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Home My WebLink AboutPermit Electrical 2006-5-16 S.FIELD ZON L'D'2-.. ~~ INITIALS 'l'l' ~ ~. . DATE.5 ~ ~1 -<)(" . . ""JI "" SOURCE ' . /_ /. ~-~Ut-~ s:/ fJ/ 6 c::. -..J I' ...... ..1' .~, .. ~ -, - ..~ ~ - . ,.., .... -. , 3. . ~211f!',LETEF!!E.~CHEpULE BELOlY .' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 7~r- LlI r"";;!:. 601 Am~S}~~lq~.\\N\I~~'~ Phone ,)\fOulf,t.:.? u i\12,ver,zIOOO:AmpslYoltsN\YI 1~1'3 I't.RW\\\ Sn D'R:e~qnn€cf0~Y'~\ \ r\~'O i\UW~\lt.D UNa ~~~B'~Q9~~~. .; . . - .... .-.-. - ;yj'M~~~t.~ ~~R\u6~1!~~I}..~~rvic"~'?~l':eed_e~~ u _ /p.\il'{ \ Inst~llation, Alteration or Relocation / 200 Amps or less Constr. Contr. Number . 20 I Amps to 400 Amps / . 401 Amps to 600 Amps Expiralion Dale ~ Over 600Amp~ or 1.000 ': o~ts se~ "B". ab?ve. Signature ofSu rvising Electlician D. _.~~~nch ..c::i~c~its._ _. .. . _. __._.... New AIterotion or Extension Per Pansb 'f One Circuit <Jci\le'!> '1_ \ \\\.~'l$i.\43.00 l(") Each Additional Circuit or,wlrhOle~v'. cJ'}\ \0\,. _ Service or Feeder Pemfit'~ \'(\e _ "Ie '!._f)}$ 3~0 .s .. _ ;i\O~.O~~~C?;~~I\)~-o!>-'i'~~\>\~,!>\J. ...- E. l\1isc'ellaneolis\Ser\,i.!.1/feede't not,il'lcludedp-t);;ach Installation i"\ ':_'~"""C;:e",""",O\\"~ 1.0"''' ~-e'fJv.. i!.,o" ..... ,n\\O'll "r/0 ,JJJ. C09 . ~,e \~\C?:' Pump..or)rrigation'"l. O'OW$\ I~OW' ....__, ~O. $ 50.00 ...\0\\\ :-. 0('"''''' '\I ~ \: \.)\.\". f1.t.\~ I" SigiVOutline Lighiing ,,\\3' ,,0" n D." $ 50.00 V\ V" ,,"{o'"" 0 ...,.0 '"',e'::l 'j,,)"'- Limited<EnergylResidential ,'O,)lY $ 25.00 $.... ~..\\"~ 'o~ \.\. _ '.~ .. Limited Energy,lG:ommetcial $ 45.00 0.'\\"~' (,\3\\- Minimum Elec~ric Permit Inspection Fee is $45.00 + Surcharges lfb 3l:>K I..{{,O ')'{2.-6 ELECTRICAL PERMIT APPLICATION c;. Z City Job Number Co......z.c::>o6 - 005 1. LOCATioNOFiNSTALLATION.' .. . .. . ~"'t- . .. .._"..... _... . - .. -".,-'.~'---' . 8> 't t.( a,^~",.4-l-r S LEGAL DESCRIPTION /7D3273f 00((2 JOB DESCRIPTION Jdd 2- c.(~~\ ~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. . -"(' ~ .....,~ '. ':0'. . . 2. . C.O~RAcrOR IN~TA!'/..AT!..oN ONLY Electri~~;con~:ct~:O;'~~~ Address wcJ W. O,^'Y1u-ef s+- City C::r-,...J:.JJ - f' \J Supervisor License Number Expiration Date Owners Name a;-/~ 4Je~ Address Q<-ft.( W. (3U.-I ,;y~-;;:r- City '59('1 I".'J r:,~Phone ,"J0J er I ~ OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. 07Y7t:a77 ~.~U{~L Inspection Request: 726-3769 Date A. :.:~ew.R,s~de~Jial::- Si~gie or lVIUlti-F~n~~y ~er d'~el~~;~_un~. _ , Service Included 1000 sq. ft. or less Each additional 500 sq. ft. Dr portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. ' Services or Feeders. - Installation, Alteratiolls or Relocation: $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 .. ." $ 50.00 $ 69.00 $100.00 ""~. ". 4. SUBTOTAL OF ABOVE . c _ ~. ,. -"'- . 8% State Surcharge I 0% Administrative Fee TOTAL Shared Drive(T:)/Building Fanus/Electrical Permit Application I-06.doc DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE 1 I 0.00 I $0.323 = I $0.00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE 1 I I 0.00 I I $0.323 I 50% = I ITEM 1 TOTAL - STORM DRAINAGE SDC SO.OO' 2 SANITARY SEWER - CITY . JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS L STORM DRAINAGE A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 4 I CITY OF alNGFIELD SYSTEMS DEVELOPMEevORKSHEET " I~ Cl 18 ~ 10890 !:: en G ~ COM2006-00392 Charles Anderson 844 W 9uinall 1703273100112 SINGLE FAMILY RESIDENCE o BUILDING SIZE (SF: o LOT SIZE (SF): DISCOUNT $0.00 $0.00 11070 COST PER DFU $25.07 $100.28 11091 B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 4 I $19.07 ITEM 2 TOTAL - CITY SANITARY SEWER SDC $76.28 r I 1092 J l I 1093 1'-'. - - ,. I i094 1'--' I I 1054 I =, $176.56 3_ TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x , NUMBER OF UNITS 1 I 9.57 I I 0 B. IMPROVEMENT COST: ,_.. .,., I ADT TRIP RATE I _ x I NUMBER OF UNITS I I 9.57 I ' -:. I. . 0 I ITEM 3 TOTAL - TRANSPORTATION SDC 4 SANITARY SEWER, MWM~ A. REIMBURSEMENT COST: INUMBER OF FEU's 1 x I 0 ICOST PER FEU I $82.03 = SO.OO B. IMPROVEMENT COST: INUMBER OF FEU's 1 x ICOST PER FEU '0 I $865.31 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, . SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5_ ADMINISTRATIVE FEE: ISUBTOTAL x I ADM. FEE RATE 1= I $176.56 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Cheryl Slaymaker 4/4/2006 PREPARED BY DATe . