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Home My WebLink AboutPermit Electrical 2007-10-10 1. ZON ." ~'" . ~ ,. ~'. . --.,,' 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~~: /7- I>D /0 l( b I"'> brc> I~' ~ 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 \ . I I ~ . 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 ',' '\'. 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, " . \ ~ '" ... . \ J~. \ \. . , 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