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Home My WebLink AboutPermit Electrical 2008-2-6 j il( N (Y\~oe dO ~ p:'. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00180 ISSUED: 02/06/2008 APPLIED: 02/06/2008 EXPIRES: 08/06/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 935 65TH ST ASSESSOR'S PARCEL NO.: 1702341200407 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Service Change Owner: PEARSE JEAN V Address: 935 N 65TH ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Contractor License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Sidewalk Type: , ' ATTENTION. QreQon IA,W.'!fW " Storm Sewer Available: follow rules ad~Ot~8sBo.1hs~-Oai'&~ you. ~o Special Instruction: Notification Centt Th y e regon UtIlity I OAR r, ose rules are set forth :raCE' WORK n 952-001-0010 through OAR 952-001- N~tG, I. HAll EXPIRE \f THE 0090., You may obtain copies of the rules b "\.I\~ PERM\T S _ _I\\~ rcol\J\\T IS NOT call1na the CPntM {fllnto.. H.._ ~-I-.-J1' Y AUTHORIZED UNut:n 1 u ONED fOrI r.Q:ilt r the Oregon Utility Notir.~:'''' COMMENCEO OR IS ABANO Valuation Descri tion nter is 1-800-332-2344). tlon AMY 180 DAY PER\OD, D I' t' T f C ' $ Per Sq Ft Square Footage escnp Ion ype 0 onstructIon I . I' Value Date Calculated or mu tip ler or Bid Amount Pa\;!e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00180 ISSUED: 02/06/2008 APPLIED: 02/06/2008 EXPIRES: 08/06/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Paid' Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 2/6/08 2200800000000000162 $8.40 2/6/08 2200800000000000162 $3.50 2/6/08 2200800000000000162 $70.00 2/6/08 2200800000000000162 Total Amount Paid $88.90 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. I Reouired Insoections I Electric Service: Approval required prior to utility company energizing service. 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. Owner or Contractors Signature Date Pal!e 2 of 2 ZON INITIALS DATE SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAWERMIT APPLICATION City Job Number ~)01 ;;JII2JJ?' ,- ()O;.!:O 1. LOCATION OF INSTALLATION: G)3s I\J, &51h ~T LEGAL DESCRIPTION /70~ S</ /2(JlJ t.j07 I JOB DESCRIPTION' ~\)Ice C~NqR <..J Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ""'" Phon/ ",.,,/ Supervisor License Numgef ',,- / '" Expiration Date // "" / ~ ::;:~umh~ "" Signature of Supervising Electrician ~, City Owners Nam~a\~\ \J?fL'V"\ ve6..... Address 93/) 1\J. G 5~ sIr City ~'N3CEld Phone 54/-514-b73J OWNER INSTALLATION The mstallation is being made on property I own which is not intended for sale, lease or rent. Date 3. : COMPLEtE lflili SCHEDULE BELow ' , ~, , " / "..&~"~'''''' ~ ,< v A. ; 'New Residential- Single 'or 'Multi-Fa mily per dweUi~g unit. v ~ , <" < {{<< <~",""",,'<,l,,, ~",,>, -.. Service Included 1000 sq ft or less Each addltlonal500 sq. ft. or portion thereof Each Manufact'd Horne or Modular Dwellmg Service or Feeder $117 00 $ 21.00 $55 00 C. Temporary Services or Feeders " " ,~ / <'( "x ,I, " ( "<ii' Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 55.00 $ 76.00 $110 00 Over 600 Amps or 1000 Volts see "B" above. . sA.I'fljlENTF'Ji'I' -;" I'~,/" ' ::: /,1 ~o D. Branch CirctlltS ", U' ,'I'>" fCI~AC'.(f'r .}' ~ 4 >>/v\<?~'l>~ o;!'~;<ty New Alteratio)ll9lf.E:xtension Per Panel ,.' ." "(" s,')t !Grth One CirCUlt in CAR ~J::.,~-lJ I-':'v' ,l d II GdS:J~ ~.ffi>952-001- Each Addltlon&l~€u)tcM W~ oblam CUpll;;:S of the rti;\;;;) Ly ServIce or FeedetC~the center. (Note $1eJtOOephone number for the Oregon Utility Notification r.clDtAf'is 1.:AClO 232-234!41 1"1' E. Miscellaneous (Servi~tewernbf"iliciuaedJ=-Eitch InstaUation " v,d'> > , ' -"<~Hd Pump or irrigation $ 55 00 SlgnJOutlme Lighting $ 55.00 Lumted Energy/Residential $ 28 00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges , .4..rtPlJ.o.iuTALOFABOVE ~,,,,(,,, '7 () zrV t~OTn.J't:.. ~t<.L1;vQmE IF THE WORK ~~'ic;, Pr-R~~'M>ltlUanar~' IS NOT 3 ' 5 () ! ,11'_, '- ~' ~1JWtJ!!Rrift\iW3Fe~RMIT r- . 4-0 , ,LI \ ~-~P~~q- GhnoJS~l!~DONED FOR '7, 6\.:::) ;,r\[.'