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EOUIV ALENT UNITS rBATHTUB 0 0 3 = 0 IDRlNKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE lOlL / SOLIDS / ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND / AUTO WASH I ETC. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER / MOP SINK 0 0 3 = 0 ICLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) I 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. I 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. I 0 0 3 = 0 I SHOWER. SINGLE STALL I 0 0 2 = 0 I SHOWER. GANG (NUMBER OF HEADS!. I 0 0 2 = 0 I SINK: COMMERCIAI.JRESIDENTIAL KITCHEN I 0 0 3 = 0 I SINK: COMMERCIAL BAR I 0 0 2 = 0 I ISINK: WASH BASIN/DOUBLE LAVATORY I 0 0 2 = 0 I ISINK: SINGLE LAVATORYIRESIOENTIAL BAR I 1 0 1 = 1 I URINAL. STALL / WALL Ie 0 0 5 = 0 I TOILET. PUBLIC INSTALLATION I 0 0 6 = 0 I TOILET. PRIVATE INSTALLATION I 1 0 3 = 3 I MISCELLANEOUS DFU TYPE NUMBER OF EDU'S j 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 4 :EDU (EQuivalent Dwellirm Unit) is a disc~ eQuivalent to a siOluefamilv dwelling unit (20 DFlfs) set at 167 ~Ions per day . MWMC CREDITCA"LCULATION TABL"E: BASED ON COUNTY ASSESSED VALUE CREDIT RATEI$I,OO~ ASSESSED VALUE . $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 I YEAR ~EXED r-- BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 19% 1997 1998 1999 2000 2001 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 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE /1000 CREDIT RATE SO.OO x S5.29 !I I ~, SO.OO CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE /1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT SO.OO = e.' \, ../ ". ..' . 'Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: (..OVV'\ _ b - (,) 0.3 9 Z. QV.llAA. 11- Date: ~/I sj (j b Issued by: '6Lf~ V D~ Address: 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. FilI in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ 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 ~B. I will be my own general contractor. If! 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Constructio~esponsibilities on the reverse side of this form. ~ 5 75:-cJ~ (Signature ofpermi(applicant) (Date) . (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 06-01-04 'A~~nWl~ ~~ -A1ini OWIDl ([;eIDlell"~n C'IDl~Il"~~~@Il"? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Infolmation 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. lEmjp>lloyeJr Re!ljp>olID!ln]bJm~fie!l You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors nqt 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 'fax Law: As an employer, you must withhold income taxes from employee wages at the time employecs 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 purpo;;es- 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 nwnher 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 appropriate 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 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 1-800-829-4933 or visit their web site at www.irs.l!ov. (())~lIneIr lRe~Jl)l[]Im~nlbfinfitfie~ llllllllrll AIr'elllS OJ[ <COnniCeIrnn~ Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that ~ay 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 app' vp' ;ate 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 Springfreid, Oregon 97477 541-726-3759 Phone .1iiL~ <;& of Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 COM2006-00392 Payments: Type of Payment CreditCard cRece;ntl RECEIPT #: 1200600000000000653 Date: 05/15/2006 Description + 10% Administrative Fee + 8% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Stonn Admin Building Pennit Vent Fan Fixture Minimum/Adjustment Plumbing Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 8% State Surcharge Paid By CHARLES ANDERSON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 015823 In Person Payment Total: Page I of I II :56:28AM Amount Due 28.34 3.68 4.60 43.00 3.00 100.28 76.28 8.83 185.40 14.00 42.00 3.00 39.00 10.00 22.67 $584.08 Amount Paid $584.08 $584.U8 5/15/2006