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Home My WebLink AboutPermit Electrical 2005-4-7 SPll'iINGFIELIO'.::'LJ.. :'::'~;" , ........, \ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)~6-3689 ELECTRICAL PERMIT APPLICATION ~~O";1:>~ City Job Number ('01/1/12-6 0 ') --CO"J 7 S- Date 3 - ~ 0- ~~5A - , ~ J 0; ,-,.., 1. ~~~~i!A!i~~f!~~~~rA}0!!q~= ".~"_.,~:: 3. !;~G9Jt,{p~~'~ffEi:: iiEij~iiow .,'-'~' ;73:) tU CIl,u!er/j/, 'G 1 & I,,~ I - :~-":'=::~:~~~;=c:~r^.~~~~~::::.=::.'.. LEGAL DESCRIPTION i 70> Z 71..{ 4 obzoo A. k~~~'.'l:;tR~si~~~!ial:7,~jn~~r,. !~d'li'!lmfi~~DJ!'rellJ~g;unit " .. i , . ""","'.."..." ",'-"..'."'.. ..."....'''''h.J,,",' .~~'~." .'''~'' .' ;c:',., ,q;.a:'(I'~".';"'"'' ",...',"", , , AAJ 2 2{) P l\~ \ +4 f? Pre: \::: OprA'(eservice Included '" '" ~C' ~":'O~ JOB DESCRIPTION. h ~{ 1000 sq. ft. or less , . '" ~ ' $106.~~t t? .-..:.. ~ .n. { . , ( ) L~ach additional 500 sq. ft. or '0.. "~ ?f;X?''' S~C CA-1.A-<-S e- SeA'! PAM O(l.ut~rtion thereof ~ $ 00 , Permits are non-transferabl: ..4 expire if wor~ Each Manufact'd Home or ~ ,I, not started within 180 days orii~';uance or if work is Modular Dwelling Service or $50 00 Suspended for 180 days. Feeder . 2. t~" ': ~;'/r"7:rt>7.":' -'~~\W};"^', _ _~ ~; '<<:?"iT,:'U.-,'~ ~;::UX;~~:ir; :J)'~~"SJC: V;;;;'"~_'::", '. '\ - ..::-..~-:~~, CON!IRACTORINSTAttATION ONLY,;' __~J::__ ,~;..:_~:.. ,_:...::......,;.'>:.,,_~..,:- ,~i._::<::.~:_~....:.. '~:'S.::L>L-, ~:":.~_::"k>~.___.; ...L)s. _~ .:._..:.-:.J f- ~~;~,,:?T7:-7~~'>-:':;,.'_'::-;_.';.' L:-~-:":~~---:;._'~":~!/~(:"---\"-;;'~':":"'-'" , . ,:~~;.' B. 'SeryicesorFeeders'-"Insfallation, Alterations or Relocation:': . :""_!';':::'~./,.;i>_~_' ..%/;._._,. "'~:~!!~:::2L,_::__....-:__>;:'~',' ..~._. ~~.. __.L:....,~ City o 200 Amps or less Z $ 63.00 / 201 Amps to 400 Amps $ 75,00 , ATTENT'~:~8rV?BtfPs . $125.00 ,,/ fo~I?W rulf&)a~~ I!>~~~~res yo~ to $163.00 Phone // ~ot/f'cat;on~fltOOO"fl:ro~YBlE!s gon UtIlity $375.00 / '" OAR 952iOOlb.ooq~u are set furm $ 50.00 / 0090. You ma ob' . gh OAR 952-0Ul. II' '. Y )~n,coPle~l.t:fthe5rfJ/ n:" --'" " , Supervisor License Nwnber /' ca 109 the m....~.~ rffJ'Oti:s:IffJ\a'F~~i~' ,,,.,. * / ii~mber for the Oregon Util!tyJ~ . ~ o~e Expiration Date ./ CeniBtliU~~~!fi2~YMion / 200 Amps or less Constr. Contr. NU91ber 201 Amps to 400 Amps / 40 l' Amps to 600 Amps E . . D xplratlon lJa? <?~7~,.~qQ.'A.1l1pSOl' 1000 Volts see "B" above. '._',..-,._".. Signature o~upervising Electrician D. ~~E~2~~5~ircuits IZb Electrical Contractor Address $ 50.00 $ 69.00 $100.00 New: ~teration or Exte.nsion Per Panel One Circuit $ 43.00 .. ) I J NO: Tf CJ::~ch Additional Circuit or with /- ' , / C" OwnersName Iv fl..-lfcrl-/V1 IJ-J ({ ~''''lerviceorFeederpennit -:> $ 3.00 ~ Addre" 7 3{) 0 ,.J {' e ,..;-J--pp N' ~~m~\~IlIr!6fl',;d~;~EaChi;stall;ti~; City Sfl I" Ae..JJ Phone /:?C- 59 J "5ANy'1V~cr~Jo~Cti~~~ANDONED' FOR $ 50.00 . 7' . ( (2-1' Sign/Outfme iflgnting $ 50.00 OWNER INST ALLA nON 52\ - '1l !).. Y Limited EnergyfResidential $ 25.00 Limited Energy/Commercial $ 45.00 The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45./10 + Surcharges ;lr,.;;<~:~~ 4. SUBTOTALOFABOVE,/' 1?P- '-. ~: :':~,:?)JG:;ij~e;;)(i,: :>:::,} o':i~ '< ~,~:"~\~:,,,~,v {L-(( ,/87 1({10 If}! '!!- 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 1-Q3,doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00375 ISSUED: 03/31/2005 APPLIED: 03/31/2005 EXPIRES: 09/30/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 230 W CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 170327440.6200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New PROJECT DESCRIPTION: 200amp service upgrade, sub panel and 5 circuits Residential Owner: ADRIANCE WALTER MAXWELL IV, Address: 230 W CENTENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-736-3913 Contractor Type Electrical Contractor OWNER , I CONTRACTOR INFORMATION I ou\O ea.u\~EI3i't'O\.~~'l Expiration Date Phone _ ,/,"01' \a\f'l,~ n o~eQ01' ~p"o~\n 6-i I - 5"""::tt - q I ~ 8 ~\t:k-\"BUNp,i~crWF~ - '9~ IS'2.-Q\)~~ po. \ u\\:::'-' ~ \ .. Q~ ~u\eS \o\\~\f'l ~ o(W<;S&fi~~p. \n~OU: eS 0\ \ne ~o1'e R-~O\\\~~ ~Sjr~i~t~fb~l~. \~e ~~~~\ca\\O(\ \1' 0 0 '(oJYl\~\X~Il.t:~ l' \j\\\\\'l l\l\) VN 009 ~\\1'~l'e?~ee:eQo o.!3~'2.-'2.~ . c~ \~~I)'~:\-~O (\U~'oE.e~~ath: Sprinkled Buildinrf:/ ,,"-'n/a - ~'~ Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: . Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: _ \r- 'n..\~ \NOI-'\<- I PUBLIC~ReV~~~N::r-~t OYH'\~l~\'A\I \S N\J \ \\-\\~ nJ.., UN R \\-\.\S _ r ~r.:r\ ~OR . f\U\\-\OR\I't.D R \S f\~I~\~~4l CJlype: CO\'J\N\'tNC'tD 0 'tR\o\WownspoutslDrains: f\~'( '\ 50 Df\'( ? Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00375 ISSUED: 03/31/2005 APPLIED: 03/31/2005 EXPIRES: 09/30/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Pai<<1l Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $14.10 3/31/05 1200500000000000400 $9.87 3/31/05 1200500000000000400 $15.00 3/31/05 1200500000000000400 $126.00 3/31/05 1200500000000000400 Total Amount Paid $164.97 I Plan Reviews I 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. I Reouired InsDections . 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. NAcll.h.e~ '5 -5 I ,- 2005 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 #: C6U1 z.,oo_ '0037 s-. Address: 'Z30 t;J ~n I u:"" L-,,- I ~ I Date: -p /~ r Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentia/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 be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ilfl. ~ 2. 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. 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 :eoard. ' OR Ja' 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 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. ' ~- h, ~LUL.d--.--,/V~ (Signature ofPermit applicant) 5~5/~o~ (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 , Acting 'a:s ,I olit:Own:Generai Contractor? \ - " ' . ~ ' , -" :_-' INFORMATION NOTICE TO 'PROPERTY OWNERS _, - -;, ,:\, 'ABO~T"CONSTRUCT~ON,RESlPONSIBllITIES . -.... \'" , . '" .... \..,. -- . .' ~ . . ~ . '. " . '-,I' , -- 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. Employer Responsibilities You will, in most instance~, ,be rul~d to be an "employ~r",.and the ~ontractors'you contract with ';"ill be ~"employees" if you :use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the constru'ction or i:nprov~ment of a re,sidenti~l str.Uctur~. A~ -the employer, you must comply with the following: l' . , ' 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 tne 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 f~r both Oregon Withholding and' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, yo~ are subject to the Oregon Workers' Compensation Law, and must obtaip. workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be ;~bject to' penalties and be liable fo; all claim'costs If one of yoUr empl?yeesis injured on the job. For more information, can the Workers' Compensation D{VisiOli'at the Department Of Consumer 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 nwnber, call the IRS at }'.;800-829-4933 or,visit their web site at w,x.,w,irs.gov. "Other Responsibilities,and Areas 'of Co~cerns, ~ Code Compliance: As the permit holder for this project, you are responsible for res'olv'ing any failure to meet code requirefl?ents that may be brough~ to your attention through inspections. Liability and Property Damage Insurance: ,. 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. 'rime: Make sure you 'have sufficient time to supervise your employees. . ..-..' ~ Expertise: Make sure you have the skins to act as your' own generat' 'contractor, to' coordinate the work of rough-in and finish trades, and to notifY building officials as the appropriate tin:es 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 _ O\.vner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt relopment Services Department Public Works Department Job/Journal Number COM2005-003 7 5 COM2005-003 75 COM2005-00375 COM2005-00375 Payments: Type of Payment Cash Change Job/Journal Number CpM2005-00375 COM2005-00375 COM2005-00375 COM2005-00375 Payments: Type of Payment Cash Change \ , i 3/31/2005 RECEIPT #: 1200500000000000400 Date: 03/31/2005 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By WALTER ADRIANCE WALTER ADRIANCE Item Total: Check Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By WALTER ADRIANCE WALTER ADRIANCE Item Total: Check Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: Page 1 of I 2:25:09PM Amount Due 126.00 15.00 9.87 14.10 $164.97 Amount Paid $165.00 ($0.03) $164.97 Amount Due 126.00 15.00 9.87 14.10 $164.97 Amount Paid $165.00 ($0.03) $164.97