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Home My WebLink AboutPermit Electrical 1996-3-7 , . ' ~~pITOjeetQ$lIJilb~'h"~'" , --.... anddoe$nct II' .,-..,., approval. . requ.l! ~ .. Zoning cI f) f-J 225 FIFTH STREET Dote~ SPRINGFIELD, OREGON 97477 Aut~~"'. ~ INSPECTION REQUEST: 726-3769 ~., OFFICE: 726-3759 1. LOCATIj>>J OF INSTAL.J,.<ITION I~~.\ KM"'-f!!:bo-V >1')('. A. LEY>\L DESCRIPTfOft\......, IYX1 0.. TYJ..AJi"\ f<~ ,ll~ vtLl \ \ \J "y,:rrr V ():JIULJ ..10B DESCRIP'qpN /"' .~I""'j rY......<...'I-f ( .\...u......... Permits are non-transferable and expire if york is not started vithin 180 days of issuance or if york is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor il..J !ft.],..., f,b.~ . ~ 0' Address ~cbl ~ (o~ . City C)c.....t. Fhone'I..~bW~' Supervisor License Number ~~ S Expiration Date IO/t?7 I Constr Contr. Number d-O-Icf:r-c ~ /0/1 P I ervising Electrician Expiration Date Na~e ~~ ~M Ulil'\ Address \~\({\ f\ ~~/. "' Ci ty ~\0\v Phone 1"ID (j1{Lf- OVN;R '\N~ALLATION The installation is being made on E. property I own vhich is not intended for sale, lease or rent. Ovners Signature: ;;rn;-------~'1)"T(fVi---.. 5. RECEIPT #: I.. &::J' ~ . t::/" ) RECEIVED BY: () :/ ELECTRICAL PERMIT APPL;Wr9N o:.~ Number o'Sl \}\ \. \ 3. COMPLETE FEE SCHEDULE BELOY Nev Residential-Single or Multi-Family per dwelling unit. Service Included: 1000 sq. ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular 'Dvelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to' 1000 amps Over 1000 amps/volts Reconnect Only C. Items Cost Sum $ 85.00 '$ 15.00 $ 40.00 S 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see II B II above Nev, Alteration or Extension Per Panel One Circuit I $ 35.00 .3s>O Each Additional Cit'cui t or vith Service t.JrP or Feeder Permit ~ $ 2,00 Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 3CJ 00 I .,... ~ 41..l\G- \~ -~- . . Permit#: ~t:>~// Address: /~V5~~,-:""".~ ~A' Issued by:. 4~ Date: 7-/3"~S- , ./,/' Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4), requires residential construction permit appli- cants who are not registered 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 registration under ORS 701,010(7), need not submit this statement, This statement will be filed with the permit, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: [Z] D I, I own, reside in, or will reside in the completed structure, 2, I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D 3A, My general contractor is (Name) Contractor regis, # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board, OR JE] 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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 C:t'ction Responsibilities on the reverse side of this form. ,~~/ / _ 62--~;' /-/ ~ -57 (Signature of permit applicant) (Date) (White copy to issuing agency permitfile, pink copy to applicant) . . ][U1~ormBl~Bon U\IIo~ics ~o I?i'OpsL1ly OWi'iSi'S AIbJ~llI~ COi'is~i'llIc~ioll'il IRssiJloi'isibiii~iss . '. Note: This Information tJotice to Property Owners about Construction Responsibilities . wa.\' developed by the Construction Contractors Board in accordance with ORS 701.055(5), 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 areas of concern, !EMPLOYER RESPONSIBiliTIES: If you hire persons ',/lot registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees, 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 more information, call the Oregon Depl. of Revenue at 945-8091. 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 Division at the Department of Human Resources at 378-3524. 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 may be subject to penalties 'and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' COlT\pensation Di vision at the Department of Consumer and Business Services at 945-7888, 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 more information, call the Internal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: 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 overs pray, water damage from pipe punctures, fire, or work that must be re-done, Time to supervise employees: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, If you have additional quesiions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer SI. NE Suite 300, in Salem, prop-own.pm4 t/94 .8 NO. 1-50<111 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) . NAME OR COMPANY: FteetJ I ,.kA y' ])AV /? LOCATION: /"-?4-5 1(A-IN1b4W PR., I 1()"?Z74-? -tJ"?4-/)O DEVELOPMENT TYPE: LDIC.. - AbOrT/ON BUILDING SIZE: LOT SIZE SQ. Ft. 1. STORM DRAINAGE IMPERVIOUS SQ. FT. 10"2-1 X $0.209 PER SQ. FT. r;-Z\4-"~ '--- ..-/ 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) X $43.26 PER PFU G-) -......-. ----- 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $436. 19 G- ) ----- ----- X X $436.19 $ X X $436.19 $ 4. SANITARY SEWER-MWMC NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADM FEE $ (Use PFU Total From Item 2 Above) TOTAL-MWMC SDC $ G=) MWMC CREDIT IF APPLICABLE (SEE REVERSE) '- ---- SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ ""2.14- c.~ 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X ,05 ~~~c-L Date: , - -0 Kip Burdick SOC Coordinator r., fir" Jqr;, I I 'TOTAL SDC C \O'~) -......-. ..-/ $ -z. 'l? ~:!. .' . .:....../f... . . FIXTURE UNIT <;;ALCULA TION TABLE: Number of New Fixtures X Unit Equivalent =. Fixture Units . . . I ' 10 " ," ~ (NOTE: For remodels; calculate only th.aI additional fixturesl . . ,., , NUMBER OF UNIT FIXTURE " FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS Bathtub.,...,.."......".,....,.".................,.. -..,....,......... -... Drinking Fountain........................o............................ Floor Drain,.,.."..,.,...",...,.."..,..",..."...,",. ,...,......".'" Interceptors For Grease/OiI/Solids/Etc................. Interceptors 'For SandlAuto Wash/Etc.................. Laundry Tub/Clotheswasher.....,.....,.,........,............ Clotheswasher - 3 Or More..,......_..,........................ Mobile Home Park Trap (1..PerT~~iierl..:.~:~.::.:..,:..,.' ." Receptor For Refrigerator/Water Station/Etc........ Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall................................................. Shower, Gang............ ........... ,... .... ..... .............. ,;,..... Sink: Bar, Commercial, Residential Kitchen......................... Urinal, StalliWall........ ,....." ......... ...,. .... ..... ....... ...:.. ... Wash Basin/Lav'atory; Single....,.,.,......................... Toilet, Public Installation.........,.,."............,............ Toilet , Private...........,..",...._",..,.,."..........,.....,:..., Miscellaneous: " 2 1 2 3 6 '", '" ~ 6 6' . 1 " '.. ',3 2 lIHead 2 2 1 6 4 " TOTAL FIXTURE UNITS = CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table, calculate credits separates, '\ Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 1980 1981 1982 1983 1984 1985 $3.46 3.38 3,32 3,21 3.06 2.92 2.73 1985 1986 1987 1988 1989 1990 1991 1993 $ 2.46 2.14 1.77 1.37 0.97 0.61 0.44 0.15 :\ Improvem'l\'t (if after annexation date) X $ (Rate X Assessed Valuel X $ (Rate X Assessed Value) = Credit for Parcel or Land Only If Applicable = CREDIT TOTAL = $ ...... ~_...: " J .. . . --,' ';; ~ . .. ..: I