The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2006-6-2 spr FIELD r:::X.3S:::''!:'', ZON L.b2- ~' ,--~. ~;' INITiALS tJ f'/'-' .. ,..:-,~.-. '.. , . .' "'" . '>. -" c '"~'~"~'0 ~~~~CE~~ Date t,-Z-/? (: 22~.FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(S41)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number (' /9VV\. 7 /?/"?&.... /;:?/?/7Z / . . 1. LOCATION OFINSTALLATIOff, ...,. 70 r:>)~~-~~-4b~;~' - - ~ - LEGAL DESCRIPTION 1701cJ"JL( 15000 --L ../ I JOB DESCRIPTION kJ17 Lc.'C-.A,h Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 3. CO~IPLETE FEE SCHEDULE BELOW A. New R~sjdential-Single or~fl~lti-Famil);per dwelii~g uIlit." , ' :. ., '. ,.' " .,.,.... , . . ~;. - ,.., , '. -1'. . ,.. .. , Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 ...~" "c\:. 'iC ," .... :-' ~ :. I -..J .,' ... - .r '. ' 2. . CONTRACTOR INSTALLATION oNrfr B. ,Servj~e'sh~F,~.e~~rJ:r.-:ihstaJ!:J.Hon, Alterationsor Relocation: Eleem,.l Contm"o, /~;, A^",_-r -200 A,.~PS'~;\~C:~;:,::~':o~~,~: $ 6300 . . . / I' '2Ql AII\PM0\4bO~Ar9ps\-\:: \\..." '.\ $ 75.00 . - - ,,\-u'~ ,~,,~ 'J'\Qi\~ Address ,. .,~:" \..4D,i &'!1nis"'t&,6,QQ..AllJ,:J'S:::'-:.',.., ,\0\'\ $125.00 / \ ,-' , i \(.., [\ .),~. -, '\\\11..:2\. OJ J:" ~-.,,'6P~~mps to 1~Q9MPSv\: $163.00 \' r '.\\-' ^^,~-.r1'J\ ()n 'I..-r'~ City Phone ,-:._" ,':.oJ .Q:vw,31::1\:1(j'A~m,-sl.yoifs'J' $375.00 _' \1)\ . '\ ... \ v- \\0.\;10.;;1 ;ib.~~~&f-Ol1Iy $ 50.00 \i"J Expiration Date Supervisor License Number / Signature f Supervising Electrician Owners Name rA~e:s t-f.p....~'^'" u/kl?S~e Phone t:;SV - 872 K' Address 7S, r l>r~ City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: _~~n/1 4rt-- ~'~I- /_#~~. Jv-.I'~I'_-'"'' Inspection Request: 726-3769 C.'Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps . 40 I Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "~\ab,ove. . ., #i\\' \"\,,~.~." D. Branch CIrCUIts . ~~ . \' i.' t.' . ~.,I"'\'~\ ,.. ~1" \f' ., ,..-\\~e~ ~t~~~~!?~dj: E~~~~~&1l\P~r\~bel I \..0 \ 1;~jrC~i(~Dt5\\~' N~\'~\\ . $ 43.00 ''\ \'\\~ . r~~dMi'riP\\lJll\9~U.~. or with I ~\'0\\~, i _~~;~F~~~\t)~lt $ 3.00 \JG\'l\'i'I\ " '0\':: i \-- , ~{~ 'Miscellaneous (Service/feeder not included) -Each Installation 1I) -;> 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. SuBTOTAL OF ABOVE '{to :r6~ l/6D St(' z e 8% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/Eleclncal Pennit Application I-06.doc . Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00026 ISSUED: 04/06/2006 APPLIED: 01/05/2006 EXPIRES: 12/02/2006 VALUE: $ 10,400.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 757 BLACKSTONE ST ASSESSOR'S PARCEL NO.: 1703233413000 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Alteration PROJECT DESCRIPTION: Replace carport w/ garage & add breezeway roof Residential Owner: Address: HANNUM JAMES W & MARY A 757 BLACKSTONE ST SPRINGFIELD OR 97477 Phone Number: 541-554-8728 Contractor Type Electrical utO u\~e5 \f0 .' ~,., \a\N ~eq _r<r\f\ \J\I\It\f . -nON', UI V~~,.\ h\/ \De v' ~ -::.0 c:;e\ iUI '" P. -rn::.N\ CQ1N5rRNc.1QR,IN\F0R'M~'f,'~ 'o\~~\N ~'\oO\l ce\l''-<=: . \D~OUg\ \J' p..~u\e5 u ContractoAo\I'lcat~5'2._001 -001 ~\I cop\e5 0' ~'&J~~ose> OWNER \~~~~. ::' \ rna~ ~~:~. \~$)\~;~~~~: ~r<ti\\Ca\\O\l a\\\h(BliJIILDlN.6(WJilORMA.1BIOO I c ~ iU\ ,., 8IJU-')"- urn'oe \pJ. \5 1- \I C#foMStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Expiration Date Phone # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: occu~~i.oad: _"e ~ _:\ I DEVELOPMENT INFORMA TIOI~{,..t\\\t. \\'\\~\\ \S ~\; ~~ c.~~\..\' "-rU\S?t: c.$ ~\J'kEQUlRED PARKING \~'\\" . ~I\\\ ~ ~\\ \ p D\J~~ OvertaY1'Js~~\\\\I\ '0~\) ~\)~~ Total: # Strelt\1\~e ~g~\) \) \J\\ \S ~ Handicapped: Paved ~~ ~<re~~t: ~ ?\:.\\\\J . Compact: % of Lo ,a&s:\) t:\ ~~'{ n/a R-3 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 12.20 I PUBLIC IMPROVE MEINTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes Sidewalk Type: Downspouts/Drains: To Storm Sewer Notes: Storm drainage piped into existing to stub 1/10/2006 CAS I Valuation Description' Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Bid Amount Bid Amount Use Bid Amount Use Bid Amount Fee Description Plan Review Residential + 10% Administrative Fee + 8% State Surcharge Building Permit Plan Review Residential SDC Sanitary/Storm Admin Storm Drainage Impervious Area + 10% Administrative Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Initial Review Plannin2 Review Public Works Review Structural Review CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00026 ISSUED: 04/06/2006 APPLIED: 01105/2006 EXPIRES: 12/02/2006 VALUE: $ 10,400.00 $1.00 $1.00 4,600.00 5,800.00 Total Value of Project $4,600.00 $5,800.00 $10,400.00 01/05/2006 02/09/2006 ~ Amount Paid Date Paid Receipt Number $44.46 1/5/06 1200600000000000017 $11.52 4/6/06 1200600000000000422 $9.22 4/6/06 1200600000000000422 $115.20 4/6/06 1200600000000000422 $30.42 4/6/06 1200600000000000422 $1.62 4/6/06 1200600000000000422 $32.30 4/6/06 1200600000000000422 $4.60 6/2/06 1200600000000000782 $3.68 6/2/06 1200600000000000782 $43.00 6/2/06 1200600000000000782 $3.00 6/2/06 1200600000000000782 01/10/2006 01/10/2006 01/10/2006 $299.02 I Plan Reviews , 01/10/2006 APP SKG 01/26/2006 APP TAJ 01/10/2006 APP CAS 02/09/2006 APP DLM No Planning issues. Impervious for Breezeway only 1/10/2006 CAS See documents for Plan review comments 01/10/2006 To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. l..Reouire~nsDections I Foundation: After forms are erected but prior to concrete placement. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Firewall: Located and constructed according to plans. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Pa2e 2 of 3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00026 ISSUED: 04/06/2006 APPLIED: 01/05/2006 EXPIRES: 12/02/2006 VALUE: $ 10,400.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. ~A ~-o-"--'----: &--Z-C/h ~ner or Contractors Signature Date Paee 3 of 3 . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address: 7 S 7 Permit #: C.l>M z.o,- ~ :.. 000 Z-b Elk~~k~, '1'\ (f Date: blz-~ b I / Issued by: Statement: Inf~rmation'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 cdn be. issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed'o.rchitect 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ~2. Iown, reside in, or will reside in the completed struc~e. 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 ~3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. IfI change my mind and hire a general contractor, lwill 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 Construction Responsibilities on the reverse side ofthis form. .. ~A .~~_~~. ~-Z-ab / (SIgnature ofpermlt applIcant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 Acting'Cas '"our: Own 'General Contractor? '.1 r '; '. ';INFORMAT'iON NOTICE TO PROPERTY OWNE~S . i A~P':JT CONSTRUCTION 'RESPONSIBILlTIES,. 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'oi'"make a subs~tial improvement to an existing structure, you can prevent many problems by being 'aware of the following responsibilities and concerns. .','\. . Employer 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 lic~nsed with UJ-e Construction ContI:ac~orsBoard'to do labori'n cO!lstructing or to assist in the construction or, ilup.ovement of a residential structure. 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 Depar1:rrlent of Revenue at 503-3784988. ' 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. ~- The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.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 insur~nce. for your employees. If you fail to obtain workers' compensation insurance, you could 'be subject to penalties aIld be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Divisiort 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' wa~ 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 r.800.:829-4933or visit their web site ,at www.irs:l!ov. ,., ' Other Responsibilities and ,Areas of Concerns ' Code Compliance: As the permit holder for this project, you are responsible for resolving 'any failure toti1eet code requirern,ents that ,m~y be brought t~ yo,:!r attention through inspections. Liability ahd Property~ Damage Insurance:', 'Contact':youi' 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 ha~e sufficient time to supervise your empl~yees," J '.; \ , ' , ' Expertise: Make sure' y~u h~~e' the' ~killsio ~~f as' your oWri g~neralcontract'or; to coordimite: 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 06-01-04 225 Fifth Street Springfield', Oregon 97477 541-726-3759 Phone fit . of Springfield Official Receipt 8k~elopment Services Department Public Works Department Job/Journal Number COM2006-00026 COM2006-00026 COM2006-00026 COM2006-00026 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200600000000000782 Date: 06/02/2006 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + 10% Administrative Fee Paid By JAMES HANNUM Item Total: Check Number Authorization Received By Batch Number Number How Received DJB 145732 In Person Payment Total: Page I of 1 1I:57:15AM Amount Due 43.00 3.00 3.68 4.60 $54.28 Amount Paid $54.28 $54.28 6/2/2006