HomeMy WebLinkAboutPermit Electrical 2007-12-14 2:;5 FlFI1l S rREET . SPRINGFIELD, OR 97477 . PH (54])726-3753 . FAX (~41)726.3689 ELECTRICAL PERMIT APPLICATION City Job Number C CIA^. ~ C 7 ~O ( S? S-:s: ZON mrtJ7./ lNlTIALS N ~ DATE I d.-I I, I 0 .. SOURCE \Y\ '(IS l'" ) Date IZ-It( -e:.-( 1 3 :~OMPLETEFEESCHEDliLE~Ef!Jij-- ,. LOCATIOl'f OF ll!S~ALIATION: <) I) 7 A % S-tNe t LEGAL DESCRIPTION 17C>Z- 333 2 03 11.3 A New ReSldentlal-~SlUgle or ~ultl-Famdyperdwelling UDlL 'S f" '''3 r. € \ d DR. CJ 71.( 7 8 Service Included JOB DESCRIPTION 1000 sq ft or less Each additIOnal 500 sq ft or portIOn thereof [2t=-PLke jJ.A-N~L Permits are non-transferable and expire If work IS not started wJthm 180 days of Issuance or If work IS Suspended for 180 days Each Manufact'd Home or Modular Dwellmg Service or Feeder 2 ~-~---- , , CONTRACTOR Il'fSTALIATION ONLY, B Services or Feeders - InstallatIon, Alterations or RelocatIOn: 7U New Alteration or ExtenSIOn Per Panel One CircUit Each Addlllonal CirCUIt or With () Servlce or Feeder PermIt Owners Name rn'('~H) Ire,l,,\ Address 5 I ~ A S~" ~::J~'{!I ~ ;),HAll :x,,'~II~;lIaneo~:,~servlce/feeder not mcluded) '-E;chIn.tallatlon City '\I',,^c,\,eld Phonegvffm~DERnl'm'~ rdrt'RK $5500 U ./ 7 7 '/7 f3 COMMENCED OR IS AB~tffl'1 '1;\ J!.1i1MQl $ 55 00 OWNER INST ALLA nON ANY 180 DAY PERIOD. Llmlte~ nefWkesldenllal $ 28 00 The mstallatlon IS bemg made on property I own whIch Lumted EnergylCommerclal $ 50 00 IS not mtended for sale, lease or rent Mmlmum ElectriC PermIt InspectJon Fee IS $50 00 + Surcharges 4 SUBTOTAL OF ABOVE -;7 0 , 8% State Surcharge ;;b= 10% Admmlstratlve Fee -7 5% Technology Fee --<:' ro &6~ Electncal Contractor 200 Amps or less 201 Amps to 400 Amps Address 40 I Amps to 600 Amps 601 Amps to 1000 Amps , ',,\ City Phone ,N ,..,'^~ Over 1000 AmpsNolts , , - OIJ't~dV'b' law requ~SOl1nect Only , Y the 0 yOU to /[, ,,' -e'ller Tho regon Uti I O ' '/. J01 0 se rul_ Pl. SupervISor License Number G, 1J y~~_ . 010 throu h ..,.arilllfelV8fi1try Services or Feeders , Cq/'/'21t I?~e ~~ uDtam COP/~S o~AR 952-00'. ExpJratlon Dale nU'l!~t;: lor th^nter (Note th t t~liSlltl!qjt!lf, AlteratJon or Relocation t7 v Center ~S 0; ~~on UtJ/1tye N~cfIt.!?~S or less Constr Contr Number 0-332-2344P.O~1J.; to 400 Amps 40 I Amps to 600 Amps ExprratJon Date Over 600 Amps or 1000 Volts see "B" above D Branch CIrcUIts SIgnature of Supervlsmg ElectriCian Owners Sf1r'a~ure /J 1YttrJ,4J! C? I~ '~ Inspection Request 726-3769 TOTAL Shared Dnve(T )/BUlldmg FormslElectncal Permit ApplicatIOn 7-07 doc $11700 S 2100 $55 00 S 70 00 $ 83 00 $13800 $18000 $413 00 $ 55 00 S 55 00 $ 76 00 $110 00 $ 48 00 $ 400 -~ .,""" , CITY OF SPRINGFIELD. Building/Combination Permit Status Issued 225 FIfth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectJon Lme PERMIT NO: COM2007-01853 ISSUED 12/14/2007 APPLIED 12/14/2007 EXPIRES, 06/14/2008 VALUE' SITE ADDRESS 5137 A ST ASSESSOR'S PARCEL NO 1702333203113 SprIngfield TYPE OF WORK ElectrIcal Work Only TYPE OF USE PROJECT DESCRIPTION Replace 200 amp panel Owner MICHAEL PERRY Address 5137 N A ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type ElectrIcal Contractor OWNER LICense BUILDING INFORMATION' #ofUmts PrImary Occupancy Group Secoudary Occupancy Group PrImary ConstructIOn Type Secondary ConstJ uctlOn Type # of Bedrooms # of StorIes R-f\TTENT'Offl~WrfhfW'lu re follow rules] ~~ at equlres you to -p\jltltlcat/on CW~ ~ the Oregon Ublity In OAR 95"-Ooo.(j~(f!!lfce rules are set forth 0090 You m'ljl'1OOJi'41,Jl~u9h OAR 952-001_ calling the CSjl1tllrld(jIJl}.