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Home My WebLink AboutPermit Electrical 2004-10-8 -=~\.r-~JiliM~~"" ' <:.~RINQ.."....D""_ _~!!'!II.~~:u.!;.~~ ;0'0 A ~ 225 ~u.n STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)1t6-~9 "!" ~ ELECI'RlCALPERMIT APPUCATION "-'o-,,~: ';JjQJ' City Job Number Co&\. 2..tC(\-- 6 l-z.. S d-- Date.. t C> - e:, .- CY<.~ . '~\. . 1. e.!'i'lQGArrON:'OBiNsT:;4T;T~fi0N~1.!Il~ 3. 'i,CQMj>E'bji;;'ii'EE"':;2.iii.trUlElkEL-'. ~"";f"'?:4_=~~""""'~-~'._"'~ ,..' .~..'....,..".....,.""""""" ... ., qj(" If .J. ~arl~/.';"jd 1)R ~7c;77 LEGAL DESCRIPTION I U ( \'\. 6'?:> 3~ t'\-'C..- 0 3>~DO JOB DESCRIPTION 200 Amps or less S 63.00 20 I Amps to 400 Amps S 75.00 ,.\\)~'*' 401 Amps to 600 AmP~ S125.00 'I;\\. 'I' v.\)~1 Amps to 1000 Amps S163.00 Phone r :-,,~ '\ . \\ \S R- Over 1000 AmpsIV olts S3 75.00 \.~\'0~'Y.\.~\":\;> <';\:l Reconnect Only S 50,00 ~\>-\.\..o. \~S~:\;>\)v.<(;..""",_".."",.._..,,,,,,,,,,,,,,.. "''''!':t_'''''''''f~o;i'i Supervisor License Numl:ler. .\'\ S .\<:\<(;1' ~<(,"" C. emRor3g"Sec.jices.. r!F!,eoer '.~io:~~1:"J'J1R');i:~~~~ ~'\\"'~~" :\;> \)" \':l' . . ,.)\0 Expiration Date ~\\\S 'Y..r\~l-~v\\ \)~~\):\;> . Installation, Alteration ~Be'l\?~lltI~'(\ 'tr\S\\'~\.":'v\)~ \. 200AmPSorles\>Il~0~\0Q.~:\;0\'~\' S50.00 Constr. Contr. Number,~~, ,<0\\ 201 Amps t8~ ~ ~0"''3' ~0I<b'l-'.? 'O'i S 69,00 ",":" 401~Pit~v~~~u,,'(\O~ ~"'\\)~ ,'^0_ SIOO.OO "...\\~ . 2.~Py: ,\X" -,o\)" 0' ;,..,o'\V ,;,n~ -<,\wve ,go\l ~ifils ~ s ~6~,~W. ~' . . .,.,.... ..."... .~"'li,-~..l'l~..,. "~~'~~ ,1\--0: ,^ ,'-'CIt; ...~;.,.~.., ,~W....i.:r., ;. 'o~: ~.,... " ""'..<; ;;':Jri."(';'- \ ... ~, ,-.i~:. ~l/ ~: ~ , V.O'l~\'~'A1~~~6\l~~~.~ anel . , \f- ~d?C,l1l"t.'0 i(;<.00 ....'o~r;:, I S43.00 Lf-S,D1J ,~alll~~'1~iforwith I '7 on S~~~~}Ornnt S 3.00 ,>, I E. :Misl:i\llifii1oltif(S~e/~~~tiffift~d~\~E'8~mmnilfi~ '" "'''',. '"'<f.-CWV,;rlI.$.1't"li.~~~",,,,,,,,~,,,,~_,_,,,,,,,'~~,,,,,,"""";;~d~,,_.!l~r~ .. ~^I;rL ~k (l~k~. A-,p( ~IA1+fl6 I I , Permits are non-transfera Ie and expire if work is ... not started within 180 days of issuance or if workis Suspended for 180 days. 2 lr.GON1~. "\'''CF..7J.''1iJ!N..ST).7t'f.iKfioMO.:'- ~H' . f!~Ji,,,,*,,\4 ~"'P~~',I'''''~,!';:-''. . '.~ Electrical Contractor Address City Expiration Date Signature of Supervising Electrician Owners Name ~" P<~ L'v.. '0:f(fJl.J Address q,){g A {,+.' City ~'fll Phone J!f.H~'2~~.1L OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: J"i~ ftJiLs ' Inspection Request: 726-3769 Each Manufact'd Home or Modular Dwelling Service or Feeder S50.00 '1'$.lll1~_'~!'''''~Jl~~''''2:i>'-'''''~'''''''"",'A-~=~ill B. ~.~er;Vife!i,<:t.:I!~eae~~iit7-I~~falJ.ati~n~~!~ra~ons.l,2jg~~~t~~ Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 S 50.00 S 25.00 S 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Sureharges ~~''',e;~';:.:a4.Yo\dl~;''''';;~''''''''':~;'' 4. <1;:;wHuTAEOFABo. .' ,. ~~~~~.,.,:;",~.g~.. . -.'~~, .~~:. L!(/J,DO ~ ,?.. 'L 4-,(:,0 5'3-,2;0 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/BuildinR; FonnslElectrical Permit Application 1-03.doc . . CITY OF SPRINGFIJ!,LlJ Building/Combination Permit PERMIT NO: COM2004-01254 ISSUED: 10/08/2004 APPLIED: 10/08/2004 EXPIRES: 04/08/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 956 A ST ASSESSOR'S PARCEL NO.: 1703354203500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Rewire 2 circuits. Owner: DILLOW JOSHUA & LISA Address: 956 A ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER I CONTRACTOR INFORMATION I License Expiration Date Phone I BUlLDING.'INFORMA TION, . ,,\'0'" 'S ~v # of Units: <. \'1: #~Q(Srorips: \<;(..'- ,..,,," <\ '.\'" Primary Occupancy Group: R-3 'i:..~ ~~eig~tot Structure Secondary Occupancy Group: 'X,~\-\- "\'x\\S~\~~e of Heat: Primary Construction Type,<. ,-< S VN!(.<;(.. a.~'~ Water Type: ......v .1\\, .\~v ~\} Secondary Constructi~n, TYP$::I'\\) \) R- {:> :\). Range Type: # of Bedrooms: \1i 'x\\S '( !0~1) S\) \J 'i:..~\J Energy Path: '\ ';:0"\'>(1.. ,'i:..~" ",-.l, ~ Sprinkled Building: W ,."', _ \\1" ,,\J" \'Cv ~~-.l, Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbaeks: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant ~: ..,0 ,>,,,,t I DEVELOPMENT INFORMATION I \0o.,)\\"'~~ \);~\O~. \~"" 0\0, ~6UI~D PARKING '00<0 ;s.0 ~0'i> . ~\)': 'i> '0'1 Overlay Dist: ~. 010 ~00 '0'\ 50 \\) :\\ ~~J.0 ~e # Street Trees Rqd: ~,\\O ~oo~ ,\,\\0 ~o-Jg ~~ ~~~~ Paved Drive Ra~~'i:;: I-J\0'i> r0(\\0\,\ 0 'IS' o~\e'i> ~ ~l,f7Y' 0/ fL tC r .~~ "v. Cl" ."v e''I1 0 /00 0 overage:' ~O" ,,0'- ~?p,. ~'O'l . ,",~' _rJ)"..... \~ .~\C-a; ~v 0'0 ~ \~l~'\"~:r 'J. ~o\:"I>.X'- ~'1i.. (\\~'\ ~(\\el. _"o~ "",,/:"/I I PUBLIC IMPROVEMF;J:'f.sJ~~9, ;s.0 ;;s.0 ': V'O<;},l- U~'\' <>1 \0 el "" ~\).(\\'O's~lk Type: Downspoutsillrains: nla Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee I of2 i Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid . . CITY OF SPRI~'-:.1<u'LU Building/Combination Permit PERMIT NO: COM2004-01254 ISSUED: 10/08/2004 APPLIED: 10/08/2004 EXPIRES: 04/0812005 VALUE: I F....s tlW!.I Amount Paid Date Paid Receipt Number 2200400000000001263 2200400000000001263 2200400000000001263 2200400000000001263 To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. $4.60 $3.22 $43.00 $3.00 10/8/04 10/8/04 10/8/04 10/8/04 $53.82 I Plan Reviews , I Rl'Ouir..d \Iw'..ctinns I Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, that I have earefully 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 aceordance with the Ordinances of tbe 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 eacb 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. ./J~ I};/I,,-u oKner or Contractors Signature /()h hi Dat / Paee 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 Address: C\ S cO L~ ~ \-z.C;4- CA, >,\:, -.J M "? Date: \0 -8-0t\- 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 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 befiled with the permit. Fill in the app.vp.;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ 1. I own, reside in, or will reside in the completed structure. o 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 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 ~ 3B. I will be my own general contractor. If! 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 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. fL /JL) (Signature of permit applicant) Ink Ivy / I (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 .. . Adnlill~ ~~ '((J)llJlJl" ((])Wlill GelI1lell"~R Cmill!rll"~ct@Jr? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES " NOTE: This Information Notice to Property 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 own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. I Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with 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 improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold 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 from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a 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 nwnber for both Oregon Withholding and Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsuav.htmll for the at',-- ~p' :ate fonns. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job, For more information, call the Workers' Compensation Division at the Dcpartment of Conswner and Business Services at 503-947-7815, U.S. Internal 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 www.irs.l!Ov. Otllner ResponsilbUlities aJrnd Areas of COJrncerns 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. Liability and Property Damage Insurance: Contact your msurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint ovcr spray, water damage from pipe punctures, fire or work that must be redone. 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. Property_owner.doc 06-01-04 .. 225 Fifth Street . Springfield, Oregon 97477 .541-726-3759 Phone . Job/Journal Number COM2004-0 1254 COM2004-01254 COM2004-01254 COM2004-01254 Payments: t r Type of paymeot ; CreditCard I" ~,... 10/8/2004 RECEIPT #: tII"~R1N.lU!I. ,I!!,O.. . :.'. ~; .'. ; --.,...- . ~ of Springfield Official Receipt "elopment Services Department Public Works Department 2200400000000001263 Date: 10/08/2004 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By JOSHUA DILLOW Item Total: Check Number Authorization Received By Batch Numher Number How Reeelved jmp . 464148 In Person Payment Total: Page I of I 3:18:45PM Amount Due 43.00 3.00 3.22 4.60 $53.82 Amouot Paid $53.82 $53.82