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Home My WebLink AboutPermit Electrical 2006-8-17 ZON L-T:f2- " INITIALS . N fV\ , -~ DATE lW It /OV · SOURCE 9t1~ gJ 7 j r- '..' ../.. I .. 3..C;OftlPLETE FEE SCHEDlJLEBELQUt .225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICALPERMIT APPLICATION City Job Number ('_C::>~Z.OOb - 010 hb 1. ,.LOFATION OF Ii'fSTALu'iipN:" , JL( SO Ct\A.' ~~&&;\,.4.. (. I?I" cl. LEGAL DESCRIPTION: /70:SZ $33 o 8" zoo Date . ..~ . . . A,Ne,wResidential-:Single ?f}VIulti-Family per d~v~lling unit. .' Service Included JOB DESCRIPTION: 1000 sq. ft. or less $106.00 lL {( / J I 1/ !'L Each additional 500 sq. ft. or "de t:> c...(lf""c....\A,.:-- -S 'I- /u"v va r portion thereof . $ 19.00 Permits are non-transferable and expir/ifwork is Each Manufact'd Home or t t d. I' 180 d f' 'f k' '. 'M" . arl' ,- BIfII rl"l.nLJ'S'es 'IOU to no s arte WIt un ays 0 Issuance or I wor' IS '. 0 u ar '.owe lllg ervlCC) or. Suspended for 180 days. 'Eeeder. b~' 'lhe Oregon t1l1ty $50.00 ..., .' '.' ....... .... . .,.... .. ' . =- .,:teL "100:)8 r,ules, a;.;t ~$t !<?::h;. . 2.COP"f:lCTi:!!l INST~TIO~o.:1:r\0~ ;~~fJ(~'2~"r!s':~~Tg~~.~tiO'" AUm';o.., 0' Rdo,.tio.., Electrical Contractor w,~:: 1\;J the CEf.9!eA.~~:S':'Q.B!~sse t~::~ho~e $ 63.00 number for th€P(!)~~I2slt0J.jJj00fA'mpsflcatlon $ 75.00 Address Centetl0J 1\Bfp~.t3Z606?P!m1}3 $125.06 601 Amps to 1000 Amps $163.00 City Phone Over 1000 Amps/Volts $375.00 Reconnect Only $ 50.00 Supervisor License Number ltil ~ OJ Expiration Date. ConstL ContL Number Expiration Date Signature of Supervising Electrician Owners Name <:~ fi, ~(~ /M c- ~ur- ~ Address 070'i( City ~~W;.f!~J If'&- .-o2.&f Phone .f(. ~ ? 't"? ~ ~'f(, (qI7-1C. " The installation is being made on property I own which is not intended for sale, lease or rent. OWNER INSTALLATION ~re:c4 / . Inspection Request: 726-3769 ,:_:;'_,,"'-)":'7'':'' ,--:_:' ,"'.s:-: ;, ",'-\'r.' y ::'.' : :' C.TeJnPor,ary Services or Feeders, , -."." _. .,_~'.- _" .:. ~ ...,-.;;.. . w.- - <..., Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 ~UT1CE: 401 Amgs,tq..6OOAmWTHE wapI:{ $100.00 THIS PERM&}~~~t~;~~~t$rs~~i" above, . . AUTHORllE,.B . 'ch-rR lluOOMEDFOt\. . . '. CO M M E <<c Eu ~p.. f,,:nffRhi!.. .......... ...d........ ; ANY 180 &ftwPAiak'lilon or Extension Per Panel / One Circuit . $ 43.00 Each Additional Circuit or with cr- Service or Feeder Permit :;> $ 3.00 l/:> /,1' "-".' ->. . - '<<"~''':' . ,'< .~ . '. ".. ; E.Miscellall~ous(Service/fee~er ilOt Illcluded) -Eachlnstall~tion Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential I $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. "Sl.TBTOTAL OFABOVE 8-:1 8% State Surcharge b b'f 10% Administrative Fee 8;70 5% Technology Fee 4' r /02- ~ zs- TOTAL Shared Drive(T:)/Building Fanns/Electrical Pennit Application 8-06.doc CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01066 ISSUED: 08/17/2006 APPLIED: 08/17/2006 EXPIRES: 02/17/2007 VALUE: Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1450 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703253308200 Springfield TYPE OF WORK: Electrical Work Only Residential PROJECT DESCRIPTION: Add 6 circuits and low volt phn TYPE OF USE: Addition Owner: STUART GOURLEY Address: 39091 MCKENZIE HWY SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATION I # of Stories:-'3quires you to R-3 HeightofStru{itfife')n Utility Typ~ot'Reat:\es are set forth VN . . ~'a,t~rlTry.R~~h OAR 952-001- ,.,.' \' '"J ,r,l' (~J~~:~~ e(~p,!lJ;S of the rules by U'J ,u, .."' \ Ener~y\;P.ath:the telephone cailin9 'lhe ~e.sl0iilnkol~d;Jiulild,ing3tifiCation nla '~llrnhFr fer tl18 r3\:j II VlIIILY' .," _ '_ .4 lH'" '-4;--<'~-/'l.~a..yJt I \0EV'E~()PMENT INFORMA nON, Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Phone Number: 541-746-0269 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: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: N01\CE: HAll EXPIRl(!~f~~d(~I.1ll.'i1li4ns: 1HIS PERM\1 GNDER 1HIS PERMI1 IS N01 AU1HORIZE~D OR IS ABANDONED FOR COMMENCL . .", ~nr\ ('I\Y Pt=RIOO. .Mol\-! , .