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Home My WebLink AboutPermit Electrical 2007-9-11 3. ZON L 'D.e- INITIALS tV)v'\ ~ DATE a -\ I -0" WA" SOURCE \'{\. ~ ~/O7 f;OMPLETE.EEESf;HE;l)ULEBELOW 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Phone J ,~etl~)Il~~Nolts . Oregon taW f~nt~\~ ~~;tm eS ~doPte~::S~fU\eS are set ~grt~ Supervisor License Number \ ~.. \ion center. 0 t"r&tg"~~e~yviCeS or Feeders tJ ..11. AR 952.-0Ul-~~ain copies ot tn~ f~one Expiration Date J nqO. YoU ma~~~f. (Notel~i1f!\~a\tonation or Relocation D \$/ camngrt~; the oregon_~~~l.or less Constr. Contr. Number numbe c~nter is 1-800 3r6'1 Amps to 400 Amps I 40 I Amps to 600 Amps I! Over 600 Amps or 1000 V oIts see "B" above. D.BrauchhCirClIits ELECTRICAL PERMIT APPLICATION City Job Number (?S) v0 'Z.c:::> c '7- D I ] g Z. 1. . LOCATION OF INSTALLATION: '-S 2.0 ')0'" -I~ .0 .S1-f'<LQ.f LEGAL DESCRIPTION: /7033SsC.( '~ft"'f'al; (je q~!T7 A. D () /0 0 JOB DESCRIPTION: '2-efL..~ Sc(lAfLce Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONrRACTOR INSTALLATION ONLY Electrical Contractor Address City Expiration Date Signature of Supervising Electrician Owners Name (,J i ILA IN1 -rodJ (.:;o.rJI1Q./'" Address -32.0 <:~ h ~ 5-J..fG..<l f City Sf J' .' J ~ ~~(d Phone ::{7'1 - 07 53 Date New Residential-:- Single Or Multi-Family per dwelling unit. 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 $117.00 $ 21.00 $55.00 B. Services or Feeders - Installation, Alterations or Relocation: I 70 $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 48.00 $ 4.00 E. Miscellaneous (Service6feeder nOfincluded) :-Each Installation Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 OWNER INST ALLA nON Limited Energy/Residential $ 28.00 The installation is being made on property I own which Limited Energy/Commercial $ 50.00 is not intended for sale, lease or rent. CEo Minimum EI~~itflf"WtlRl(pection Fee is $50.00 + Surcharges Owners SiJ,ature _ fA ~~~\'ERtv1lT Sllt.\W'_R'~VE 70 CLZ~ ~t--~n\40R\IEO UNO l\<>tt~M~9af~R 560 v 'COMMENCED OR \S 'ijd!o'Administrative Fee 700 p.,NY 180 DAY PER\O:)/b Technology Fee 3")0 vb-~ TOTAL o. Shared Driye(T:)/Building FormslElectrical Permit Application 7-07.doc Inspection Request: 726-3769 CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-01382 ISSUED: 09/11/2007 APPLIED: 09/11/2007 EXPIRES: 03/11/2008 VALuE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 320 S D ST ASSESSOR'S PARCEL NO.: 1703353400900 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Replace electrical service .TYPE OF USE: Repair Residential Owner: GARDNER WILLIAM TODD Address: 320 S D ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical 1 DEVELOPMENT INFORMATION. Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-579-0783 Expiration Date Phone n/a 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: 1 PUBLIC IMPROVEMENTS I f 1\\~ 'NO\'\~ . ~~~ (W\\\ \S \,\0 ~!)1\ti~\lI1I $~r;;~J.'l\\S ~,y\)\\ ,\\\S J~~\l'C.\) U~\\ \$ ~~~~ ~U\ ~t.~ct.\) t.\\\OU. CQ\J\ ~~ \)~ ? ~ ~N '\ I Valuation Description I Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pal!e 1 of 2 Value Date Calculated Status Issued CITY OF SPij.INGFIELD Building/Combination Permit PERMIT NO: COM2007-01382 ISSUED: 09/11/2007 APPLIED: 09/11/2007 EXPIRES: 03/11/2008 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 J Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 $3.50 $5.60 $70.00 9/11/07 9/11/07 9/11/07 9/11/07 1200700000000001179 1200700000000001179 1200700000000001179 1200700000000001179 Total Amount Paid $86.10 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. wiIlbe made the same working day, inspections requested after 7:00 a.m. will be made the following work day. LReouired InsDections I Electric Service: Approval required prior to utility company energizing service. 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. ;Jt '/~ 119/11/117 "V Owner or Contractors Signature Date Pal!