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Home My WebLink AboutPermit Electrical 2007-9-7 ZON L va-. INITIALS N i'-A ~ )~cE~9~ 7/7/07 I I COMPLETE FEE SCHEDULE BELOW 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATI9N CityJobNumber (ooAA'Z-007-C> 13f::r! Date 1. LOCATION OF INSTALLATION: 2bD C"'~v1;t.~ LEGAL DESCRIPTION:' 170 l333 I 7 be (" k.lt../) 1\'\0....... L h JOB DESCRIPTION: 3. l.N o 330t> A. New Residential- Single or Multi-Family per dwelling unit. -& ,j;~ A.~~ Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. I $117.00 / /7 $ 21.00 $55.00 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: Electrical Contractor Address City Phone Supervisor License Number Expiration Date Over 600 Amps or } 000 Volts see "B" above. D. Branch Circuits Signature of Supervisi Owners Name ~ ~ ~ ~""" L~ (( Address /0 l \ J l> h....J "'V tW t:- city{dlht &i>lc Phone bS~ - 207U New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 70.00 .;. 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 $ 48.00 ,p 4.00 . .... E. Miscellaneous (Service/feeder not included) -Each Installation OWNER INSTALLATION ~5.00 ~e. \NQi' 5.00 \'l'C- _ ~ ~,~~ \~ ~ 28.00 V;:~ ",If\ f\)~ $ 50.00 ~ $50.00 + Surcharges } 17 c; -.:fro " 7~ S- 8~- /4J ?L The installation is being made on property I own which is not intended for sale, lease or rent. ownerZtur~ Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01368 ISSUED: 09/07/2007 APPLIED: 09/07/2007 EXPIRES: 03/07/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 260 CHAPMAN LN ASSESSOR'S PARCEL NO.: 1702333103300 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Rewire house Owner: RUSS KIMBALL Address: 1025 JOHNSON AVE COTTAGE GROVE OR 97424 Phone Number: 541-654-2070 Contractor Type Electrical Contractor OWNER . ~'\,::~ r CONTRACT~~A'''''ON I ~ ~ 01..e($~e re,0 ~~t::)Y ~ ~ \'6 ~e ~ere, 0I~ QJ~~i$;.e~~e ~ "~1~:...0.~.)' ~l.\~~~-V\O~ f1~ #. I ~~'" ~~~~~~~tt-O""~~" ~pt~~CJ~t(J??; ~ (Jf~l ~~ ~ ~\\O O~ ....o~ ~ ' ~6' vt~~~~~~IJ' pe:' ~ Ralge Type: ~ Energy Path: Sprinkled Building: Expiration Date Phone # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handi~fPped: C~~~ ~<<; ~ ~~ & ~....,..~ .('\~ ~",Vi;" ~~,. &,<.)\ ' . ~\, ~~Co ~~~ ~.. ~~~~~. . ~\f.J" ~~"<.~~~f~rams: ~~ ~ ~~ ~1,,~ <t.,,~ f;:j ~~\) '\~ ~~f;:j ~~\J ~ ~ ~~~~,CO~ ~ ,I Valuation Description I~~ Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pae:e 1 of2 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-01368 ISSUED: 09/07/2007 APPLIED: 09/07/2007 EXPIRES: 03/07/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Residence Wiring 1000 Sq Ft Amount Paid Date Paid Receipt Number $11.70 $5.85 $9.36 $117.00 9/7/07 9/7/07 9/7/07 9/7/07 2200700000000001413 2200700000000001413 2200700000000001413 2200700000000001413 Total Amount Paid $143.91 1 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. Reauired Insoections I Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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 dur;ng 2tion./?/~ 9/7/07 'V Owner or Contractors Signature Date Pae:e 2 of2 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 Permit #: COm z-co 7 - 6/"3 6Y Address: zb () ch Afc/IA~ ~(f Issued by: LN 1/7/0 7 I I Date: State~ent: Information Notice to Property Owners About C,onstruction -R~sponsibilities , Note: Oregon Law, ORS 70/055(4) requires residential construction permit applicants whoare not licensed with the Constr:uction 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 licensing under ORS 701.010(7), need not submit this. statement. This statement will be filed with the permit. . - Fiil in the appropriate blanks and initial boxes 1 and 2, and either box 3A or; 3B: ~1', @2. , , I own, reside in, or will reside in the completed structure. I understand thatI must become licensed as a construction contractorifthe structure is sold or offered for sale before or on completion. . 0 3A. My genera! contractor is (Name) (CCB #) I will insf!uct my general contractor that all subcontractors who,work on the structure must be licensed withthe Construction Contractors Board. - OR ~B. I will be my own general contractor. If.! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I 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 ofthe contractor. . . thereby 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. L .ZLd 'l!)/b'j r . - - (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-0.1-04 '} ,.J '., . ~cting \<<s )tout;' -1;' f',' ,', '.' -\ ' 'INFORMATION-NOTICE PROPERTY OWNERS ABqUT,CONSTRUCTION RESPONSIBILITIES General Contractor? . " " " ""'I NOTE: This information Notice to Properly 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 ov;rn contractor to construct a new or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the Jollowing respons~bi1ities and concerns. Employer ,\h ;0.:', ~ . You will, in most instances,be ruled to"be an "employer'o you use contractors not licens~d with the Construction construction or improvement of a residential structure. th~ contractors you contract with will be "employees" if Board to do labor in constructing or to assIst in the , you must comply' , t~e following: Oregon's Withholding employees are employees. Law: As an' employer, you must income taxes from'employee wages at the time will be liable for the tax payments even you don't actually withhold the tax from your more infonnation, call the Department 'at 503~3784988. " Unemployment on the wages of As an employer, you are For more information, can the to pay a tax for unemployment insurance purpose~ ' "'~ Employment Department at 503-947-1488. - The Oregon Business Unemployment appropriate fonns. '~ Identification Number (BIN) is a number for "oth, Oregon Withholding and . . '. . Tax. To file for a BIN, can 503-945-8091 or w\vw.dor.state.oLus/fonnsnav.htmll for the '. -'-. lnsurance: As an employer, you are to the'Oregon Workers' Compensation Law, compensation insurance for YOllf you fail to obtain workers' compensation subj ect to penalties and be liable for, tosts if one ~f your employees is injured on the more info:mlation, cail the Workers' Compensation Division 'at the Department of-Consumer and Business Services at 503-947-78 U.S. Revenue Service: As an employer, you must withhold federal income tax from employees' wages. '",- You will be the tax:. payment even if you didn't withhold the tax. For a Federal Ern number, call the IRS at 1-800-8294933 or visit their'web site at Responsibilities of Concerns As the pennit holder for this be brought to your attention you are for resolving anyfailure to meet code and coverage for accidents and that must b(f \ " " to see if you have adequate insurance water damage from pipe punctures, fire or , , , '. \\'C; """ ... )- ~ Make sure you sufficient time to supervise and finish sure you have the' skins to act as yoilr own to notify building officials as contractor, to coordinate work of rough-in so they can perfonn required inspections. (503-3784621) or write the agency at PO c 06-01-04 225 Fifth Street Springfield', Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-0 1368 COM2007-0 1368 COM2007-01368 COM2007-0 1368 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Residence Wiring 1000 Sq Ft + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By RUSS KIMBALL City of Springfield Official Receipt Development Services Department Public Works Department 2200700000000001413 Date: 09/07/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 01592Z In Person Payment Total: Page 1 of 1 3:20:58PM Amount Due 117.00 5.85 9.36 11.70 $] 43.9] Amount Paid $143.91 $143.9] 9/7 /2007