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Home My WebLink AboutPermit Electrical 2007-11-21 3. 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEt.;lKICAL PERMIT APPLICATIOjV City Job Number COtM LOO 7 - 0 J7/ b Date Installation, AJteration J).1' Relocation A TTEi'-!iION: Ore,(hon law reqUIres you to follow rules adopte'B ~e>m~on Utility $ 55.00 N:.ltification Center?Ojl~'o~~orth $ 76.00 in OAR 952-001-00lW~~001. $110.00 I\I\QO vou may obtAin i s of the r es bv \lW7 . " (Tv olts see "B" above calling the cent . number for thell:> Center is ~qjrfaf.~1k Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit 1. II l' { LEGAL DESCRIPTION: 176l303l{ D~OOC JOB DESCRIPTION: r!o..-~ f: ~ , /L.~ 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. Electrical Contractor Address ? City Phone d' Supervisor License Number ~ ~ Expiration Date 0 ~ Constr. Contr. Number / I' Expiration Date I , Signature of Supervising Electrician Owners Name 1/);//"./.1 Z ,.((';("t/L If Address / /1 f ..,; -:7 tJ e City C:-2?(,'~ I':; [tj(J Phone 2Ld~.(/(. -c;q z, f ) f OWNER INST ALLA TION The installation is being made on property).. is not in ~d D~o"ale lease or "/tnt. ,/If ers~a\~ /( /' _L_ ( / . C.// ~~ V V which Inspection Request: 726-3769 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 I $117.00 117 $ 21.00 $55.00 B. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 70,00 $ 83.00 $138.00 $180.00 $413,00 $ 55,00 C. $ 48.00 $ 4.00 E. $ 55.00 TOTAL J lf3 ';1 Shared Drive(T:)/Building FormslElectrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01716 ISSUED: 11121/2007 APPLIED: 11/2112007 EXPIRES: OS/2112008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1191 30TH ST ASSESSOR'S PARCEL NO.: 1702303403000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: House rewire Owner: ZURFLUEH DAVID Address: PO BOX 818 MARCOLA OR 97454 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: Enes!V:olil\ij1: ,...... ~:!.'-"\()1\\: Oregon law :e6~~1&fJertlmyilding: nla -. - -'. 'f"j t P. - i.A~ ).,)W ~ ~.l~~fC~~~~t 1I1oD\E_W~WaNFORMA TION I ~ootlt~~~~2_001-001~tlllv"'ies oHM rums oJ III " obtain cop +o\prhnn, Frontyard Setback: 0090. You may t r (Note: tne\le1'~ fUU6n Side 1 Setback: ca\ling the cen gr"egon UtmW~f\W<frees Rqd: Side 2 Setback: number for the.s 1.a00-332.j~1}"Drive Rqd: Rearyard Setback: Center' % of Lot Coverage: Solar Setbacks: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street.Improvements: Sidewalk Type: Downspouts/Drains: Storm Sewer Available: Special Instruction: E. ,.\-\~ WOR\{ ~~~~ER!A~ ~~~~W~~~i~~~f~:OT ~U1HUt\' ~ - ~ ,,~';N\;:\:\lU.U - CQMMEN ~ Descri tion A~'{ 180 $ Per Sq Ft Square Footage Type of ConstructIOn or multiplier or Bid Amount Notes: Description Value Date Calculated Page 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01716 ISSUED: 11/21/2007 APPLIED: 11121/2007 EXPIRES: OS/21/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Residence Wiring 1000 Sq Ft Amount Paid Date Paid $11.70 $5,85 $9,36 $117,00 11/21/07 11/21/07 11/21/07 11/21/07 Receipt Number 1200700000000001431 1200700000000001431 1200700000000001431 1200700000000001431 Total Amount Paid $143.91 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. 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 aU 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 ofany structure without permission ofthe 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 Pa2e 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.oi..us Permit #: CO{.lvrzoo 7~O ',71 f, J / '1 I "3 di- L S +- '/ '~:S Date: II/Z 1/07 / Address: 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 no/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: ~ I own, reside in, or will reside in the completed structure. ~ 'I ~derstand that I must become licensed as a construction contractor if the 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. .-./' ,OR Y 3B. I will be my own general contractor. Iflhire 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 CCBand will immediately notify the office issuing this building permit of the name ofthe contractor., -l herebycertif e above information is corre and that I have read and do understand the Information O:v;;Ska/ nsibifities on ilie reverses;;: ;::s i: / (Signature Of~6=1~r pTidult)' , (Date) , / , '" (White copY1 to . ~uing agency permit file, pink copy to applicant.) '--" Property _ owner.doc 06-01-04 A.ctlng as Your General Contractor?.. INFORMATION 'NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about ConstructionResponsibifitl~s was developed by the 'I Construction Contractors Board in accordance with ORS 701.055(5~, passed by the 1989 Oregon Legislature'J 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 instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with th.e Construction Contractors Board to do la~or in constructing or to assist in the construction or improvement of a residential structUre. As the employer~ you must com~ly with the following: Oregon's Withholding Tax Law: As an employer, you must withhold inc01~e taxes from employee wages at the time employees are paid. You will be liable for 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 number for both Oregon' Withholding and '- Unemployment Insurance Tax. To file for a BIN, can 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' cvwpensation insurance, you could be subject to penalties and be liable for all claim costs if one ofyotlr employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer aIld Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wagis,:-, . 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 wVilwoirs.Qov.. . : Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving a~y' failure to meet code requirements that may he b~ought to your attention through inspections. Liability and Property Damage Insurance: ' Contact your insurance agent to see if you' have. adequate' insunmce' coverage for accidents and omissions such as falling tools, paint over spray, water damage from pip~ punctures, fire or work that must be redone. . ' f :~, '.' ',,.:.:. '.J Time: Make sure you have sufficient time to supervise your employees; ... Expertise: Make sure you have the skills to act as your own gerier~l confradot~. t~ coordinate the work of tough:-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 _ owneLdoc 06-01-04 225 Fi(th S.treet Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01716 COM2007-01716 COM2007-01716 COM2007-01716 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Residence Wiring 1000 Sq Ft + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DA VID ZURFLUEH City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000001431 Date: 11/21/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 009067 In Person Payment Total: Page 1 of 1 10:15:05AM Amount Due 117.00 5.85 9.36 11.70 $143.91 Amount Paid $143.91 $143,91 11/21/2007