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 Permit #: COW\'ZO'c::> 7 - 0 ) r'i?Z Address: "5 Z- 0 S 0 Issued by: .~.' Date: 51- 7~~7 I Statement: Infol mation 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 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.,,:ot 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: .~. /~.. 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. offered for sale before or on completion. D 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 ~B. I will be iny own general contractor. If I hire subcontractors, 1 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 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 of this form. 11/;(" (C (;Jt( cJ9 ( II / 67 . (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) --- Property_owner. doc 06-01-04 Actihg.'as ~Y"orir 'Own General Contractor? < ( INFORMATIt>N NOTICE TO PROPERTY OWNERS \', " ABOUT CONSTRUCTION RESPONSIBILITIES . . '. "-.-. .' -t.' NOTE: This Information Notice to Property Owners about Construction Responsibiiities was de~elopedby the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. - " If you are acting as your ~wn contr~Ctor to construct a new home or make a substantial improveml1nt to. an existing s1.:n,lcture, you can prevent many problems by being aware of the following responsibilities midconcems. Employer Responsibilities .. ' . ., . You will, in ~ost instances, "e ruled to bean "employer" and the, contractors you contract v,ith wilL be ,"employees" if you us.e contractors not licensed wi!h the Construction Contr<)ctors':Boar4 to do labor in constructingoI"to assjst in the construction R~ improv:elTIent ofa residential structure. As the empl~yer, you must co~ply with. the' following: OJregon's Withholding Tax Law: As an employer, you must Withhdld 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 frOI!1 your employees. For more information, call the Department of Revenuc' at 503-378-4988. "'.i . ~. Unemployment Insurance Tax: As an employer, you are required to pay a tax for lino;.mployment 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 preg<m Witl$olding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsDav.htmll for the appropriate forms. ',. '. .( -. .r' Workers' Compensation Insluance: As an employer, you are subject to the oregon Workers' Compensation Law, and must obtain ~orkers' cVJ1lpensation i.nsW;~nce for 'your e;mploy,ees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for al1 claitn costs if one o{your employees is injur~d on the job. For more information, call the Workers' CompensatIon Division at theDepartment~ofConsumer'and Business Services at 503-947-7815. U.S. In~emal 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 a Federal EIN number, call the "- IRS at 1-800-829-4933 or visit their web site at \v'\'lw-irs.gov. '. , . Other Re~lI)}([)lDl~ilbili\,ti'~s :~~@ Area~ olf COlDl(eer!lll~ 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 throug~ inspections. ~ . . If. ..! Liability and Property Damage lnslllJralllce: . Contact' your' 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. " ... '. \ ) ) _._'f J '~'-- ... Time: Make sure you have sufficient time to supervise your employees. . ' Expertise: Make sure you have the skills to act as yo~r owiF'genet~1 contractor, to"co6rdi~ate 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 wTite 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 City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01382 COM2007-01382 COM2007-01382 CO M2007 -01382 Payments: Type of Payment Check cReceint) RECEIPT #: 1200700000000001179 Date: 09/11/2007 Description Perm ServIFdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By TIFF ANY KROEGER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1155 In Person Payment Total: Page 1 of 1 8:23:57 AM Amount Due 70.00 3.50 5.60 7.00 $86.10 Amount Paid $86.10 $86.10 911 1/2007