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Home My WebLink AboutPermit Electrical 2004-6-30 ~:iLc:;:::t~~[~\iC~-=;~ ELC 225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(54I)726-3753 · FAX: (541Y,.a~~t!)g.ol'0' ELECTRICAL PERMIT APPLICATION <J/ CIoG/~Ct<J88 - ~' , ,', I c, ,"c I I " 9<Jfi1 ">0' ( OIl'G "blr)' City Job Number Lt ~~iZc'C'(' C L' / ( Date L' 1: r ,;.' e'l)I!)',; 9"11'. ~lteCl' <Jrl) ~ e 8 /}<J 01'/ ;Dee' 8 II) 1. LOCATIONOFIN$TALLATION 3. COMPLETEFEEScif~L L .(13' IFtc/q/'je/o//O/fl. /}qt"I'€ '-- Fe (f U8e 'I'{c, <3(~2_('p4ltkXlYLla.l SJutd. LEGAL DESCRIPTION I , J ?()~~<;2bL{~<;' C)6 'iCe) JOB biscRIRlON A. -..., jL\J L L l.\--r'r-iC-C / . ^" 1'- L_ ~ h_-,-L "-. \ \ --::-. 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 , $ 19.00 / Permits are non-transferable and expire if work is ,~ not started within 180 days of issuance or if work is Suspended for 180 days. $50.00 2. CON7.'RACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: Supervisor License Number 200 Amps or less J V 20 I Amps to 400 ~~b 401 ~~~I6OO~~\1 ~~: Ot~:~iM~:!~~~~"" tJ"P,'"_'..:..m adO? ~'r\ns-e-~'~, ~~J;:, p,',) )' ' . C1fI tv"""': sf. Nee-onne~\'vw1' ' ~~ ~1\ ~ '\0 \\iro\.::. _ 0\ \':'8 ,~ ~o\\f\CS 'f{J.$'\-OO . ,'. ~\>\eb. _AP\ePI IV" ~ oJ>..f\ 9 "f(\a'l6b\~eti&.w:~~~ea~.oFee~ers f1J9O. ~ centet. ~ \ "',\\\\'1 " . ce.\\\nO ~t \\,\e (b~~~~~~f.~tion or Relocation be- to .....,,'\~?,O' ~ cent6t all:! Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps ,. ----, $ 63.00 G~ - .. $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Electrical Contractor Address City Phone Expiration Date Constr. Contr. Number $ 50.00 $ 69.00 $100.00 Expiration Date Signature of Supervising Electrician Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with / ' /1 _ ~. p /1 C' Service or Feeder Permit :2-\ $ 3.00 . Owners Name L-/':A: --v\e..v'I\(Je-- L-;V'~I, ~,. . . . ~~'t- Address 'B(~ '7 (' .e.v'\\p.w,:a ~. E.l\1iSCellaneOUs(sef~,'b~iIlclUded) -Each Installation City~~~telolc- Phone )H-l Lf6t:) Pump or irri~~~~~<<'~~\ ~~~ $ 50.00 ~ l' ..j Sign/O~~-L~~~v~\\~ $ 50.00 OWNER INSTALLATION ~ ~\t~.~\~;a~\~~'n)enti~1 $ 25.00 !he in.stallation is being made on property I own WhiCh\\~\<}S ~"~~~\~merclal $ 45.00 IS not mtended for sale, lease or rent. '\ ~~:':\~le't;~~rmit Inspection Fee is $45.00 + Surcharo-es ~~~~~~~ b ~~~~~OTAL OF ABOVE L . 7% State Surcharge l( F' ~~ 10% Administrative Fee c Owners Signature: -/ " .//.--/~ J ,I, '. ..' ,,,,I.tI1(, '/.A'{ \.. {/,-L-.! '-~ ,_~ ~ l/ _/ /- ~ ( .-/;. ~~.i.~tY , .r I I Inspection Request: 726-3769 TOTAL .J '-..~I- 1.S I) rj'-- --- Shared Dnve(T:)/Building Fonns/Electncal Pennit Application I-03.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00791 ISSUED: 06/29/2004 APPLIED: 06/29/2004 EXPIRES: 12/29/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 832 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264300900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Service change and 2 circuits Owner: CRAIG CATHERINE S Address: 832 CENTENNIAL BLVD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor OWNER , .. .n Oregon \a'14 ,em:}fffi~o.iH'ORMATION. ~\ON: ted bY \"8 vl"'!.~~n\ , # of Units: 1\ cu\8SadOP hOsef\1\e~~fi60~. Primary occupancl;o . centeft1~ \"tOU9" Ghl~6'K1\~~f'tjjcture Secondary Occup~ ~..oo,\..QO. cOPies. ot~e 0 ~: Primary Construc\1b ~ (f\8."/ o~\n Note: tn ~., ftlO Secondary Constru 'lh\l~ centef. ~ n Uti\itIJ.~~ ype: # of Bedrooms:' ca\'\ tot \l\8 Otego 0-332..ga&'\)y Path: ~et Gen\et \$ ,\*&0 Sprinkled Building: n/a , I DEVELOPMEN'{ INFORMATION I Contractor Type Electrical License Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 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: I PUBLIC IMPROVEMENTS;t ~ ~Ol\Ci-', \1~ll t~P'Rt \f M\f ~alk Type: 1\1\S Pt.RM\\ ~~Ot.R 1\1\S pt.f\ r.O iOl\ownspoutslDrains: ~\j1\10R\2t.OO OR \S ~BM~OO~ CO~~t.~COt.~~ Pt.\\\OO. ~~~ 160 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 Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00791 ISSUED: 06/29/2004 APPLIED: 06/29/2004 EXPIRES: 12/29/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L Fees Paid' 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 $6.90 $4.83 $6.00 $63.00 6/29/04 6/29/04 6/29/04 6/29/04 Receipt Number 1200400000000000996 1200400000000000996 1200400000000000996 1200400000000000996 Total Amount Paid $80.73 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 ReQuired Insoections . 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 Page 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 #: (aM 290 007 9/ Address: <632- Cc-?\-fc-v,lAJ",4.- J DtJ Issued by: Date: b -2.-7~O Y 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 be filed with the permit. Fill in the appropriate 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. D 2. I understand that I must become licensed as a construction contractor ifthe 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice ~perty Owners abont Cons~on Responsibilities on tbe reverse.,ide of tbi, form. -r~~_L/ r L?~4,~ ~/~/oL) L (Signature of penn it applicant) if ~ (ltate) I (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 03/11/03 f, Acting as Your Own General 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. Employer Responsibilities You win, 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 fonowing: Oregon's WithbokUng Tax Law: As an employer, y<?u 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 a State Business ill number, call the Business Information Center at 503-986-2200. \ ' 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. 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 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 number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and 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. 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 frompipe punctures, fire or work that must be redone. Time: 1\1ake sure you have sufficient time to supervise Y?l!f e,mployees. . 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 buildirig 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 03/11/03 . 225 Fifth Street ~ ~pringfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt relopment Services Department Public Works Department RECEIPT #: 1200400000000000996 Date: 06/29/2004 8:21:21AM Job/Journal Number COM2004-00791 COM2004-00791 COM2004-00791 COM2004-00791 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 63.00 6.00 4.83 6.90 $80.73 Amount Paid Check CATHERINE CRAIG djb 3841 In Person Payment Total: $80.73 $80.73 "'Y' h, '\;~; 6/29/2004 Page 1 of 1