\:J!ENL,t urn ~[1Y i 8CfIf0,vA~ER\OD. JI X J(. 10 Shared Dnve(T )/BUlldmg FormslElectncal Permit ApphcatlOn 1-08 doc ~e Sll{l)a~: _.~ ,2J ,t ) .f) n IW\ ~. <...,. Inspection Request: 726-3769 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 .. Pernut #. (~lVJ1 ~ 6' - OcJ J ftJ A~dr~ss' 965 VS-#-' sr-- Iss~ bY''l/lL(.(( Date, d./ a/of'"" I Statement: Information Notice to Property Owners , About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentzal construction permzt applicants who are not licensed with the Construction Contractors Board to sign the following statement before a buildzng permit can beJssued. This statement is requiredfor residential buzldzng, electrzcal, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licenszng under ORS 701.010(7), need not submit thzs statement. This statement will be filed with the permzt. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A, or 3B: '~ 1. o 2. I pwn, 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 i,s (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 P 3B. I will be my own general contractor. C ~J-Rl' CA--L-- ) If I hire 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 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 Owne~s about Construction Responsibilities on the reverse side of this form. ~j(~S~o~J~~licant) Cl1_! OGJ~e~ (Whzte copy to issuing agency permit file, pink copy to applicant) Property- owner. doc 06-0 f -04 Acting as 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 actmg as your own contractor to construct a new home or make a substant1al1mprovement to an eXlstmg structure, you can prevent many problems by bemg aware followmg responslbllItIes and concerns. You wIll, in most mstances, be ruled to be an "employer" contractors you contract wIth wIll be "employees" If you use contractors not hcensed vnth the ConstructlOn Contractors to do labor m constructmg or to assIst m the constrtlctlOn or improvement of a resldent1~] structure. As you must comply with the following: l"aw: As an employer, you must You wIll be . liable for the tax more mformatIOn, call the mcome taxes from employee wages at the time even 11' you don't actually wIthhold the tax from your Revenue at 503-378-4988. of all As an employer, you are reqmred to pay a tax for unemployment msurance purposes For more mformatlon, can the Employment Department at 503-947-1488. on IdentificatiOn Number (BIN) 18 a number for both Oregon Wlthholdmg and Insurance Tax. To file for a BIN, can 503-945-8091 or wW"I,v.dor.stnte.or us/formsnav.htmll for the Insurance: As an employer, you are to the Oregon Workers' CompensatIOn Law, must workers' compensatIOn msurance for your If you fail to obtam workers' compensatIOn msurance, you could subject to penalties and be hable for all claIm costs If one of your employees IS mJured on the For more call the Workers' CompensatIOn at Department Consumer and Busmess at As an' employer, you must You WIll be the tax payment even If you dIdn't actually IRS a~ 1-800-829-4933 or V1sit their web SIte at W\v'W.1rS ,go_yo federal mcome tax from employees' wages. the tax. For a Federal EIN number, call the may holder for you are to your attentiOn through for resolV1ng any faIlure to meet code Cod~ your msurance omISSIOns such as faHmg tools, over to see if you have adequate msunmcc water damage from pIpe punctm es, or Time: sure you tIme to supervise your and sure you have the S.l0.115 to act as your own to bmldmg officials as to coordmate the tImes so they can perform the rough-m mspectIODs. call the ConstructIOn 97309-5052. (503-378-4621) or wnte agency at doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00 180 COM2008-00180 COM2008-00 180 COM2008-00 180 Payments: Type of Payment Check cRecemtl RECEIPT #: 2200800000000000162 Date: 02/06/2008 DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By PAUL S VERMILYEA Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received 134 In Person Payment Total: nJm Page 1 of 1 3:04:20PM Amount Due 7000 350 840 700 $88.90 Amount Paid $88 90 $88.90 2/6/2008