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Home My WebLink AboutPermit Electrical 2003-5-21 : " j, )>'.: '5"',' >'C,,:t~v- 'A:rs~~t"~-ei!TIET;n~" diffi~c)N~~G~ ':{~\.,,/'''), \. ,~, , ' , ' ,1,;1' VI" ,l.;)", J1"'1' :e J....i '" ' ,,' , ..}<" ~ . , ' , ~ oCt ,< ,> > v::.: '" " , " ,~< , ~'v >.., >' ",'%~1;> .,'~ ~ ,. ,,/, $<;~'<-"->"A"" .," ~>, '- .'> , ~ ' '" , 1/1 ~.o~ \p, 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION \,\0 200 Amps or less.., '1in\.",-; ,-,()V.\\\J~ . \ \'\\\\\) , 20 I ,~l]1ps'to 40gg\mps ~(\{ \ '\;\' ot:o", ,,; \" . "'.,)"'01 ^, ,,,",0 600 ^'~c.,.. , , -..J\v'''o..r..:mps'to , J':tUups,., ('\{Y, J\'" '" \J' \~::; oJ" ~ ~~'V~ \'-" ,()\.r. -('>0 f\~ '-' ,'c>. q~1~ "'"', '.: ",,; ~ \"~ 0.00, ,!,o.;1rMiips to~pplihAmp.s\e<;; V) , ,.1 ~IJ Ii;. ~e\ ~.'O\ ''',,0 \u f,.....\\U'l. . f\ f' G{\\ Oyertl'OOO'Amp.s(Volts '__0""6 \ V "\.'" ~'" ,t.....~ . . Q~ 'I It'~ :0- ,:," \cC;\.\U. (') .,t r, ~\iR:econn. ec'P, 6n"I,y.p.. t. e\C "~~."'~\O. '('\ " "" " . ~I:'l,,_~v' b\'cl'" ...'.. \\\..., 1i-\\\v....\. 0"\'\ ':')' "''\! (), ...... .,,-\/,\\0.. S ,,'-o\.\ 'F d ' , ';'\ ;\ . \\ t".(" C H.!\e"l!,porar~~~.e'rvlc~ or ,ee ers , .. ",,'1' CI-;nl....tlf' \'h" ":-!iL\Dr,. , J\J"dV '\\..(\~ \nO :_ I.Mtanatio.nl!~\te;ation or Relocation '~0;1\' .. \"" \\ ,oJ ,9 Oll . \. . e" ~" ',... \ ~.) -~ \ ~ \... n\)\"- C f\6 ",e ' 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps City Job Number CdlMZC03 --00 357, Date :-1. LOCA TION ,OF INSTALLATION /; ,\, I.{ 33i.( :bA-1 s.'y sr- 0/1. , , LEGAL DESCRIPTION '1'70'2. 323<1 JOB DESCRIPTION 2E:t. O~IC::::- f7 (< ru <<-e- o L.{~2 Z. I I', I I ". '-I 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, CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name mQyt~.C; ~ ?sr: Address y.~y txlLa ~b city~r1Ptl.1L Phone C!alJ )f21o-1J5~3 l OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. /5:Z:::z r 16 // - ~#'l Inspection Request: 72r;:;{~' 3. 05'"'08'03 COMPLETE FEE SCHEDULE BELOW A. New Residential- Single or Multi-Family per dwelling unit. 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 $106.00 $ 19.00 $50,00 Services or Feeders - Installation, Alterations or Relocation: B. ' --- - $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. D. ' Branch Circuits ' "fuc. \N()?~ - - ' . , ' x.'W \p\.. S ~Q\' .... New AR\'C~.n or ES\\~siIwW~~qet\\~~ ~()\\ on~r~~t.\\~\\ \j~\Jt.? \Qrr...~G()wc. $ 43.00 '7'3 \\\~ ~\1t.\) p- \s r\v Each, ~d~gre~<8La.a.i9or ~~. Servlce.nf~l1~a~r pe1'R1Rt.." $ 3.00 \)~' ''\~~ VP', , E. Misc~Uh"heous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Ele~tric Permi! lnspection Fee i(S4~ + Surcharg~s SUBTOTAL OF ABOVE ., ';,--- 4. ! .. " L(J Sf) I.(~-C 5Z6) 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application 1-03,doc ._Q'.fIMqJl~! , e e CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2003-00357 ISSUED: 05/16/2003 APPLIED: 05/0812003 EXPIRES: 11/16/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4334 DAISY ST ASSESSOR'S PARCEL NO.: 1702323404322 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Relocate electrical fixture, remove plumbing fixtures Repair Residential Owner: MARCOS RUIZ JR Address: 4334 DAISY ST SPRINGFIELD OR 97478 Phone Number: 541-726-7533 I CONTRACTOR INFORMATION' Contractor Type General Electrical Owner Plumbing Contractor OWNER OWNER MARCOS RUIZ JR OWNER License Expiration Date Phone ','" ,\'/ in",/, A - '\ ","" . i.'!":'\.~ .f6': ~,\1\J'" &~ , ,\\\ ,,\... ")' ...,;J~> ..\<-\t~ r :,~~\\ . ~\\V f':),V .,,,,\ ,\ .,~, f\"'-.;~' J :" ,;.. ,- '\ \.' ,.\\J.. ~_ >V. -,~3'" "_~'"l\-"': ....,\,.Jt ~\. \...... _. ,;':~ _.. ""..,'J'_ ~-..", 541-726-7533 # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . 1,......' '" \; '~'1 . e.....\ ) ~ , \ \,,-Y~BUILDING,INFORMATION1.,~.~ ,,,~. '~...... ,'-', ,~~...' , ",".. . ,\"", ift., . 'I'" \C\J ,'(:)'" '"",(:,' :,J' ,,' \"'~"\"'0P ':-- t ~\\\, 'l\'.u fS' t' \.'