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Home My WebLink AboutPermit Electrical 2004-3-11 ~~~~~:~:9J 'S>~' ,e~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-36~~~\lo.\l\< ELECTRICAL PE~! !P/LlCATION ~\o...\t'-9J1~~: ",0\ \. City Job Number ~/S5Date '\~.~~9J' .",0 l.v" ;.,10.\ ~'(\Q, t _.~-,,--~~-~-~ -. .... ~ - --'---" " ... ";'-- .~-- -' ~ rf},Q - .:1..:ot" '\ 1. t:L()cAtIONOiIN~rAfiA.1'!ON';< : 3. 'J:01l1.J>iJ~T.EF,EJ!SCHEDV LO 1:'.'.,/" ..,...,.:..,.. ~--JI- ~' -r-'-.---- ,~--.-,...- -_. 'p7.\e -- .o~:~",.\\l'" . '"-.--. - LEGAL DESC~ION IV- 11 A. l.Nk,,: R~~ill~niiaI2 Sifjgrtb~'l.j\.lulii:F~rriily per' d',':efIiitg,~nit. . .,...__. ___I.<- .~~~_ :1.4.. ..........~_~ ___ __, . ._,.-;.-' ___'_'_ .~_., ,~~. .',.1 ,.,h .l'1/)*5 :2.<!:i _3'- OI':UJ1? JOB DESCRIPTION PA'MD1Jd/~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 200 Amps or less $ 63.00 201 Amps to 400 Amps $75.00 401 Amps to 600 Amps $125.00 / 601 Amps to 1000 Amps $163.00 Phone Over 1000 AmpsNolts $375.00 // Reconnecl Only $ 50.00 A NTION:Oregon laW requl~e~~tt;:-._,_:-_.. .' -----; -,-- ~- -,--.---, SupelVisor License Number',\ ~ _ _ ~""....tp.d bv the 0 0.~sef16wJemces .or!..!~",.~__; . ..._.. i..L _. '. ..J o ow v.~- - , Those rules ar T ation center. 010 oe?no .lotl Ie _._ "",-1'1'10 thrOugh Installationl Alteration or Relocation n U/,\n ,,~'- -'- . s of 'ho rules Y obtain COple 200' Amos or less )090 YoU ma t . the tnTep,nonl:l .:.. _ ....~ ~o....tp.r. (No e. 20I.A!))P.MI'1400 Amps ''''"''b''''r i'~~ the Oregon Utility 1'481'~7;~s to 600 Amps nUm e . p(\(\_QQ?-2344). _. _'M'~ 1- .. Over 600 Amps or 1000 Volts see "B" above. !:""" __ - --~. ....-- _.~ ........ ~_. - - - ";'I ------ - -. - .~--- D. k~rane~_~i~euil<.__ _ __ _.._~ ,_ __._ "-"_.- ____~ New Alteration or Extension Per Panel One Circuit V"'" $ 43.00 Each Additional Circuit or with SelVice or Feeder Permit ~- -----:-......., -:..'._~....., --"-' -~_ -1 2. " qPr[rR,-49'I:OR. INSTALLATION. ONLY: '--.;t-,-__~, - _________,',.___ - , E1eetrical Contractor / Address City Expiration Date Signature of SupelVising Electrician Owners Name Ala<<iLL /j l/A'BC Address /4-h 1- QlI INA-t..r City --5,tlpJ Phone 71-J,-IJIt;7g ~.~. , OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. v~bM~ /' ,- \J Inspection Request: 726-3769 Service Included 1000 sq. ft. or less $106.00 Each additional 500 sq. ft. or QI( portion wc;r~nfi-, "nmc I~ itlEW'9.\Jo' ~U \I""" ~r.,LL EI'rn'" S NOl Each 1j\!1l'5l\C\:a).i~Tn? r 1=1'1 1\-1\S PERM\1 ~R Mod~:'I{\J'~'\'l\t!1is. . l\JrS r.,er.,NDONE.D r$50.00 Feeder ME.NeE.\) OR I r,~ : - _COM "T1t.,:,OlE.RIOD. ._,- -- ~'---;- , - d' B. t\~~~~r1f&~~! __~nstall~t~~n~A~:,~ons 91' ~~c1oc~tioIl:. $ 50.00 $ 69.00 $100.00 '2 4~(JD ~ 6~# $ 3.00 r--:-- -~. - -;------- ....._--'~. - - -.,....--.,:--. E. . Miscellaneous (SerYiee/feedernol inCluded) -Each InstallalIon .-. '. . ....~..:........--._- -_. .._. ._-'-- ----- ._--~---- -_.- _.::--~_.j Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ...--- -. .._--- -~--- ------- 4'.~D . . f:J .~. 4..""0 ~~3 4.: SUBTOTAL, OF ABOVE ,. ,--...._---~~,_._-,_._- .- 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:}/Building Forms/Electrical Permit Applic::ition 1-o3.doc CITY OF S!GFIELD SYSTEMS DEVELOPMEN'-ORKSHEET JOURNAL OR JOB NUMBER: Com2004-00 155 NAME OR COMPANY: Merril Bur'!.e LOCATION: 1464 quinalt TAX LOT NUMBER: 17032532111200 DEVELOPMENT TYPE: SFD Addition NEW DWELLING UNITS 0 BUILDING SIZE (SF' 0 LOT SIZE (SF): T STORM DRAINAGE DIRECf RUNOFF TO CITY STORM SYSTEM I tMPERVtOUS S.F. x I COST PER S.F. CHARGE I t 80.00 I SO.290 I = I $52.20 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCfED TO CtTY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I DISCOUNT 0.00 I SO.290 I I 50% I ~ I $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC S52.20 o I I'" I~ 10 I~ I~ 15 ~ S52.20 1070 2, SANtTARY SEWER - CtTY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I COST PER DFU I 6 I S22.64 ' S135.84 1109t B. IMPROVEMENT COST: I I NUMBER6 OF DFU's I x COST PER DFU St7.2t S103.26 11092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , S239.10 I 3. TRANSPORTATtON A. REtMBURSEMENT COST I ADT TRtP RATE I x I NUMBER OF UNITS I x I COST PER TRtP x INEW TRIP FACfORI I 9.57 I 0 I I St7.23 I 1.00 I SO.OO 109J B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNtTS I x I COST PER TRIP x INEW TRIP FACfORI I 9.57 I 0 I I S76.01 I 1.00 I SO.OO 1094 ITEM 3 TOTAL-TRANSPORTATION SDC = , SO.OO 4. SANtTARY SEWER - MWMC A. REtMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I