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Home My WebLink AboutPermit Electrical 2008-2-12 3. ZON LLtu INITIALS /"I M '" .A!... DATE ;)-IL....f) ~ UII" SOURCED\.rK~?) Dare ~~? ' , ~ ,~ ~ ~ ~ ~~ ~i,~ ~t~i~~~""--::::~ v ,""'~ ~ ~ , ,~ ' COMPLETE,FEE SCHEDULE BEWW ' " //,~~iM i <' / 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number C OU12C>D R _ 00 Z I "3 ,_ iW~~es1Vg,u.~O ATTEN \\U,..t,-Oregon IoQflt~~Qfb~t,j\l\'l- folloW rules adopted vr ~,reL~~t~ '~ut.~iCC.t!.~r. r,p.nter. ThQ~'uQhOA\\~OmS in OAR 952-001-0010t~';&t~8@~S Phone 0090. You may Otbtai~~~':l_~ae~!S calling tne cen er. Q&t~t~catiOft number 1::,e ~~~-332-~). . ' _ _',' ~~Jl c C. ^T.mpo':'ryServ.......'F.~, . J Installation, Alteration or Relocation o 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "BOO above '~j"l, , 1. LOCATION OF INSTALLATION: , './"" N ',/" ~ 20 5: (; -f-..fi LEGAL DESCRIPTION: 17025(LfZ C:> L(L(O( JOB DESCRIPTION. rJ /:.-v1-J S 1':7 tZ-u, c.L-.- 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. <i:/ t; " ""! !<!'.'iqv) j~\, 'j , ~ >>" '*>>" CONTRACTOR INSTALLATION ONLY ", t) >~ >' ' > Electrical Contractor Address City Supervisor License Number ExpiratIOn Date Constr. Contr. Number Expiration Date SIgnature of Supervising Electrician Owners Name -7; /-?? H be /V" ~ Address J Z--L:-:> -3 G rf7 CIty 0 r-:7r'/ '7.;f ~none 7Y}~:5 1"2- OWNER INST ALLA TION The installation is bemg made on property I own whIch is not intended for sale, lease or rent 2w.nersiIgIl.~ty.r.e+- ___---::? ____---.., #' __~f / t:..~~~ - --*--- ~_.--/~.;.~~- ~ -. .. ---...... Inspection Request: 726-3769 A. , New Residential- Singl~ or M,ulti':Family per dwelling,,~nit. Service Included 1000 sq. ft. orIess Each additional 500 sq. ft, or portion thereof Each Manufact'd Home or Modular DweIlmg Service or Feeder $117.00 $ 21 00 $55.00 B. " Services or Feeders - InstaJIatio~, ,Alterations or Relocation: -.. ~ ,~ / <1 < " '"r I $ 70.00 $ 83 00 $138.00 $180.00 $413.00 $ 55 00 70 v<(), ,A~ i'J C / $ 55 00 $ 76,00 $110.00 >,,- D. Br:nchCircuits ,"t'WO~l .,AI'" "" Notli~. ~~b~~l~i~~f~!CNOl lH\&) 'tUNOER lH\S P ft cnQ $ 48 00 AUT 1fi~~~~~ElJf\'i' CO~ ~'f~ J\mmit $ 4.00 00 DAY r M1;- ANY 1~>> .. w E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrIgation $ 55 00 Sign/Outlme LIghtmg $ 55.00 Limited EnergyfResIdentIal $ 28.00 Limited Energy/CommercIal $ 50 00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges 4. SUBTOTAL oil .ABlJ'VE N '"i 70 'B~O '7 >TO ~g <;D 12% State Surcharge 10% AdminIstrative Fee 5% Technology Fee TOTAL Shared Dnve(T )lBmldmg FormslElectncal Permit ApphcatlOn 1-08 doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00213 ISSUED: 02/12/2008 APPLIED: 02/12/2008 EXPIRES: 08/12/2008 VALUE: SITE ADDRESS: 320 36TH ST ASSESSOR'S PARCEL NO.: 1702314204401 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace 200amp service Owner: TIM ABENA Address: 320 36TH ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-747-3702 I CONTRACTOR INFORMATION' License Expiration Date Phone R-3 BUlLDING:OO'!!~qUfreS you to , - , ~ ,,'I ; :.Jues a opted by the Oregon UtUit , '~lo~:S-tone&snter, Those rules are set fbl!.Size: 1,~%fei~{ilt56f~~nath1J(B through OAR 952-~~ 1st Floor: OJ2ftpeCO~R\iit:obtain copies of the rUlejg,8t 2nd Floor: CW'~~a- tilM~nter. (Note: the telephorfifI tt Basement: nLfffigge ~J~, Oregon Utility Notificati5,. Ft Garage/Carport Ener8El'1lm: IS 1-800-332-2344). Sq Ft Other: Sprinkled Building' n/a Occupant Load: VB I DEVELOPMENT INFORMATION' REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: NOTICE: I PUBLIC IMPRO.Niis/~'T SHAll EXPIRE IF T vnlL D U~k\iR ~ HE WORK COMMENCED OR ~ :Rl1A1!!~MIT IS NOT ANY 180 DAY Pt#.o'B.p'truWII~'r1aD13:FOR Total: Handicapped: Compact: I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00213 ISSUED: 02/12/2008 APPLIED: 02/1212008 EXPIRES: 08/12/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $7.00 $8.40 $3.50 $70.00 2/12/08 2/12/08 2/12/08 2/12/08 Receipt Number 2200800000000000190 2200800000000000190 2200800000000000190 2200800000000000190 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 InsDections 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. ~~ --.... 