HomeMy WebLinkAboutPermit Electrical 2007-10-10
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. --.,,' CITY:OF"SPRINGFIELD~ OREGON> .'
225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number LC~:2 c:::> c:::>~ -0 I S"3 Z-
Date
3.
LJ
LEGAL DESCRIPTION:
I/D327:sl
A.
OZ,o(
Service Included
JOB DESCRIPTION: liOO sq. ft. or less
d lA_ f ( .r . ( h additional 500 sq. ft. or
A"M,C. e- S-~VL 4-- n-c1d. / ~ C(/~. ion thereof
f .
Permits are non-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
$117.00
$ 21.00
$55.00
2.
B.
Electrical Contractor 200 Amps or less I
201 Amps to 400 Amps
Address 401 Amps to 600 Amps
601 Amps to 1000 Amps
City Phone Over 1000 AmpsNolts
Reconnect Only
ATTENTION~' Ore on law requires you to
S . L' follQ.\~(!~le8 ado by the Oregon Utility C
upervIsor ICMffifi'bWfiBff C _ "!'~9SG-M€S e!'9-Set forth . '
.. In OAR 952~CU .t)01 0 through OAR 952-001- , , .
EXpIratIOn Dat8090. YOl.-"I..:N obtain eODies ofthe rules by Installation, Alteration or Relocation
calling tRJ center. (Note: the telephone 200 Amps or less
Constr. Contr. ~r for ,the Oregon Utility Notlfloation 201 Amps to 400 Amps
Ctlllun la I-oUV-')')~-4l:,)""J. 401 Amps to 600 Amps
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
7D
$ 55.00
$ 76.00
$110.00
Expiration Date
Signature of Supervising Electrician
qver 600 Amps or 1000 Volts see "B" above.
D.
.OwnersName 5ANrcs ~oNtoCH(tLWu5
Address /O'tO l/ tV' s r
~r0 Phone /5b - ~l(3
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
/ .s- $ 4.00
bo
E.
City
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
Limited EnergylResidential $ 28.00
Limited Energy/Commercial $ 50.00
Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
O~~:
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Inspection Request: 726-3769
Nb
THIS ~J ~&fnr)RE IF THE WORK
AUTHpj ~1ttHIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY (i(JlJvA'/ PERIOD.
Shared Drive(T:)/Building FormslElectrical Permit Application 7-07.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1040 W N ST
ASSESSOR'S PARCEL NO.: 1703273102901
Springfield
PROJECT DESCRIPTION: 200amp service upgrade and 15 circuits
Owner: SANTOS ADO CHIRINOS
Address: 1040 W N ST
SPRINGFIELD OR 97477
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01532
ISSUED: 10/10/2007
APPLIED: 10/10/2007
EXPIRES: 04/10/2008
VALUE:
TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
Phone Number: 541-736-8843
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OWNER
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
R-3
VB
License
Expiration Date Phone
nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
In 'ClmoN:~onfawFao~i!rive Rqd:
Nfo~,.!. adOpted by th'trOfl lfWIlAge:
OUINQ'IUR Center. Th on-Utility
In ~ pM.nn...,& tt~~~ rules are set f~rth
uo9O. Youmayobfaj -- - .. NTS
Street Improvements: ..::: t ::nter. 0 e: e telephone
I'-",,___e Oregon Utility Notification
Storm Sewer Available: .91.,," Ie 1-800-332-2344).
Special Instruction:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Notes:
.-0
I Valuation Description I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Pal!e 1 of 2
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
fi..OTICE~tilll .
