home set up permit. These requirements may include, but
are notlimiled to the items listed below, Specific land use requirements regarding your parcel are nOled on
your approved set up plans andlor permit and your partition approval if applicable:
. Street Trees
. Paving Driveway
. Minimum 32 square foot storage structure
. Completion of partition approval
. Removal of any existing structures as noted on your partition approval
. Signing and recording of any required partition, easement, improvement agreements, etc.
. Final lot grading
. City Sidewalk and curbcut installation
. Any outside agency approval as required Le" Division of State Land approval.
By my signature below, I agree to complete the above mentioned land use requirements.
y,-- 'c.~
Owner Signature
~_-3-""t.1
Date
Contractor Signature
Date
CITY OF SP!GFIELD SYSTEMS DEVELOPMENTtRKSHEET
JOURNAL OR JOB NUMBER: Com2004-00097
NAME OR COMPANY: Don Smally
LOCATION: 5760 Rid~e Court
TAX LOT NUMBER: 18020411 tI 7800
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF: 0 LOT SIZE (SF):
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S,F, x I COST PER S,F. I I CHARGE
I 3590,00 I $0.290 = I $1,041.10 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS SF I x I COST PER S.F. I x I DISCOUNT RATE I I DISCOUNT
I 0.00 I I $0.290 I 50% I = I $0,00
ITEM 1 TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I
I 21 I
$1,041.10
7939
$1,041.10
ri
u
e<:
t.Ll
1~
1070
COST PER DFU
$22,64
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x COST PER DFU
I 21 $17,21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I
I 9.57 I I I
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I
I 9.57 I I I
ITEM 3 TOTAL - TRANSPORT A TIO,N SDC ~ ,
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I 1 I $314,63
B. IMPROVEMENT COST:
INUMBER OF FEU's I x leOST PER FEU
I I I $214.23
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER So( = ,
SUBTOTAL (ADD ITEMS 1, 2,3, & 4) = ,
5. ADMINISTRATIVE FEE:
ISUBTOTAL I x I ADM. FEE RATE I~
I $3,296.59 I 5% I
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Virginia Jurasevich
PREPARED BY
2/3/2004
DATE
$836.85
COST PER TRIP
$17,23
x I NEW TRIP F ACTOR I
I 1.00 I
COST PER TRIP
$76,01
$892.31
x I NEW TRIP F ACTORI
I 1.00 I
$475.44
$361.41
$164.89
$727.42
1091
11092
I
11093
1094
$526.33
=
$314.63
1054
1055
1054
1056
$3,296.59
=
$214.23
($12.53)
$10.00
CHARGE
$164.83
TOTAL SDC CHARGES
111.74
$53,09
=, $3,461.42
1079
1078
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE RXTURE UNITS
(NOTE, FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL RXTURESj
NO, OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS I
BATHTUB 2 0 3 I = 6 -1
DRINKING FOUNTAIN 0 0 1 = 0 1
FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE lOlL I SOLIDS I ETC 0 0 3 = 0 I
I INTERCEPTORS FOR SAND I AUTO WASH I ETC 0 0 6 = 0 I
I LAUNDRY TUB 0 0 2 = 0 I
ICLOTHESWASHERI MOP SINK 1 0 3 = 3 I
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG I WATER STATION I ETC. 0 0 1 = 0
I RECEPTOR FOR COM, SINK / DISHWASHER I ETC 0 0 3 = 0
SHOWER. SINGLE STALL 0 0 2 = 0
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLE LAVATORY 1 0 2 = 2
ISINK: SINGLE LAV ATORYIRESIDENTIAL BAR 1 0 1 = 1
!URINAL, STALL! WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 21
,.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DRJ's) set at 167 gallons Dcr day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
I YEAR CREDIT RATE/$(,OOOi
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT?
- - (Enter I for Yes, 2 for No)
BEFORE 1979 $5.04
1979 $5.04 IS IMPROVEMENT ELGlBLE FOR ANNEX, CREDIT? 0
1980 $4.95 (Enter 1 for Yes, 2 for No)
1981 $4.88 BASE YEAR 1998
1982 $4.75
1983 $4.58 CREDIT FOR LAND (IF APPLICABLE)
1984 $4.41 VALUE I 1000 CREDIT RATE
1985 $4.20 $27,24 x $0.46 ~ , $12.53
1986 $3.88
1987 $3.50 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 53.07 VALUE I 1000 CREDIT RATE
1989 $2.60 $0,00 x $0.46 0
1990 $2.14
1991 $1.71
1992 $l.S2 TOTAL MWMC CREDIT = $12.53
t993 $1.38 I
1994 $1.19
1995 $1.03 I
1996 $0.87
1997 $0.68 I
1998 $0.46 I,
]999 $0.27 II
2000 $0.09 I
L- 2001 $0.04 'I
225' Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
COM2004-00097
Payments:
Type of Payment
Check
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Wi:.
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Receipt #: 1200400000000000265
Description
Plan Review Residential
Addressing Assignment
Willamalane ManufHome Private
Manufactured Home Feeder
Manufactured Home Service
Add, Alter, Extend CiTc Ea Add
Foundation Permit
Garage/Carport
Sanitary Sewer - 1 st 50 Feet
Water Line - 1st 50 Feet
Storm Sewer - 1st 50 Feet
Manufactured Home Connection
Manuf Home State Issuance
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
Annexed 1998
Fixture
Plan Review - Planning
Manufactured Home Placement
+ 7% State Surcharge
+ 10% Administrative Fee
Check Number
Batch Number Authorization Number
Paid By Received By
PALMAIN MOBIL HOME SALES, jmp
LLC
1349
City of Springfield Ori'icial Receipt
Development Services Department
Public Works Department
Date: 03/0312004 8:08:04AM
Amount Paid
Item Total:
5,07
31.00
1,000,00
50.00
50.00
3.00
52.80
115.20
45.00
45.00
45.00
45.00
30.00
1,041.10
475.44
361.41
164.89
727.42
314.63
214.23
10.00
111.74
53.09
(12.53)
14.00
59.00
160.00
43.75
62.50
$5,317.74
'.
.
How Received
In Person
Amount Paid
$5,317.74
Payment Total:
$5,317.74