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Home My WebLink AboutPermit Electrical 2007-9-10 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number [0 "'^ "Z,.O(:) 7- 0 ( "3 '7 3 Date 1. 3. 5'S r SO, If ~ hT 6'P rL.. 0, D t2" 6 LEGAL DESCRIPTION: J7D232SL( Ob"tOO JOB DESCRIPTION: It:> O~" S ~\lL I ~ C l r c..,^7"' Permits are non-transfent~le an~ expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. E]ectrica] Contractor Address City Phone ::::::;~: :~::n" Numb., J It" o Constr. Contr. Number Expiration Date Signature of Supervising Electrician ;[p>.. w es p,. 1 t?-)I C'Ce M Owners Name ~ Address e~;( 47 City C, .p F 1-- IV r-<? /) ~ Jf" 2... Phone 6 f? e r" 1l{b - 57' z.. OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Ownljrs Signature: " 1 , _/"ff ~ ~ /L. (j /A./VL./JI L1 LJ A (J - ' t Inspection Request: 726-3769 A. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or \ portion thereof Each Manufact'd Home or Modu]ar Dwelling Service or Feeder $] ]7.00 $ 21.00 $55.00 B. 200 Amps or less 201 Amps to 400 Amps 40] Amps to 600 Amps 60] Amps to ] 000 Amps Over 1000 AmpsN o]ts Reconnect Only c. ATTENTION: OreQMJt.wim9wrmJlmt ~ Relocation fellow--ft;fJes adopfecf5y"tlie OregonUtiJitY Notification Center.2tN1&wMeft're set forth in OAR 952-001-00l0It~g"tpG~1. 0090. You may obtabnl ~slltcOfltbe\f$s by calling the cente~.. N : e tele number for the Oni Center W.1 New Alteration or Extension Per Panel One Circuit Each Additiona] Circuit or with Service or Feeder Permit .2 E. , $ 70.00 $ 83.00 $]38.00 $] 80.00 $4 ]3.00 $ 55.00 7{) $ 55.00 $ 76.00 $] 10.00 $ 48.00 $ 4.00 f' Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited Energy/Residentia] $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges ~ 78 NO. ~6tate Surcharg~~n~E IF THE WORK "'elf THIS RfiR~A~~~/l'lee" 7110 AUTHIDfqIIID.mlM~PelHIS PERMIT IS NOT 3 po COMMENCED OR IS ABANDONED FOR 9.5 !!L ANY 1~~fa~~b~R(T:)lBuilding FonnslElectrical Penn it Application 7-07.doc CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01373 ISSUED: 09/10/2007 APPLIED: 09/10/2007 EXPIRES: 03/10/2008 VALUE: Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 559 S 42ND ST ASSESSOR'S PARCEL NO.: 1702323406400 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: 100amp service and 2 circuits in pump house TYPE OF USE: Repair Residential Owner: JAMES R & SYBLE R JANECEK 1999 REV Address: 559 S 42ND ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical License Contractor OWNER BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: U Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: An-ENnON: Oregon law req"Vb&,fJ1:. . . follow rules adopted by the 0M[8R'UflliYllldmg. n/a .-.UlIlllil:tllbn ",emel. I n.~ J,~ r~1l1'h!~ ~lT InOAR952-o01-0010t~FORMATION I 0090. You may obtain copies of the rules by Frontyard Setback: calling the center. (Note: the~t: Side 1 Setback: number for the Oregon UtilltyJ~9.W~~s Rqd: Side 2 Setback: Center is 1-800-332-~M Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: Phone Number: 541-746-5792 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: NOTICE: . THIS PERMIT SHAll EXPIREYf~waWKains: AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pae:e 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01373 ISSUED: 09/10/2007 APPLIED: 09/10/2007 EXPIRES: 03/10/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.80 9/10/07 2200700000000001418 $3.90 9/10/07 2200700000000001418 $6.24 9/10/07 2200700000000001418 $8.00 9/10/07 2200700000000001418 $70.00 9/10/07 2200700000000001418 Total Amount Paid $95.94 I. Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections 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. I Reauired Insoections I Electric Service: Approval required prior to utility company energizing service. . Final Electric: When all electrical work is complete. Rough Electric: Prior to Cover 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 timces during construction. . . /A~I"'_L K- () /'IM~ '1 -//3 r" 0 7 - V Owner or Contractors Signature Date Pae:e 2 of 2 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: Permit #: CO VV\. Z-crc 7 --- 0 I'~ 7:> . 4 7-~ ~f- Date, r~/()7 5~~' '~ s Issued by: 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 thefollowing statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbingjJermits. Licensed architect and engineer applicants, exemptfrom licensing under OR~ 70j,~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: .cPl. fr2. 