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Home My WebLink AboutPermit Electrical 2008-1-29 , '~~ "_ 'f _.." ..~''\;;',.o ~~-'" ., ,'~ . . : ;;i.! '~I:.rY;uqt'SR~.{li,'ll~;, ORE6~QNf ' :: ", '. ZON \ &.....u INITIALS \:>1-"'-- DATE \ - "30 - tl<;( SOURCE'N\, ~,""/7./ i25 FIFTH STREET - SPRINGFIELD, OR 97477 _ PH:(541)726-3753 - FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION Ciiy Job Number Ct>lNI Z- C> 09' - 00 ( Z 0 200 Amps or less 201~st0400AmPS ATTENrif . IP ulres yoU to follow I'IJ es a 9Pt~~mregon Utlllti Notificat~lh~\ffi~r.~~ are set f","h In OAR 9@Z'lJd~~ OAR 952.001. 0090. Y~'OI!J!atriJCopies of the rules bv calling c Note: numl@.r Ik% "W""d'_d 'd'y_____ --" d, ''"7'I:''TTnii:ff'iJiijffi:,'-''::iI 1. lu'J:"g,g;rI;21V:Qfr~~~l(!~ II 0 8 7+'-1 .5-f- LEGAL DESCRIPTION: J7D-:s3 SI2.. 0"3 70 ~ JOB DESCRIPTION: AI+f'YFX'r~1\. S' C"c....",...{. Permits are non-transf~rable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor ' ON f\e r Address...... ,S",^,,- e ~ City Supervisor License Number E.' 0/ xprratlOn ate / ' ConsQ:/Contr, Number / Expiration Date Signature of Supervising Electrician Owners Name A-l\der:.s~Ld;:e Hc.rs'k1-1,e11 Address \( () ?: ') f" S-t ~ City:?l"I''\:fe \~ Phone 7IS-"::,LfCff OWNER INSTALLATION The installation is being made on property I o~ which is n~t,~;,,~~~:,d':,~,OfSale, ~e,or~~~?f/ Owners Signature~... y-/ / &/ ,///" V./ '/,~r.r'~ ' ' ' ~- ~/ 'V' I // I /' Inspection Request: 726-3769 t / V-.q I 0 ~ Date 3. :,HP;q;f'!,~I't],ljj\l'fl4i~%'}i#':'TIY'iPFE:::;;jj!0ffiM0c,z24j;",*<j>s"X~+J1~;;4'Mfg1ii'50j-;H>-;!i'/ii~0;;0U2'w". 'ia:rqr A. ~N.e\Y'l!~iilenti1!!;";'sIi:1gle;o~i.Miil~i:El!,!!ily.p!il.:;Qjys!!igg;u.nit~;;~{. 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 $117,00 $21.00 $55,00 B. $ 70,00 $ 83,00 $138,00 $180,00 $413,00 $ 55,00 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps $ 55,00 $ 76.00 ,. $110,00 ,Over 600 Amps or 1000 Volts see "B" above, D. New Alteration or Extension Per Panel One Circuit I $ 48,00 ~ ~ Each Additional Circuit or with Z 5? Service or Feeder Permil' $ 4.00 E. $ 55,00 $ 55,00 $ 28.00, $ 50,00 5G b""'Z. '}b'" Z150 TOT Ai.'-" 7 / I Z. Shared Drive(f:)/Building FonnsIElectrical Pennit Application l-QS.doc , , CITY OF SPRINGFIELD' Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2008-00120 ISSUED: 01/28/2008 APPLIED: 01/28/2008 EXPIRES: 07/28/2008 VALUE: SITE ADDRESS: 1108 7TH ST ASSESSOR'S PARCEL NO.: 1703351203700 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Add/Alter 3 circuits TYPE OF USE: Addition Residential Owner: HARSTAD LESLIE Address: II 08 7TH ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMA nON I Contractor Type Electrical Plumbing Contractor OWNER OWNER License BUILDING INFORMA nON J # of Units: # of Stories: Primary Occupancy Group: R-3 Height,ofStructure Secondary Oc~upancy Group: Type of Heat: Primary Constrnction Type VB Water Type: Secondary ConstrnctioQ Ttne:, Range Type: # of Bedrooms: AI 't:I~ IION:,Oregon law,retjull'lls'YbQIto fOlI.ow J'!l'eSadopted by the ~1l"'Vl>>>>Jding: n/a Notification ~rtf"" Th,,~~ ~.I~,:, ':'.": :*~::-t: J1I OAR952-OO1-o01"IUUQ~ImB'2IDIl'IFORMA nON I fI09O. Youmayobtalr. t""IU!f(;/ Ultr.'JIVS oy calling the center. (Note: the telepl1.