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Home My WebLink AboutPermit Electrical 2008-2-20 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number r A.Jr'n;J..t)O g ~ (m~).A-/ q .. ~ "iit'f1?{""-' / , ~'f" i ~,>> > 1. ,LOCATION OF INSTALLATION: <' , h, ,+~,,~' ,~,~ < -? ?/p C~L41/1prJ/~ 1. .,;Or ,,,A LEGAL DESCRIPTION: \ 1 a-).. 33 4-4 u l ~ G Lj- JOB DESCRIPTION: ~,/~ ~"d Permits are non-t~sferabIe and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. CONTRAcrO'R'INSTALLATION ONLY ,,~::7; ~>> ~, 2. / / City ~ ExpIration Date ~ '" ~ Expira ion Date / / ~{gnature of Supervismg ElectrICIan " Own=Name 1fkd{Jj~---L Address -5? 'L~b/ ~ CIty ~/ ~~~ Z$ S.~~j OWNER INSTALLATION The installation is bemt made ~PJf~ I.oWP.Which , , -rrUJ\l "'VDI 'IHtWUKI\ IS not mtend6d1forrsaIB, leas'e 0 , I ,clt~!ZED UI~DER THIS PERMIT IS NOT .~JED~ Inspection Request: 726-3769 ZON INITIALS DATE SOURCE Date J /J -:::>~ - 0 '25 3. COMPLETE FEE SCHEDULE BEWW ~~"" /<<,~, ~> A. New Residential - Si~gle' or Multi-F~~ily per dwelli~g '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 $11 7 00 $ 21.00 $55 00 B. Services Or Feeders - Installation, AJter:~ti~ns or Relocation: ~I ~ ~ 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only C. Tem~ra.jServices or Feede~'" ' Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above D. Branch Circuits ': ", < " ,~~, ~~ ( New Alteration or Extension Per Panel One CIrcuit / Each AddItional Circuit or with ServIce or Feeder PermIt $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 ,<, <1 ,'~ ~ > >'"*,, $ 55.00 $ 76 00 $110,00 j ~ :>~>' i ii> i' $ 48 00 $ 4.00 t/-t,DO '> '/'''''/'' 1'1"111"" , E. Miscellaneous (SerVice/feeder not included) -Each Installation Pump or lITlgat1j,tr $ 55 00 SignlOutIme 4~t~NTION: Oregon raw rest~!r.. you to Limited Enerfi~d~:l adoplt:u by me P2~fWn UtilIty rrlienter. Those fU19S are se\ IVI ill Limited Ener~IO~€I2i@D1-001 0 throlJ9h1'O~pt%5WO-1- Minimum EIectricqo~i~fM~@M~i~$f;,j~;':c.f 8ke-ddqby ," " . ." C,!; ~ryQ:tl:fHenter. (Note: the telep~ )1'1"1 4 SfJl:uoTALrttUliMtilh 0 ''''''ju:,~~~;, vu . " " ~ "",',, .~" regQtl-ulllity,Notiflc ' 12% State Surcharge Center is 1-800-332-2344). ft.,.DD 10% AdminIstrative Fee ,,5 I aD 5% Technology Fee d-'~-o TOTAL (;3.9) Shared Dnve(T )/BuIldmg Forms/Electncal Permll ApplicatIOn 1-08 doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00249 ISSUED: 02/20/2008 APPLIED: 02/20/2008 EXPIRES: 08/20/2008 VALUE: $ 1,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5774 CAMELLIA ST ASSESSOR'S PARCEL NO.: 1702334401204 Springfield TYPE OF WORK: Family Room TYPE OF USE: Residential PROJECT DESCRIPTION: Owner: GRISWOLD T AMI D Address: 5774 CAMELLIA ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Tvpe Contractor License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: SprinkJed 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' Street Improvements: Sidewalk Type: ATTENI1f(})N~JO~Mm:requlres you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth NotesNOTICE: in OAR 952-001-0010 through OAR 952-001- ll"C:: DJ:DI\~!~ ~~^I_l tVPlR1: II: THI:' WQ.nK 0090. You may obtain caples of t~e rules by ." .!!! f - . I calling me cerner. ~1'lUlt:. lilt: Ltm_tJl,uIIO AUTHORIZED UNDER THIS PERMITII~~ahtion Description lumber for the Oregon Utility Notification COMMENCED OR IS ABANDONED Fel~ - I' Center is 1-800-332-2344). D J.\Nt'f 180 DAY PER InD. t t' $ Per Sq Ft Square Footage escnp .on 'Type of Cons ruc .on It. I' B'd A Value Date CalcuJated or mu Ip ler or I mount Storm Sewer Available: Special Instruction: Pa2e 1 of 2 Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00249 ISSUED: 02/20/2008 APPLIED: 02/20/2008 EXPIRES: 08/20/2008 VALUE: $ 1,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project L Fees Paid I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Plan Review Residential Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $48.00 $2.00 $32.50 2/20/08 2/20/08 2/20/08 2/20/08 2/20/08 2/20/08 2200800000000000223 2200800000000000223 2200800000000000223 2200800000000000223 2200800000000000223 2200800000000000223 Total Amount Paid $96.00 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. Reouired Insoections I Rough Electric: Prior to Cover FinaJ Electric: When an eJectricaJ work is complete. By signature, I state and agree, that I have