~lq~ the rules &16 number tnr tho '"'__ _. . .... telephone I~~M~~ Frontydrd Setback S,de I Setback SIde 2 Setback Rearyard Setback Solar Setbacks Overlay DlSt # Street Trees Rqd Paved D"ve Rqd 0/0 of Lot Coverage RepdJr ResidentIal Phone Number 541- 747-1980 Expiratlon Date Phone Lot SIze Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Gardge/Cdrport Sq Ft Other Occupant Load REQUIRED PARKING Total Handicapped Compact I.PUBLIC IMPROVEMENTS I SldeWdlkjye OR\<. N01ICE: roaw.J;,'~ ~ 11ilS PERMIT SIi"L~ 11ilS PtR m \1101 AUlliORlZED UND~S ABANDONED fOR ~?I~~;~~~~ ~~R\OD. I ValuatIOn DescnotlOn I Street Improvements Storm Sewer Available Special InstructIOn Notes DeSCriptIOn $ Per Sq Ft or multJpher Square Footdge or BId Amount TVJle of ConstructIOn Pa~e I of 2 Value Date Calculated Status Issued ' 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO. COM2007-0]853 ISSUED' ]2/]4/2007 APPLIED: 12/14/2007 EXPIRES' 06/1412008 VALUE' Total Value 01 ProJect F~e. PaId I Amount PaId Date Paid Receipt Number Fee DeSCrIptIOn + 10% AdmmlStratlve Fee + 5% Technology Fee + 8% State Surcharge Perm ServlFdr 200 amps or less Totdl Amount Paid S700 $350 $560 S70 00 12/14/07 12/14/07 12/14/07 12/14107 2200700000000001842 2200700000000001842 2200700000000001842 2200700000000001842 $8610 I Plan ReViews , To Request an mspection call the 24 hour recordmg at 726-3769 All mspectlOns requested before 7 00 a,m Will be made the same workmg day, mspectlOns requested after 7:00 a m Will be made the followmg work day, I ReoUlred ]nsnec!Jonsl ElectrIc ServIce Approval required prIor to utlhty company energIZIng servIce By signature, I state and agree, that I have carefully exammcd the completed apphcatlOn and do hereby certify that all mformatlOn hereon IS true and correct, and I further certlf) that any and all work performed sh.lIl be done 10 accordance With the Ordmances of the City of SprIngfield and the Laws of the State of Oregon pertammg to the work descllbed herem, and that NO OCCUPANCY will be made of any structul e WIthout permISSIon of the CommuDlty ServIces DIVISIOn, Bulldmg Safety I further certify that only contractors and employees who are m comphance With ORS 701 005 Will be used on thIS project I further agree to ensure that all reqUIred mspectlons dre requested althe proper time, that edch dddress IS read.hle from the street, that the permIt cdrd IS located at the front of the property, and the approved set of plans will remam on the SIte at all hmes dUring construction Ow,,~,,/ib Date \7--;;'-( ~, / I Pa~e 2 of 2 (I) Construction Contractors Board 700 Summer 8t NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone' 503-378-4621 Web Address www ccb state or us Pemut # COo/lA C:CCn- () I ~ S- 3 A- ~-l-- / Date / Z //r;/o7 I / 5/37 I /? .} '-"- 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 followmg statement before a bUIldmg permit can be Issued This statement IS reqUIred for resIdential bulldmg, electrlcal, mechamcal and plumbmg permIts L,censed archItect and engmeer applicants, exempt from IIcensmg under ORS 701 010(7), need not submIt thIS statement ThIs statement wIll be filed WIth the permIt Fill m the appropnate blanks and mll1al boxes 1 and 2, and eIther box 3A or 3B 01 2::(/2 I own, resIde m, or wIll resIde m 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 #) 1 will mstruct my general contractor that all subcontractors who work on the structure must be lIcensed WIth the ConstructIOn Contractors Board OR ~B I Will be my own general contractor If I hIre subcontractors, I wIIllnre only subcontractors lIcensed WIth the ConstructIon Contractors Board In change my mmd and lnre a general contractor, I Will contract WIth a contractor who IS lIcensed With the CCB and WIll ImmedIately notIfY the office Issumg thIS bmldmg permit of the name of the contractor I hereby certify that the above mformatlOn 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 m:aJj q;?~ (Z-!r~(/u 1 (SIgnature of p"''''': applIcant) / (Date) (WhIte copy to Issumg agency permIt file, pmk copy to applicant) Property_owner doc 06-01-04 A_cting as Your Own General Contractor? 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 substan1::tallmprovement to an eXlstmg structure, you can prevent many probl'ems by Bemg aware of the followmg responslbll1tIes and concerns Employer Responsibilities You WIll, m most mstances, be ruled to be an "employer" and the contractors you contract wIth WIll be "employees" If you use contractors not hcensed with the ConstructIon Contractors Board to do labor m constrnctIng or to assist m the constructIOn or Improvem:mt of a reSidential structure As the e~pIoyer, you must comply WIth the following: Oregon's Withholding Tax Law: As an employer, you must Withhold mcome taxes from employee wages at the time employees are paid You wIll be hable for the ux payments even If you don't actually WIthhold the tax from your employees For more mfonna1::ton, call the Department of Revenue at 503-378-4988 .. Unemployment Insurance Tax: As an employer, you are requrred to pay a tax for unemployment msurance purpose~ on the wages of all employees :or more mformatton, call the Oregon Employment Department at 503-947-1488 " The Oregon BUSIness Iden1::tficatlOn Number (BIN) IS a combIned nwnber for both Oregon WithholdIng and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or ww\v dor state or us/formsoav htmll for the appropnate forms Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVUOI'~HsatlOn Law, and must obtam worker~' compensatt,on msurance for your employees If you fall to obtam workers' compensatIon msurance, you could be subject to penalties and be hable for all claim costs If one of your employees IS Injured on the Job For more mformahon, call the Workers' CompensatJOn DlVlslOn at the Department of Consumer and Busmess ServICes at 503-947-7815 U.S. Internal Revenue ServIce' As an employer, you must WIthhold federal Income tax ITom employees' wages ' You Will be hable 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'OiW Irs "0\ - Other Responsibilities and Ar.eas of Concerns ; Code Compliance. As the penUlt holder for thiS project, you are responsible for resolvmg any failure to meet code reqUirements that may be brought to your attentton through mspectlons , ' . , - _ {'to _ Liability and Property Dama'ge Insurance: Contact your msurance agent to see' If you have adequate msurance coverage for aCCIdents and onuSSlons such as fallmg tools, pamt over spray, water damage ITom pIpe punctures, fire or work that must be redone - - - . "- Time' Make sure you have suffiCIent brne to supervIse your employees ,,- r I, ~ \~ . \ Expertise: Make sure you have the slalls to act aq your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfy bUlldmg offiCIals as the appropnate hmes so they can perform the reqUired mspectlOns If you have addlbonal questIons call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 ~ Property_owner doc 06-01.04 225 Fifth Street Sprmgfield; Oregon 97477 541-7~6-3759 Phone :~ ....~ ~ City of Spnngfield Official Receipt Devclopment Scrvlces Department Public Works Departmcnt Job/Journal Number COM2007-0 1853 COM2007-0 1853 COM2007-01853 COM2007-0 1853 Payments Type of Payment CredltCard cReLemtl RECEIPT # 2200700000000001842 Date 12/14/2007 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% AdmIDlstratlve Fee Paid By MICHAEL PERRY Item Total L:heck Number AuthOrizatIOn Received By Batch Number Number How ReceIVed dJb 330663 In Person Payment Total Page I of 1 9 33 09AM Amount Due 7000 350 560 700 S8610 Amount P.lld $8610 $8610 12/14/2007