HomeMy WebLinkAboutPermit Electrical 2004-2-2
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
r. EI' \ C~ . . Installation, Alterations or
Electrical'~~n(ractor L:..Ve(V~ . -Qdric.c: Jil(ll<-e Relocation: ,. .
Address p...~.E' /J2" (" 5W-1 DV,5 rQ~".f}'J€"'ve. 200 ninps or less . ..f, ." '$ 63.00 ..
...., /",.,..... ". 20Iampst0400amps:,.".. .....'.,.$75.00~
CityEVCi~'.' Phone bO't~,bq6i'" 40Inmpsto600amps:.;." '_$125.00_
. < . .. '" . 601 nmps to 1000 mnjis' ,.' $163.00
Super\'isO~License.Nl;n~ber 4bO~S)'." ..'; .OverIOOOnmps/volts': ."._$375.00 .'
.,. I ',h_ ,,; -~ . .,-~. _ _", . ,.' t ',' :"Recol1I)ect Only v' ,-t.. . ""~ $ :50.00'---=-
ExPirali~ri'Dai~IOrOI(.1..0d4C:./ ., "'", . :::'-:.'.i :::".;:" "
.c, .., ",:....:~...-".l......~ ....1. . "/';;'~~ _' C:,'Tcmporan'S'crvicesorFcedcrs";- '<~ ,,;.1
.} "':'Const; C~nif. NU~lber"l3b 3:1.:L-,~ ..-~~':;. ~::: :,;".' tl::'Instanatio~l, Alte'ration or'R~locratio'n" .>;":>.1;:. ",.': ,',': "
. ~. ':;::. Expiration ~a;~ C: ~kil o$B:'<~~ C )", ;.~.: :'::~ ,<~~o ~nl~s"or>I~;S:,::!';':<-"'~:,":} :i;~o.Z :,;. c.'
'>',/:' 201 mnpsio 400 amps ..,.,.' .-~ $69.00 ~
. . :.Signature ofSli]len'i~ing Electrician "~ .'~ Over 401 to 600 ahlps "" "'" . '$100:00 . '.
/1. / . '.':. O,'er 600 amps or'IOOOvoIts see'.~ '. . . ~
. .11/v""J. L~ "8" nb~"e law reqUlf~s you to .;.,:. :.> , . '.
J. '~f.' . ' j),TTEMriB:}~\igf~~~\Vthe Oregon Utility. .
:; . Owner~ N :lIne V I A ~ ~. . ~~fJW rules aAAI,lIJilIt'eP.llionr\~iiwtWl!o.99tw.R~~el
. . ~_ . i';, jotilication Center. ThO~~u ti OAR 952-00
Address '5'76 ({ \C-. d;p . r ~ I', QAR 952-orong~18:~il 0' \~S of the rule" I $43.00 -
G090. You may obtam.~ f. h tAteohOne
. City"":.? Fb Phone \ling the oo!'iletdaulolfal G&~t ~r'f'Bah~wice 3
va berfor\'?fEf@d!lg1?l!l,h1l1hty 0)11 :.:...L,$ 3.00 _
OWNER INST ALLA nON nu\lfl r'~~+M '" 1_Fl('\n_~32-2344 .
The installation is being nwde on E. l\Iiscellaneou~ (Sen'icelfeeder not included)
propeny I o\m which is not intended .Each installmion
for snle. lease or renJ. . Pump '01' irrigntion $50.00
. I\lOTlCE:" Sign/Outline Lighting $50.00
Owners Signature. THIS PERMIT SHALL LlllHted EllergvlRes $25.00
AUTHORIZED UN EXPIRE IFTHEWl)i!tR' Energ,/Collun _$-15.00_
r:g~'!.:~[f'''' . DER THIS PERM/TIfRM
ANY 1"8' ,c;Eu UH IS ABAND01Jmi,n}J, 'ERIlric Permitlns]lectinn Fcc is S-IS.OO + Surchnrge~
o DAY PERIOD ..u rl
. -I. SUBTOTAL OF ABOVE IS"X
70/0 State Surcharge
8% Admini~t..ati\'e Fcc.
:: .'
\.
..'
"
,'#'
. .
'.' ;:
'.-.
,-: -.'.
. _t '.
','
;:-".',n,
,'.
..225 FIFTH STREET. '. ,,_ :.:
SPRINGFIELD. OREGON 97477 '., : ,"c'. .' '
INSPECTION REQUEST: 726.3769.,
P'OFFICE:726-3759 ....,:. . "
"I., Y
L; i.'
. I. LOCATION OF INSTALLATI9N . .
" C;76'1' i2,~p-c-t-."" A.