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 off~red for sale before Or on completion. D 3A. My general contractor is . I (Name) (CCB #) I will instruGt my general contractor that all subcontractors who work on the structure must be licensed with the Cons~ction Contractors Board. OR .~.J2r/3B. I will be my own general contractor. If I 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 ~hat 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 of this form. (/~ ^- (f~ 9 ~/() ~07 () (SignaturJl~{permit appli~ant) (Date) (White copy to issuing agency per~it file, pink copy to applicant.) . Property~ owner. doc 06-01-04 . \~ A~ting~as'Vtro.ir' eneral Contractor? . ..,. - \ ~ . . . . . ~ ."'\ . INFORMATION -NOTICE PROPERTY OWNERS , " , A~9UT CONSTRUCTION RESPONSIBILITIES NOTE: Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Cpntractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your O\Vll contractor to construct a new structure, you can prevent many problems by being aware or make a substantial improvement to an existing fonowing respons'ibilities and concerns. Employer You will, instances, be ruled to be an,"employer" you use cO'(ltractors not licensed with ,~e Construction construction or jmprovement of a residential structure. As c.ontractors you contract wi th will be "employees" if to do labor in constructing or to assist in the employe]!', you must cO;Rlply with the following: Oregon's ' Tax Law: As an employer, employees are You be li.able for the tax employees. For more information, call the Departllent , ' . must withhold income taxes trom employee wages at the time even you don't actually withhold the tax from your 503-378-4988." ' Unemployment Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of an employees. For more information, can Employment Department at 503-947-1488. , The Unemployment appropriate forms. ", :. ~ ....... Identification Number (BIN) is a number for both Or~gon' W~thholding and " To file for a BIN, can 503-945-8091 or wvvw.dor.state.oLus/formsuav.htmll for the . ;.. ).: Worken' Compensation Insurance: As an employe:r~ you are and mu~tobta~n workers' compensation insurance for your insurance, you could be' subject to penalties Hable job. For more information, call the Workers' Compensation Services at 503-947-7815. to the Oregon Workers' Compensation Law, ,'., you. fail to obtain .workers' compensation cosJs if one of your employees is injured on the at the Department of Consumer and Business ' U.S. Internal Revem:H~ Service: As an employer, you must You will be liable for the tax payment even if you didn't IRS at 1-800-829-4933 orvisittheir web site at wvv'w.irs.2ov. federal income tax from'employees' wage~_ the tax. For a Federal EIN number, caB the Responsibilities Concerns Code Compliance: As the permit holder for this project, you are requirements that may be brought to YOllr atte~tion for resolving any failure code Liability Property Damage Insurance: Contact coverage;Jor accidents and omissions such as falling tools, work thiiffuust be redone. insurance' agent to see 'if you. have: adequate insurance over water damage from pipe punctures, fire or Time: Make sure you have sufficient time to supervise your Expertise: Make sure you have the' skills to act as your own and finish trades, and to notify building officials as contractor, 'tocootdinate work of rough-in so they can perform the required inspections, If you have Box 14140, Salem, questions call the Construction 97309-5052. (503-378-4621) or the agency at PO Property _ owner. doc 06-01-04 225 Fifth Street Springfi'eld, 'Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01373 COM2007-01373 COM2007-01373 CO M2007 -01373 COM2007-01373 Payments: Type of Payment Cash Change Job/Journal Number COM2007-01373 COM2007-01373 COM2007-01373 COM2007-01373 COM2007-01373 Payments: Type of Payment Cash Change cReceint 1 RECEIPT #: 2200700000000001418 Date: 09/10/2007 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JAMES JANECEK JAMES JANECEK Item Total: Check Number Authorization Received By Batch Number Number How Received ~b fu~non djb In Person Payment Total: Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JAMES JANECEK JAMES JANECEK Item Total: Check Number Authorization Received By Batch Number Number How Received djb djb In Person In Person Payment Total: Page 1 of 1 IO:43:28AM Amount Due 70.00 8.00 3.90 6.24 7.80 $95.94 Amount Paid $100.00 ($4.06) $95.94 Amount Due 70.00 8.00 3.90 6.24 7.80 $95.94 Amount Paid $100.00 ($4.06) $95.94 9/1 0/2007