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Home My WebLink AboutPermit Electrical 1993-4-2 Tho f~'." ~ro'-c' 0"" h .. ~,A", ZC1;r,. _ ....; . ~_. -.c~ ~r: .-I'....m..,.Jcl h~:ih.o io/!c.ying ~.. ... '>- -.. . ...r" f ." .!f' 1-. . . ~ 225 FIITH STREET "i'pro,'c.!.' ." -" c"'lcl""ELECTRICAL' P'ERHIT APPLICATION SPRINGFIELD, OREGON 97477 2c:;:,,[ LPI? 9 INSPECTION REQUEST: 72~Ct3769./ ..~'OZ.. Ci ty Job Number ~n '7 'Z ~ OFFICE: 726-3759 ~ ~-L- ( ~ Authorized Signature-J iYf3. 1. LOCATION OF ~STALLATION 9r-J/.P.AJ~rJp.J11 A. LEGAL DESCRIPTION )'70.~ ~4 // ?;)nc./~ COHPLETE FEE SCHEDULE BELOV Nev Residential-Single or Multi-Family per dvelling unit. Service Included: Items Cos t Sum 1000 sq.ft. or less t---' $ 85.00 2SS Each additional 500 sq. ft or portion ", thereof ~ S 15.00 ~~ Each Manuf'd lIome or Modular Dvelling Service or Feeder $ 40.00 JOB DESCRIPTION t lI/&JJ r:, F~J5 r MT. t:f.A7(. 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 B. Services or Feeders Installation, Alterations or Relocation: Electrical Contractor Address $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only City Phone Supervisor License Number Expiration Date C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number 4-0 Expiration Date $ 40.00 $ 55.00 $ 80.00 see tlDn 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 - Signature of Supervising Electrician volts above Branch Circuits D. Ovners Nallie ---rY=-AlAlIS A)6 /AJAIL_ '/' ST 'Phone -:79C&. - 79 S I Nev, Alteration or Extension Per Panel Address ;I'~ City~V~. $ 35.00 One Circuit Each Addi tional Circuit or vith Service or Feeder Permit $ 2.00 OIINER INSTALLATION The 'installation is being made on property I ovn vhich is not intended for sale, lease or rent.. E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE /~'$.()O 5% State Surcharge - 'i ~ TOTAL J0~.i.::J Ovners Signature: ~~~;~~---~~-7~-~~~-~~~--------- RECEI PT 11: -'-- J , _ ' J(I,( J':.) RECEIVED B'flt ~./ '( AI ) '=-" ) - . '-' .. . lJ.:-<r) J "' . )\O~ -&N ) Date&.1Sfl:3 FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: .11 . 1. I -r-I I own, reside in, or will reside in the completed structure. 2.~ /' 1 understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3. A.I I My general contractor i.. Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR f/l 3. B.l }J'-' I 1 will be my own general contractor. / If 1 hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. If 1 change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understand the Inform' Notice to Property Owners about Construction Responsibilities on the reverse Ide of his form. ./ ,./) 'Y.( .'41#~-ZJNA~ l!~te/S~93 /~gnature of Permit Applicant ...... / ! CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ; . . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: T_hi~ lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by thet1989 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 areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or irilprov!lment 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 Department of Revenue at 378-3390. .i . 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 inform,ation, call the Oregon Employment Division DHR at 378-3224. 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' Compen~~tion Division DIF at 373-7434. 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. Fgr more information, call the Internal Revenue Service at 221-3960. . " 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 overspray, water damage from pipe punc- tures, fire, or work', that must be re-done. I' 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 addition'al questions, write to: , Construction Contractors Board 700 Summer SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89' ,I ,I '",I . .OB NO. q,?o"l-? ~ CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: tJE:.NlJ 17 i D,ANfi- A!OWAI< LOCATION: "10 I P~E3.<;c...OT-r 17o~?<-+ II - 0&&}"2- DEVELOPMENT TYPE: LA?f2. - /Je-IN SrI?- BUILDING SIZE: 1. STORM DRAINAGE LOT SIZE SQ. Ft. IMPERVIOUS SQ. FT. '2.--" II X $0.192 PER SQ. FT. ~ --- ---- 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) '2.-f X $39.78 PER PFU ~q5'fi) 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP C:c.,tll~00 / X I, DOS X $401.05 ---------- X X $401.05 $ - X X $401.05 $ - SUBTOTAL (ADO ITEMS 1,2, & 3) $ (<611 '= 4. ADMINISTRATIVE FEE~ BASE CHARGE (SUBTOTAL ABOVE) X .05 G q;~.!) ~ TOTAL-CITY SDC 1.../3-t..c, ~ 5. SANITARY SEWER-MWMC NO. OF PFU'S 1---1- x $13.62 PER PFU + $10 MWMC ADMIN. FEE $ '??(.,~ (Use PFU Total From Item 2 Above) ~~~ V Kip Burdick SOC Coordinator 2.- .4~/'1~ '10 $ ?O -- TOTAL-MWMC SDC~~ "'- .- TOTAL SDC $ "7....'2-71 '30.!. MWMC CREDIT IF APPLICABLE (SEE REVERSE) FIXTURE UNIT CALCULATa TABLE: Number of New Fixtures X .qUivalent = Fixture Units (NOTE: For remodels, calculate only the NET additional fixtures) FIXTURE TYPE NUMBER OF NEW FIXTURES UNIT EQUIVALENT Bathtub............... .............. ......................................... Drinking Fountain..................................................... Floor Drain................................................................ Interceptors For Grease/Oil/Solids/Etc................. Interceptors For SandlAuto Wash/Etc.................. Laundry Tub IClotheswasher................................... Clotheswasher - 3 Or More..................................... Mobile Home Park Trap (1 Per Trailer).................. Receptor For Refrigerator /Water Station/Etc........ Receptor For Commercial Sink/Dishwasher IEtc.. Shower, Single StalL................................................ Shower, Gang.......................................................... Sink, Bar, CommerciaL............................................ Urinal, Stall/WalL..................................................... Wash BasinlLavatory, Single.................................. Water Closet, Public Installation............................. Water Closet, Private............................................... Miscellaneous: I 2 1 2 3 6 2 6 6 1 3 2 1/Head 2 2 1 6 4 1 1 .,. ? TOTAL FIXTURE UNITS FIXTURE UNITS .,~ 'Z-- 1.- 1.- o.f 1'1- '2-+ CREDIT CALCUUl.TION TABLE: Based on assessed value. If improvements occurred alter annexation date in table, calculate credits separates. II Year Annexed Rate per $1,000 Assessed Value Year Annexed I !. 1979 or before 1980 1981 1982 1983 1984 $2.83 2.76 2.71 2.60 2.46 2.33 1985 1986 1987 1988 1989 1990 1991 L '2. _ <f!?- '2.<'63 X $ 10. '17.- "X/ (Rate X Assessed Value) X $ (Rate X Assessed Value) CREDIT TOTAL = $ 7,., .,~ Cred~ for Parcel or Land Only If Applicable Improvement (if after annexation date) Rate per $1,000 Assessed Value $2.16 1.90 1.60 0.25 0.87 0.50 0.16 ;i J RUNOFF COEFFICIENTS FOR STORM DRAINAGE ResidentiaL...................... ................... ......... ...:: 0.4 CommerciaL......................................:......,:..... 0.9 IndustriaL.......... ............ ......... ............ .............. 0.45 GovernmentaL.............................. ................... 0.5 . IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT