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Home My WebLink AboutPermit Electrical 2007-11-6 Date ZON~ INITIALS (k\ DATE ,\..t..C71 SOURCE - ~(Y" /1-- 6J -{)7 :225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COJ..1AZo07 _0 I b If b ,...~~ e\ ~ei)~ ~'4\\\e ~~Jiss ~~O .'ado9\e~~~o.. ~O Amps ~\\("It t\l~~ ~(\\!';"O""":\e." 0 Amps 'v. ~\v~' $'..v:;.".\t\~'Y ~O\\~..Q. tjO'l> _d OV~ ~e" to ] 000 Amps Ph~~~!aft\et.~ ~ aOAmpsNo]ts IP"'~~ \ econnect Only C. 1. /~J7~ ( {,.EGAL DESCRIPTION. J 7/? i ? f? ':! L;f.. JOB DESCQRIPTION: iMt!e WI A-<; J / ')700 o Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. E]ectrical Contractor Address City Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising E]ectrician ~::N;"i- ~hp:;::1~ 11&( City 6 pi) d /' t/7 Phone/C.!;.fj ~~ 10' OWNER INSTALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Sjgn~e: ,1/1 ~ ~/1 J_A/tA~ }lP. C Inspection Request: 726-3769 3. A. 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 $]]7.00 $ 21.00 $55.00 / I $ 70.00 $ 83.00 $138.00 $]80.00 $413.00 $ 55.00 Installation, Alteration or Relocation 200 Amps or less 20] Amps to 400 Amps 40] Amps to 600 Amps Over 600 Amps 0 ,.J 000 V 0 D. $ 48.00 $ 4.00 Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercia] $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges s-S- if/{O >~ Z7r 67 's- 4. 8% State Surcharge 10% Administrative Fee 5% Techno]ogy Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01646 ISSUED: 11/06/2007 APPLIED: 11/06/2007 EXPIRES: 05/06/2008 VALUE: 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 541-726-3676 Fax 54] -726-3769 Inspection Line SITE ADDRESS: 1272 PARKER ST ASSESSOR'S PARCEL NO,: ]703264415700 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Raise service mast Owner: SHERR] MILLS Address: 1272 PARKER ST SPRINGFIELD OR 97477 Phone Number: 541-741-9962 I CONTRACTOR INFORMA TION , Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Stories: Lot Size: R-3 Height of Structure: Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: VB Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sg,IJ ?~Rffto Sprinkled ~tfg'ON: OregDVa law r8A~~iWU\iDt1: , _ _ . 01 ~ rt.oti h\l the OreHo I "1"J) tv..", ! 'I!'. ~~ . - . ~ose rules are sel IUI" i I DEVELOPME~C:lGl1tDN . R 952-001- Iri"0AR952-UUt-UV' thrO~gh~~hea%IW~ED PARKING .MOO You may obtain copIes ...J:\n Overlay I't~r. . n the center. (Note: the te'~t1'1Jt9~ # Street Tre~f'H.mtforthe Oregon Utility Notl~~apped: Paved DrivQlfrtI~center is 1-800-332-2344)'Compact: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Description Type of Construction NOTICE: _ _._._ . arnpy (HIS p~KMIIl>nALL "^~ ".E-lrTlIC v.. . . I Valuation Description UTHORIZED UNDER THIS PERMIT IS NOT JMMENCED OR IS ABANDONED FOR $ Per Sq Ft Square It' I' B'd A ~~~80 DAY PBJiYQg. Date Calculated or mu Ip ler or I I~nl Pa2e 1 of2 Status Issued 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 541-726-3676 Fax 541-726-3769 I nspection Line Total Value of Project Fees Paid' Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid $5.50 $2,75 $4.40 $55,00 11/6/07 11/6/07 11/6/07 11/6/07 Total Amount Paid $67,65 I Plan Review~ CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01646 ISSUED: 11/06/2007 APPLIED: 11/06/2007 EXPIRES: 05/06/2008 VALUE: Receipt Number 1200700000000001370 1200700000000001370 1200700000000001370 1200700000000001370 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. I ReQuired Insoections . Electric Service: Approval required prior to utility company energizing service, 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. ~iAU Yf!d;f Owner or Contractors Signature Pa2e 2 of 2 /"/.- h ,() 7 I Date .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 Pennit#:C0W1Z0C 7- 0/ 6Cf b Address: /77 Z '=? ,412..tC61... Issued by: '-::b~ Date: I ( -6 --0 7 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: ifl. )2(2. I own, reside in, or will reside in the completed ~tructure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before oron 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. ' If! 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 ofthis form. ~1h {/iAJ--ft1t. PI- (Signature of permit applicant) 11-~-07 (Date) (White copy to issuing agency permit file, pink copy' to applicant.) Property_owner;doc 06-01-04 \ \ ...... Acting" asY 91ft Own General Contractor? ..... \ (" .... ~ -- " . , . ..J J...J H\JFORMATION'NOTICETO PROPERTY OWNERS ABOYT CONSTRUCTION RESPONSIBILITIES l__ '0 ......., 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 follovving responsibilities and concerns. Employer Responsibilities Youwil1;-in most instances, be ruled to be an "employer" and the contractors you contract with win 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 empl.oyer, you must comply .With the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes froni 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, can the Oregon Employment Department at 503-947-1488. .... "- The Oregon Business Identification Number (BIN) is a combined number for b9th Oregon Withholding and ....... Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. 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' cUiHpensation 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 1-800-829-4933 or visit their web site at w\\r'w.irs.1!ov. 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 he brought to your attention through inspections. Liability and Property Damage Insurance: 'Contact your insurance agent to see it 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. Time: Make sure you have sufficient time to supervise your employees. . Expertise: Make sure you have the skills to 'act as your ~~\'n' ge~~raJ contractor, to boordlnate the work of rough~iri and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions can the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. "r,:. Property- owner.doc 06-01-04 225 Fifth Street Springneld, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 1200700000000001370 Date: 11/06/2007 Job/Journal Number Description COM2007-01646 Service Reconnect COM2007-01646 + 5% Technology Fee COM2007-0 1646 + 8% State Surcharge COM2007-0 1646 + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash SHERRI MILLS djb In Person Change SHERRI MILLS djb In Person Payment Total: Job/Journal Number Description COM2007-01646 Service Reconnect COM2007-01646 + 5% Technology Fee COM2007-01646 + 8% State Surcharge COM2007-0 1646 + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash SHERRI MILLS djb In Person Change SHERRI MlLLS djb In Person Payment Total: cReceint I Page I of I 8:45:50AM Amount Due 55.00 2.75 4.40 5.50 $67.65 Amount Paid $70.00 ($2.35) $67.65 Amount Due 55.00 2.75 4.40 5.50 $67.65 Amount Paid $70.00 ($2.3 5) $67.65 11/6/2007