2/12-/0% ( Owner or Contractors Signature Date Pa2e 2 of2 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 Perrmt #: C-"J vV\ 'L-O 0 g- - 0 () Z- \ 1 <" -;:.::>? ,'""'\ r;::> / I-G-.. Address: ..:::. e-'--" ~ b Issued by: -=> (3 sf- 2/~ 2:-/0 <S / ~ Date' Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS?01.055(4) requlres residential construction permit applicants who are not licensed wlth the ConstructlOn Contractors Board to sign the following statement before a building permit can be issued. This statement is requlred for residentlal building, electncal, mechanical and plumbing permlts. Licensed architect and engineer applicants, exempt from licenszng under _ ORS 701.010(7), need not submit thls statement. This statement will be filed wlth the permit. 1 ;Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: A~-. I own, reside in, or will reside in the completed structure. ~~ I understand thaU must become lIcensed as a construction contractor if the structure is sold or I 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 )Lf 3B. I will be my own general contractor. 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 Owners about Construction Responsibilities on the reverse side of this form. ;~ ~ 2-//? /6~ (Signature of permit applicant) l (D~) (WhIte copy to lssuing agency permit file, pznk copy to applzcant.) Property _ owner. doc 06-01-04 Acting as Your General Contractor? INFORMATION TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: Information Notice to Property Construction Contractors Board In accordance with Construction Responsibilities was developed by the 701.055(5), passed by the 1989 Oregon Legislature. i you are actmg as your own contractor to construct a new structure, you can prevent many problems by being a\vare or make a substantial improvement to an exisnng followmg respom:ablhties concerns. Employer You wlll, m most mstanccs, ruled to be an "employer" and you use contractors not hcensed \\I1th the Construction constructIOn or Improvement of a residentIal structure. As contractors you contract wIth will be "employees" If Board to do labor m constructing or to assist in the you must comply following: mcome taxes from employee wages at the tIme even you don't actually wIthhold the tax from your at 503-378-4988. Tax As an employer, you must employees are paId. wIll be hable for the tax employees. more mformatIOn, call the Department As an employer, you are reqmred to pay a tax for unemployment insurance purposes For more mformatIOn, can Employment Department at 503-947-1488. Idenhficahon Number (BIN) is a Tax. To file for a BIN, can number for both Oregon Withholdmg and or ;,vww.9o[.state.or.us/formsuav.html1 for the As an employer, compensatiOn msurance for your subject to penalties and be habIe call the Workers' CompensatJon subject to the Oregon Workers' Compensahon Law, If you fail to workers' compensatlon If one of your employees 18 mJured on the at the Department of Consumer and Busmess u.s. You IRS at 1 Revem:w As an employer, you must the tax payment even If you or VISIt their web slte at ~\\'\\'.lrs.l!QY. federal mcome tax the tax. For a employees' wages. EIN number, call the of As the pennlt holder for project, you are responsible for resolvmg any fallure to meet code may be brought to your attentIOn Code Insurance: omiSSiOns such as to see if you have adequate msurancc water damage pipe punctures, fire or Make sure you have suffiCIent hme to superVise sure you the skIlls to act as and fimsh trades, and to notify bmldmg offiCIals as 0\V11 to coordmate the work mugh-m can perfonn mspectlOns. times so call the ConstructiOn 97309-5052. (503-378-4621) or wnte the at If you have Box 14140, 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 COM2008-00213 COM2008-00213 COM2008-00213 COM2008-00213 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 2200800000000000190 Date: 02/12/2008 DescriptIOn Perm ServIFdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdminIstratIve Fee Paid By TIM ABENA Item Total: Check Number Authorization Received By Batch Number Number How Received dJb 01573B In Person Payment Total: Page 1 of I 1l:16:54AM Amount Due 7000 350 840 700 $88.90 Amount Paid $88 90 $88.90 2/12/2008