I S3 t4.63 = SO.OO 1054 B. tMPROVEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I I S214.23 = SO.OO t055 MWMC CREDtT tF APPLICABLE (SEE REVERSE) SO.OO 1054 MWMC ADMINISTRATIVE FEE SO.OO 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER So( = , SO.OO _I SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , S291.30 -I 5, ADMtNtSTRATtVE FEE: '1 ISUBTOTAL I x I ADM. FEE RATE I~ CHARGE I 5291.30 5% St4.57 TOTAL SANtTARY ADMINtSTRATION FEE: t4.57 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: SO.OO 11078 Virginia Jurasevich 2/12/2004 TOTAL SDC CHARGES = , $305.87 PREPARED BY DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATlO~ TABLE NUMBER OF NEW RXTURE$ x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE, FOR REMODELS. CALCUL\ TE ONLY THE NET ADDITIONAL AXTURES) NO. OF FtXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 = 0 IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 I INTERCEPTORS FOR SAND/ AUTO WASH / ETC 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER / MOP SINK 0 0 3 = 0 ICLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 = 0 IMOBILE HOME PARK TRAP (l PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRtG / WATER STATION / ETC 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC 0 0 3 = 0 ISHOWER, SINGLE STALL 1 0 2 = 2 ISHOWER, GANG (NUMBER OF HEADSl. 0 0 2 = 0 ISINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LA V ATORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTtAL BAR 1 0 1 = 1 IURINAL, STALL/WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOtLET, PRIVATE INSTALLATtON 1 0 3 = 3 MtSCELLANEOUS DFU TYPE NUMBER OF EDO'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 6 I .EDU (Equivalent Dwellin~ Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day -I MWMC CREDIT CALCULA T10N TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDtT RA TE/$ t ,000 I , ANNEXED ASSESSED V AWE IS LAND ELGlBLE FOR ANNEXA TtON CREDIT? 0 BEFORE 1979 15.04 I (Enter I for Yes, 2 for No) 1979 IS.04 I tS tMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? 0 1980 14.95 I (Enler t for Yes, 2 for No) 1981 14.88 I BASE YEAR t979 1982 $4.75 I '983 14.58 I CREDIT FOR LAND (IF APPLICABLE) 1984 $4.41 VALUE / 1000 CREDIT RATE 1985 $4.20 $0.00 x $5.04 = , $0.00 1986 13,88 1987 13.50 CREDIT FOR tMPROVEMENT (IF AFTER ANNEXATtON) 1988 53.07 VALUE/IOOO CREDtT RATE 1989 12,60 $0.00 x $5.04 0 1990 $2.14 '99' $1.71 ]992 SI.52 TOTAL MWMC CREDIT = $0.00 1993 Sl.38 1994 $1.19 1995 11.03 1996 $0.87 1997 $0.68 1998 $0.46 1999 50.27 2000 10.09 2001 $0.04 .~. I). . . \. ,f '. .' . .' . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.eeb.state.or.us Pennit#;~ ~/S".5' Address: J4t,4'- l:Jij/#A-Lr Issued by: Date: 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, ele~trical, 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 app,vp,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~l. N 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 ~tfN E r:{J2Dc::.) (Name) 7~/7L (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR / }!:Uq/flIC/'rL 'f flI.JJMT3/N4 J8l. 3B. I will be my own t;efleflll contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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 int< mation is correct and that I have read and do understand the Information Notice ~{tf .perty Owners about truction Responsibilities on the reverse side ofthis form. y /Vt\}~~.!-- ,5-),1.1/4 / '\., (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/11103 ". ... ... ." '. ,'~ . . .:. ~ . \ . Adnnng ~~ 1{ ~1illIr Ownn GenneIr~n CC~nnttIr~~tt~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 Respon.snbiRitftes You will, in most instflnceS, 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 Withholdi!lg 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 Insljrance 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' Compens'ation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and musfobtaip'.workers' compensation insurance:fQnyour.emploY~es; ..J:fyou 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 actu~lly withhold the.tax; I:or.~ Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. ,.....,.;-.,,,_. i- ..,'. -;.......... , Otlhter ResponnsibiRities an.d Areas of iColl1cems Code Compliance::: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that rnay 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. I \ . Time: Make sure,y01.hhave,sufficient time to supervise your employees: .' , . k.. 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 03/11103