\lnlt llUmber for the Oregon Utllit~NOlllrcllti'i5i't Center is 1-800-332-~,et Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: ' Special Instruction: 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: N OTI~r:nspouts/Drains: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, Notes: Paee 1 of 3 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00I20 ISSUED: 01128/2008 APPLIED: 01/28/2008 EXPIRES: 07/28/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Description $ Per Sq Ft or mulliplier \ Square Footage' or Bid Amount Type of Construction Total Value of Project Fpp,., Pli.II.I Fee Description + ]0% Administrative Fee + 10% Administrative Fee + ]2% State Surcharge + 12% State Surcharge + 5% Technology Fee + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Storm Sewer - 1st 50 Feet' Amount Paid Date Paid $5,00 $5.60 $6.00 $6.72 $2.50 $2.80 $48.00 $8.00 $50.00 1/28/08 1/28/08 1/28/08 1/28/08 1/28/08 1/28/08 1/28/08 - 1/28/08 1/28108 Total Amonnt Paid $134.62 I Plan Reviews I Valne Date Calculated Receipt Number 1200800000000000076 1200800000000000076 1200800000000000076 1200800000000000076 ]200800000000000076 ]200800000000000076 ]200800000000000076 1200800000000000076 1200800000000000076 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. R~rl'irp1 \r~i1"\tilrn: , Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Storm Sewer Line: Prior to filling trench. Page 2 01'3 / ,-$~~!!iq!il!!!-_~: "l _f. a\:""" . ' ,'.' ",', ' .' . ,"'>-', " w" Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00120 ISSUED: 01/28/2008 APPLIED: 01/28/2008 EXPIRES: 07/28/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 ensnre that all required inspections are requested at the proper time, that each address is readable from the street, that the p,.ermil card is located at the front OfRJhe pr ty, and the approved set of plans will remain on Ihe site at all times duri~g:c~truction. ~~ .--o?/ - ______' .---;:;/" /~ /' J ( /'~___----~h ~C V/~' \ {)-.q (0 ~ Owner or C~o9-Signature Date \ Pagf3 of 3 -' , , , , . ' , ' '. .' '. " 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 #: <:0 Wl c....o=--J? _ <::> Cl / z,.O Address: I/O~ .~1I 7f" S.J- Date: 1- zY - O;g--- Issued by: Statement: Information Notice to Property Owner~ About Construction Responsibilities Note: Oregon Law, ORS 701,055(4) requires residential construction permii applicants whoare 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 I and 2, and either box 3A or 3B: / . 121' 1.' I own, reside in,or will reside in the completed structure. /' , , . -' ~ I underst~d that I must become licensed as a construc~io~ 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. I hereby certify tha!J-~ aboye information is correct and that I have read and do understand the Information Notice to Prop..erty-Owners abo s ction ponsibilities on the reverse side of this form. /;;:~~. Z \Ii}-~/f)~ ~ ' I ..//"/ ~gnature ofpemht appkC'ant)- (Date) ~ (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 l) ..., .{\cling'as :Y-our"Own General Gontractor? -"'" .!. ' '''INFORMAild~ NOTICE TO PROPERTY OWNERS' , ----:;,o --~--: -\ ABOgT C.ONSTRUCTION,RESPONSIBIUTIES, . . " NOTE: This Information Notice to Properly Owners about Construction R~ponsibilitfes' ~as developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If yo.u are acting as yo.ur own co.ntracto.r to' co.nstruct a new home o.r make a subsl30ntial impro.vement to' an existing structure, yo.u can prevent many problems'by being aware o.fthe fo.llo.wing respo.nsibilities and co.ncerns, Employer Responsibilities . ~". Y o.u \'(il1, in mo.st instances, be ruled to' be an "emplo.yer;', and theco.ptracto.rs yo.u. co.ntr(lct with, will be ,"emplo.yees" if yo.u ,\se co.n1!actors no.t licensed with the C<mst~llc\icm Co.n~acto.rsBo.ard to' do. labo~,in co.nstructipg or to., assist in the co.nstructio.n o.r impro.vement o.f a residential structure, As the employer, you must comply with the following: , .. -' " . \ . Oregon's Withholdi~g Tax Law: As an employer, yo.u must withho.ld income taxes fro.m emplo.yee wages at the time emplo.yees are paid, Y o.u will be liable for the tax payments even if yo.u do.ll't actually withho.ld the tax fro.m yo.ur emplo.yees, For mo.re info.rmatio.n; call the Department dfRevenue a1503-378-4988';- , ' ., ,; , ",', , .... , Unemployment Insurance Tax: As an emplo.yer, you.are 'required to.pay'~ tlix fo.r unemplo.yment insuran'ce purpo.se~ o.n the wag~s o.f an ~mpl~yeeS, Fo.r mo.re info.rm~tion, c~n the Oregon ~mployment Depam:ent at 50.3-947-1488: ~ The Oregon Business Identificatio.n Nut;nber (BIN) is a co.mbi,ned. number. for "both ,Oregon Withh<Ming and ., Unemployment Insurance Tax, To file far a BIN, can 503-945-8091 ar www.dar.state.ar.us/fo.rmsnav.htmlI far the appropriate farms. "" Workers' 'Compensation Insurance: As an emplayer, yau are subject to. the Orego.n Warkers' Co.mpensatio.n Law, and nlu~t,o.\1tain wo.rkers' co.mpensatian insurance for yo.ur emplayees, If you fail to' o.btain wo.rkers' co.mpensatio.n insuranc'~: yiiii couliibe'subject ib penalties and be iiable for all claim casts ifon~ ofyour'emptoyees is injured on the job, For more information, can the Workers' Campensation'IiiYisiori' at the DepartriJent of'Consumer and Business Services at 503-947-7815, U.S. Internal Reyeuue Service: As an employer, you must withhold federal,inci:ime tax from employees' -wa~" You will be liable fo.r the tax payment even ifyo.u didn't actually withhold the tax. For a Federal EIN number, call the \ IRS at lc800'829-4933 or visit;their,web site atww:w,irsjlQY, ' ' ' , , '. ~" ". ; "J' . . ~. -. -~ . I ' .... ' ':c,:Otlner .!Responsibilities 'and Areas ,of C,Qllc.erns ,. ." ~ - ." ~ , ~ .. Code Compliance: As the pennit halder far this project, yo.u are responsibte for resolving any"failure to meet code requlr~~ents that may be ,bro.ught. to. yo.ur attention thr,,!ugh inspections, " .' ' '-,,,. .'. .. t, Liability and Property'Damage Insurance: Cc:intaciyoilr insur~nc~agent to' see'if you have adequate insurance coverage for accidents and omiSSIOns such as falling toals, paint over,~pray, Water damage from pipe punctures, fire ar work that must be f~dO,' e,;:, " \ / \. - " , G v \ -0 ' \ . '.. . , - - I -. ,. ) -- - Time: Make sure you have sufficient time to supervise yo.ur employees, . ,1,4., '''', , . '. ' . . .,.... ' ~,l Expertise: Make sure yo.u have the skills to. act as your own' general contractor, 'to coordinate the work of rough-in and finish trades, and to no.tify building officials as the appropriate times sa they can perform the required inspections. If you have additional questions call the Canstruction Contracto.rs Board (503-378-4621) ar write the agency at PO Box 14140, Salem, OR 97309-5052, , , Property_owner ,doc 06-01-04 City of Springfield Official Receipt Development Services Department Public Works Department 225 Fifth Street Sprin,gfi'eld, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00 120 COM2008-00 120 COM2008-00 120 COM2008-00120 COM2008-00 120 COM2008-00120 COM2008-00120 COM2008-00 120 COM2008-00120 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200800000000000076 2:19:33PM Date: 01128/2008 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Storm Sewer - 1 st 50 Feel + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Amount Due 48,00 8,00 2,80 6,72 5,60 50,00 2,50 6,00 5,00 $134.62 Paid By ANDERS HARSTAD BELL Item Total: Lheck Number Authorization Received By Batch Number Number How Received djb 026643 In Person Payment Total: $134,62 $134.62 Amount Paid Page I of I 1/28/2008