Trt1g13~~MIT ~ll EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
C()MMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD_
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01532
ISSUED: 10/10/2007
APPLIED: 10/10/2007
EXPIRES: 04/10/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L..-Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ Ea Add
. Perm ServlFdr 200 amps or less
Amount Paid Date Paid Receipt Number
$13.00 10/10/07 1200700000000001290
$6.50 10110/07 1200700000000001290
$10.40 10/10/07 1200700000000001290
$60.00 10/10/07 1200700000000001290
$70.00 10/10/07 1200700000000001290
Total Amount Paid
$159.90
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Reauired Insoections I
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building SafetY.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I
further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
,
~~
Owner or Contractors Signature
Date
,ctk
/ /
Pal!:e 2 of2
Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
Permit #:
)i
COv1/\z4?07- 0/;$'2-_
.lOC{O w /II s 1-
L:k~ Date: /ql/% 7
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~ .
Address:
Issued by:
Statement: Information Notice to PrC)perty Owners
About Construction Respons1i:bilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed with the Construction Contractors Board to sign thefollofing 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
I
. ORS 701.010(7), need not submit this statement. This statement wiU:befiled with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either bQx 3A ( If 3B:
~ 1. I own, reside in, or will reside in the completed structure.
-~~
t/EJ . 2.. I understand that I must .become licensed as a construction contn ctor if the structure is sold or
offered for sale before or on completion.
o 3A. My general conqactor is
(Name)
(CCB #)
- I will instruct my general contractor that all subcontractors who ';~rk on the structure must be
licensed with the Construction Contractors Board.
OR
Y 3B. I will be my own general contractor.
If I 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 dontract with a contractor who is
licensed with the CCB and will immediately notify the office issJing this building permit of the
name of the contractor.
-I hereby certify that the above information is correct andthat I have read and, do understand the Information
Notice to Property Owners about Construction Responsibilities on the revers~,side of this form. .
; / /
~/ ~ ;; !('i!O/{Fr
ff~~gnature of permit applicant) / I (Date)
(White copy to issuing agency permit file, pink copy to applicant)
Property_owner. doc 06-01-04
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A_~tin\g)a~.Y~our"Own General Contractor?
('.:. ItNFO~MAfION\NbT!CE TO PROPERTY OWNERS" .
ABourCONSTRUCTION RESPONSIBILITIES. .'
~_.~..c.. .
~ .. .....'
NOTE: This Information Notice to Property Owners about Construction ResponsibiJiiies 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 hom~ or make a substantial impl ?vement 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 "~mployer" and the contractors you contract wit~ will be, "employees" if
you use contractors not licensed with.the Construction Contractors Board to do labor in constructing or to' assist in the
construction' or improve~~nt of a residential stru~.tl!fe.. A~ 'the eIl}ployer, )'ou must comply with the foUowJng:
Oregon's Withholding Tax Law: As an employer, you rimsfwithhold income taxes-from employee w~gesat the time
employees are paid. You will be liable for the tax payments even if you dC.:m't actually withhold the tax from your
. employees. For more information~ call theT)~partment' o{Revenue at 503~378-4988. . ,.. . .'
Unemployment Insurance Tax: As an employer, you are requifed':to'paya 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 munber for boW, Oregon 'Wi~hl1olding and
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.doLstate.or.us/formsnav.htmll for the
appropriate forms.
. ~.
Other RespoIDJsibnulies, ~IDld Areas of Concerns
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,
, ~ "t ..... ~. ~.'. :. r . . : ~ -. . .'
Liability and 1P'ropert~ Damag(dnsurance: Coritacr your'insUra~ce agent to see 'if yo~ 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, " .
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Time: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the skills to act as your own general contractor,'to coordinate 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.
Propcrty_owner,doc 06-01-04
225 Fifth Street
Springfleltl,Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-0 1532
COM2007-0 1532
COM2007-0 1532
COM2007-0 1532
COM2007-0 1532
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
1200700000000001290
Date: 10/10/2007
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
SANTOS A CHIRINOS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 362422 In Person
Payment Total:
Page 1 of 1
10:38:07 AM
Amount Due
70.00
60.00
6.50
10.40
13.00
$159.90
Amount Paid
$159.90
$159.90
10/1 0/2007