LEGAL DE,.SCRlPTION
/(j;,OL- Dl..ftl 077(fD
. d has the to\IOwing
JOB DESCRIP~ION ~. nfo'le~~S"bm\\lSep9ci\iClOO!l ~1\"ft. or less
_, J ,= ., fPw'f'Q " ~\jl9qU\fe
{Fin- n;;:. '. _ ~1~O If./ Each addi~nal 500
(20n'0~a\ /...:D' - <1, f. ur ponion
Permits are non.trnnsferable~?,d eXpirtoning- ,0 tit
if work is not stnned within ISO days - ~ Each Mal Home or
of issuance or if work is suspendW e 0 ulnr Dwelling
5 gnaWl
180 days. f~..M,onzeCi \ Service or Feeder
".'
'. ...
\'," ~.
. E~CAL PERIvnT APPLICATION
"., 'City Joh Nunihel'fo'~ ~o,)Lf ':Oc) D '2.2;';
f-.' . ,.
" ~. ..... . " ", :~, t. ,
3. COMPLETE FEE SqIEDULE BELOW. ' .. '..
".....
".,::.
\-'0 I'
!,
.' i.:..~' ~"
"i.c".'
r'.
NewRcsidential-Singl~ or: ". .
l\Iulti-FamiI)' per dwelling unit.
Sen'ice Included:
TOTAL.
.
r. ^'''''.'''''':@Jj'urr'Y'@Jj!
:;"[.~;.;-. . . f).
.,',.' "'i'''-': 4>' :, _ .' ~ .' .,' ~
. 0
. . . . S~_GFIELD
';~~f!)T'Yl";V"OiIo"~. ..... ..' .;"'''i'''-''O''''\'~'''\' '. :'j. "'~l' I'
~~r,"/~,..'i',~.: .. ';~': 'A'~~,::~~"'t ~"'~<.</ .'-;&.:...',
. .~.r,,:> (ji:':::'~~~ 225FIFTHSTREET'
. &"..:~; ..... t;jjP ~ SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
www.ci.springfield.or.us
DEVELOPMENT SERVICES DEPARTMENT
MANUFACTURED HOME SET-UP AGREEMENT
As required by the City of Springfield Development Code; I understand and agree that with the approval 6f
the attached permits, one of the following manufactured homes will be placed at <; ?(".~
. . "-'.rl..'3-P c....lr . Springfield,Oregon, City Job Number ~uro.q-lSl:fbZ.1...
U .
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 of 3 feet in height for each 12 feet in width, that has no bare metal siding or
roofing, and that has been cenified by the manufacturer to have an exterior thermal envelope meeting
performance standards which reduce heat loss to levels eqUiValent~ll)t~pwormance standards required
for single family dwellings at the time of construction. ?/<;f L initials .
. / -V~
Type II M
A unit of not Ie than 12 feet in width enclosing a minimum floor area of 500 square feet, that has a
nominal roof pitc of 2 feet in height for each 12 feet in width, that has no bare metal siding or roofing,
and that has been'ce 'fied by the manufacrurer to have an exterior thermal envelope meeting performance
standards which reduc eat loss to levels equivalent to the performance standards required for single
family dwellings at the' of construction. initials
I fwther state, by my signature below, that I have been provided with the following information:
Manufactured Home Blocking, Water Line Connection, Street Tree Standards, Sanitary Sewer Connection,
Electrical Connection, and Minimum requirements for permanent steps.
I also understand that the manufactured home shall be placed on an excavated and backfilled foundation
not to exceed 6 percent slope within 10 feet of the perimeter enclosure, enclosed at the perimeter with
stone, brick or other concrete or masonry materials approved by the Building Official and with no more
than 24 inches of the enclosing material exposed above grade. .
If.i;/fi.-/d- ~/1-~~L/1/
/~~arure pv= I~~O
/-~1)-61
Date
. .