-.... I Valuation ~escription I Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction PalZe 1 of 2 Value Date Calculated 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 + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Cire Add, Alter, Extend Circ Ea Add Low Voltage - Residential Total Amount Paid CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2006-01066 ISSUED: 08/17/2006 APPLIED: 08/17/2006 EXPIRES: 02/17/2007 VALUE: Total Value of Project L Fees Paid _ Amount Paid Date Paid Receipt Number $8.30 8/17/06 1200600000000001280 $4.15 8/17/06 1200600000000001280 $6.64 8/17/06 1200600000000001280 $43.00 8/17/06 1200600000000001280 $15.00 8/17/06 1200600000000001280 $25.00 8/17/06 1200600000000001280 $102.09 I Plan Reviews, 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. Reouired Insoections , Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Low Voltage: Prior to cover. 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 ORS701.005 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. UL -<1~Z J' 17 i~ I . Date Pa!!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 co~ ~~~~- 61 o6G C &vv.L.""",~,( ~/~J Date: ~ J/7hb I / Permit #: Address: / l./ S-Cy ~ 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 7Q1.010(7), need notsubmit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and ini~ial boxes 1 and 2, and either box 3A or 3B: ~1. -e 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. 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 ~ 3B. I will be my own general contractor. If I 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. ~U2~ 8'.t?~D& (Signature of permit a~cant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 . -. _ b.,.... , . Acting (as -=\'ou'r..ewnGeneral.Contractor? It. r--J ". .' {'. . . .. . . . ; INFORMATI'ON'NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES " .: . " " --\ ' " ,- \ , o.j ,. \, .' 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. 't #+ If you are acting-~s your o~ contractor to construct a newhome or ma~e a substantial imp~ovement to an existing structure, you can prevent many problems by being aware of the. folloWing responsibilities and concerns. Employer Responsibnit~es .. ,.. You will, in most instances, be ryled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Con~tructi'on Contrac'tors.'Board to do labor in cqnstructing ()r to assist in the consuUctionor improvement of a residential structUfe. As the ~mployer, 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 win be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, can the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpos~~""'" on the wages of an 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, call 503-945-8091 or www.dor.state.or.us/formsoav.html1 for the appropriate fonus. .; Workers' Compensation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law, and must obtain work~rs' compensation insurance for your ,;"ul.l!loye~s. _If y<?u fail to obtain workers' cVJUpensation insurance, you could be subj ect to penalties and be liable for all' claim costs if one of your e~ployees is injured on the job. For more infortnation, call the Workers' Compensation Division at the Department otConsumer-and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from' employees' wag~> ....... 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\vww.irs.Q:ov: ", 'Otber R~sponsibilities 3ndAreas o( CQncerns 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 Prope'rty' Damage Insurance:' Contact your insurance agent :to see if youhavead~quate insu'rah.ce . coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must b~ redone., .:. ,,--' "':"! Time: Make sure you'have sufficient time to supervise your employees. . " . Expertise: Make sure you have the skills to act as your owh gerlera1' contractor, to cootdinate 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 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 C;i-. (If Springfield Official Receipt L lopment Services Department Public Works Department Job/Journal Number COM2006-0 1 066 COM2006-0 1 066 COM2006-0 1 066 COM2006-0 1 066 COM2006-0 1 066 COM2006-0 1 066 Payments: Type of Payment Check cReceint 1 RECEIPT #: 1200600000000001280 Date: 08/17/2006 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Low Voltage - Residential + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By GOURLEY RENTAL ACCOUNT Item Total: Check Number Authorization Received By Batch Number Number How Received djb 0996 In Person Payment Total: Page 1 of 1 1l:50:12AM Amount Due 43.00 15.00 25.00 4.15 6.64 8.30 $102.09 Amount Paid $102.09 $102.09 8/17/2006