...". , (.H ' .' -,;'),- ,H .1 \ ~ , . tt 0' ones' . , ' .... ' ..' ..' ','.,ql.~~ ":"\..1 _ -', ,." .hV.'" '. ~>>'~'-' ,. ",\'\~ .: V~ 'I .,. \...~.' :~\',1j,' ,&',. "'.... ~:--,,\f'.t;~ '\'"~-~v;;i'~,v,!~\'\ '~e~~hto( ~truct~~\t;\\ " ~.I}~. ~\;,\.\ " ,,), ,'Type'of',Heat. \ . d' " 'o.,..."V ~~. \ . "\ ,. . .\ ~ .,"" ., ~'\''.\;, ,',\ ._,',t.__ ,\\..,.. 4)\....... VN' ''''"''to;; W" T"....'. ~ (i-"-"'" . \\ ' , ,'\ " :-\" ater' ype:, ",p , \J\)";)~:~:..,\ ".\\ 1.:':~a.n~e"Typ~~ "'",\0("\ ~Energy Path: (\\\, \ , Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION . \)~QUIRED PARKING Overlay Dist: \~~ ~ ~'\al: # Street Trees Rqd: 'X\~<:c. \<(~~\\ \S dlandicapped: Paved Drive Rqd: ~\.. <:c.~ ~S \>~ ~\) l\)~ompact: % ofLot\~b~;tal!~~ S~~f\~~ \~I\.~\)\)~ ~'0J" 0 <::(t,W~\' \) ~\~v \S ~'vl" -'(\\\S "o.\1.~...-- (\~ ,"~. . . I PUBLIC IMP~ti_~t~1 \>~"'\- \;\..1' \'O\)' ~~'l Sidewalk Type: Downspouts/Drains: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of 2 . _ GDAl1IoIftll-J.n. ---.~..~ -~ '" e e CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2003-00357 ISSUED: 05/16/2003 APPLIED: 05/08/2003 EXPIRES: 11/16/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Type of Construction $ Per Sq Ft Square Footaee Value Date Calculated Total Value of Project Fees Paid. Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Miscellaneous Plumbing Amount Paid Date Paid $9.00 $6.30 $43.00 $2.00 $45.00 5/16/03 5/16/03 5/16/03 5/16/03 5/16/03 Receipt Number 1200200000000001231 1200200000000001231 1200200000000001231 1200200000000001231 1200200000000001231 Total Amount Paid $105.30 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 Rea.m.rfd Inspections. 1 Rough Plumbing: Prior to cover and including required testing. 2 Final Plumbing: When all plumbing work is complete. 3 Rough Electric: Prior to Cover 4 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. _'fti,,-=- ~ ( L /[/... Owner or Contractors SigoMtl,9' 5- - /6'- 03 Date Paee 2 of 2 . e 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#: COvV\. Z~'-003r7 Address: L13'3>L-j 'bA\ Sy Issued by: nU' Date: s.T s/lb/03 I , <i 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 befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: kl. ~ 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. 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. OR ~ 3B. I will be my own general contractor. Ifl 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 ofthe 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. ~-=. ~ 05 -Ifo -05 { (Signature it applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 03/11/03 e e Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . I.> NOTE: This Information Notice to Properly 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 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 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 following: Oregon's Withholding Tax Law: As an employer, you 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 ID 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 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 own general contractor, to coordinate the work of rough-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_owner.doc 03/11/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00357 COM2003-00357 COM2003-00357 C0M2003-00357 C0M2003-00357 Payments: Type of Payment CreditCard 5/16/2003 City of Springfield ~ Development Services Department. Public Works Department. Official Receipt Receipt#:1200200000000001231 Description Miscellaneous Plumbing Add, Alter, Extend Circ Minimum/Adjustment Electrical + 7% State Surcharge + 10% Administrative Fee Paid By MARCOS RUIZ JR Received By djb 3:13:23PM Date: 05/16/2003 Item Total: Amount Paid 45.00 43.00 2.00 6.30 9.00 $105.30 Check Number Confirm No 000070 004701 Amount Paid 105.30 $105.30 e How Received In Person Payment Total: e Page I ofl cReceipt.rpt