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
JOURNAL OR JOB NUMBER: Com2004.00022
NAME OR COMPANY: Vincent Zawodry
LOCATION: 5764 Ridge Court
TAX LOT NUMBER: 18020411 t17900
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF; 1782 LOT SIZE (SF):
=
11153
en
~
CI
o
U
~
en
-
c::>
~
1. STORM DRAINAGE
DlRECf RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. I. CHARGE
I 2948.00 $0.290 = I $854.92 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCfED TO CITY STANDARDS
I IMPERVIOUS S.F. I. x I COST PER S.F. 1 x I DISCOUNT RATE I I DISCOUNT
I 0.00 I $0.290 50% ~ I $0.00
ITEM I TOTAL - STORM DRAINAGE SDC '$854.92 ,
5854.92
1070
2. SANITARY SEWER. CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
I 22 I $22.64 5498.08 11091
B. IMPROVEMENT COST: I
I NUMBER OF DFU's I x I COST PER DFU
I 22 I $17.21 = , 5378.62 11092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, 5876.70
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x : NUMBER IOF UNITS I x I COST PER TRIP x INEWTRIPFACfORI
I 9.57 I $17.23 I 1.00 5t64.89 1093
B. IMPROVEMENT COST:
I ADT TRIP RATE I x : NUMBER IOF UNITS I x I COST PER TRIP x I NEW TRIP F ACfORI
I 9.57 I $76.01 I 1.00 I 5727.42 1094
ITEM 3 TOTAL - TRANSPORTATION SDC ~ , 5892.31
4. SANITARY SEWER. MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's 1 x ICOST PER FEU
I I I $314.63 = 5314.63 1054
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I $214.23 = 5214.23 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) (513.88) 1054
MWMC ADMINISTRATIVE FEE 510.00 1056
ITEM 4 TOTAL - MWMC SAN IT ARY SEWER sm = , 5524.98 ~
SURTOT AL (ADD ITEMS 1,2,3, & 4) ~ , $3,148.91 ~ ~I
5. ADMINISTRATIVE FEE:.
ISUBTOTAL I x I ADM. FEE RATE 1= CHARGE
I $3.148.91 I 5% $157.45
TOTAL SANITARY ADMINISTRATION FEE: 103.91 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $53.54 11078
Virginia Jurasevich 1/13/2004 TOTAL SDC CHARGES =, $3,306.36
PREPARED BY DATE
. .
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS
(NOTE, FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
I BATHTUB 2 0 3 = 6
IDRlNKING FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
IINTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0
I LAUNDRY TUB 1 0 2 = 2
ICLOTIlESWASHER / MOP SINK 1 0 3 = 3
ICLOTIlESWASHER.3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP.f1 PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRlG /WATER STATION / ETe. 0 0 1 = 0
IRECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
ISHOWER, SINGLE STALL 0 0 2 = 0
ISHOWER. GANG Q'!UMBER OF HEADS) 0 0 2 = 0
ISlNK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3
ISlNK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLELAVATORY 0 0 2 = 0
ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 = 2
IURINAL, STALL! WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S I
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 22 :1
.EDU (Equivalent Dwelling Unit) is a dischar~ equivalent to a single family dwelling unit (20 DRJ's) set at ) 67 Jalllons per day -
MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE
I"
YEAR
ANNEXED
BEFORE \979
1979
1980
\981
\982
\983
1984
\985
\986
\987
1988
1989
1990
199\
1992
1993
1994
\995
\996
1997
1998
1999
2000
200\
CREDIT RATE/$I,OOO I
ASSESSED V AWE
15.04
S5.04
S4.95
14.88
14.75
14.58
$4.41
14.20
13.88
13.S0
13.07
12.60
12.\4
S!.71
11.52
11.38
$1.19
11.03
10.87
10.68
10.46
10.27
SO.09 I
SO.04 II
'j
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
o
1998
CREDIT FOR LAND (IF APPLICABLE)
VALUE/IOOO CREDIT RATE
$30.18 x $0.46
~ ,
$13.88
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
V AWE /1000 CREDIT RATE
$0.00 x $0.46
o
TOTAL MWMC CREDIT
=
$13.88
~I
-.
. .
. .
. .
. .
", .,'
" .,"
..
Construction Contractors Board
700 Snmmer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.u~
Pennit #:
CL)U1 ~ y - ooc) z...z..
57 bL( 12,- j <; I-~ c... +-
"b ~ / Date: I /-5 0/0 l{
/ 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
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 filed with the permit.
Fill in the al'l"VI',;ate blanks and initial boxes 1 and 2, and either box 3A or 3B:
~1.
-:esr 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 . '2- W
l-hd~
.. (Name)
z
S b63 6
(CCB #)
I will instruct my general contractor 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, T 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 ofthe contractor.
I here~ ~y that the above information is correct and that I have read and do understand the Information
Notii/aZ6ers ;:::z: Responsibilities on the reverse Sid~~t::~'~<1
It/!' (Signa of permit applic~ ' (Date)
ite copy to iSSU~ agency permit file, pink copy to applicant.)
Property_owoer.doc 03/11/03
. .
Adnnng a~ Y ([])UllIr Ownn CGenneIrall CC([])nnttIra~tt([])Ir?
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 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.
lEmployer 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, ynu 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 purposes
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 \0 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 503-947-7H5.
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 lReslPoHllsilbHities am! Areas olf COHllcerns
Code Compliance: As the permit holder fnr 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