carefuny examined the completed application and do hereby certify that an information hereon is true and correct, and I further certify that any and an work performed shan 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. ~ )())~ /k Owner or Mntract~rs Si~ure $}J- -;2/} --oS Date Pa2e 2 of 2 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 Penmt#, CXJM WO~ - OOd Y 4 Address: :5 '7 Y)1.t; r eJiA.o... Si, ~/;;)-O lof I Issued by: Date Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4) requires resldential constructzon permit applicants who are not licensed with the Construction Contractors Board to sign the followzng statement before a building permit can be lssued. ThlS statement is required for residential building, electrzcal, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit thls statement, This statement wlll be filed with the permlt. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: e11. ~ 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. rC 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. If I 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 willnnmediately 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. /c1;C~)IJ~~b k - -:i-!--;Jo-~<6' i/ r(Signature~rmit applicant) (Date) (White copy to lSSUzng agency permit file, p~nk copy to applicant.) PropertLowner.doc 06-01-04 ,Acting as Y OD'r General Contractor? \ \ ( "I. \ INFORMATION-NOTICE PROPERTY OWNERS , \ . ABOUT CO~,SJRUCTION RESPONSIBILITIES - , \ ---"'9i 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 as your ovv11 contractor to construct a new home or make a substantial1mprovement to an eXlstmg structure, you can prevent many problems by bemg aware foHowmg responSIbilities and concerns. Employer You Wlll, m most mstances, be ruled to be an "employer" you u&e contractors not hcensed with the ConstrucTIon construction or improvement of a resIdentml structure. contractors you contract with wIll be "employees" If to do labo): m cpnstructing or to assIst m the yon mu,s~ comply the folloVo/ing: Oregon's employees are employees. Tax As an employer, you must mcome taxes from employee wages at the tIme You will be liable for the tax even you don't actually Wlthhold the tax from your more mfonuatiOn, call the Department of Revenuc at 503-378-4988. Tax: As an employer, you are For more information, call to pay a tax for unemployment msurance purposes Employment Depal1ment at 503-947-1488. U nemploymcnt on the wages all The Oregon Busmess IdentificatiOn Number (BIN) Unemploym&t Insurance To file for a BIN, appropnate fonus. number for both Oregon Withholdmg and or \v'\v\v.dor state,or.us/fonnsD2.v.htmll for the Insurance, you Job For more at 503-947-7815, In~nrance: As an employer, you arc subject to the Oregon Workers' CompensatlOn Law, c9mpensatlOn insurance your If you fall to obtam workers' compensatIon subject to penaltIes and be liable for costs If one of your employees IS injured on the can the Workers' DIVISiOn at the Department of Consumer and Busmess Workers' and must obtam Revenue Service: As an you must You lIable the tax payment even if you IRS at 1-800-829-4933 or VISit their web site at "\o'\vW!l1~.gQ~. federal mcome tax fTom employees' wages.: the tax. For a EIN number, can the pennit holder for thIS you are to your attentiOn through for resolving imy faIlure to meet code Insurance: Contact omiSSiOns such as fallmg tools, to see If you have adequate msurancc water damage from pip~ punctures, fire or Make sure you have sufficient time to supervIse your sure you the skllls to act as your own and to notIfy bmldmg offiCials as contractor, to coord mate work of rough-m times so they can perform the the ConstructIOn Board (503-378-4621) or wnte the at Property_owner 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 COM200S-00249 COM200S-00249 COM200S-00249 COM200S-00249 COM200S-00249 COM200S-00249 Payments: Type of Payment Check cRecemtl RECEIPT #: 2200800000000000223 Date: 02/20/2008 DescriptIon Plan Review ResIdential Add, Alter, Extend Clrc MInimum/AdJustment Electrical + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By RENT AL ACCOUNT BEVREL Y GRIFFITH Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received ddk 1109 In Person Payment Total: Page 1 of I 8:19:25AM Amount Due 3250 4800 200 250 600 500 $96.00 Amount Paid $96 00 $96.00 2/20/200S