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Home My WebLink AboutPermit Electrical 2008-2-11 ZON w-'Y INITIALS .NM DATE 2-JO,?J/a V SOURCE~~~r) Date ___? J~~ ) 0 .,y 225 FIFIH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number (.:o,rY12 (\VX'".... <-50;;1.... Each Manufact'd Home or Modular Dwellm~ Service or $55 00 Feeder ATT NTION' Oreqon iaw requi 101~~w rules adopted by t~~..9r ,r2~ xog"tq:, B. servicNQ~~ers~lIm8!~e10'1~tal16~~ lJtJRtMocation: :?AR 952-001-00'10 through ~:;tg~~_~orth 200 Amp~OlrfsYou may obtam QQj;2'r-,~ rof t~e7PuYBs o~ \ 201 AmPSn~rWe~ lMscenter. (Note the te$ct~~e Address "'-, 401 Amps to 600 ww,the Oreqon .Utlllty NC$IfW~n '-. ler IS 1-600-00' ~J441 '-.- // 601 Amps to 1000 Amps ...' ~'180.00 '~ Phone / Over 1000 AmpsNolts $413.00 ~ / Reconnect Only $ 55.00 SupervIsor LIcense Number X C. Temporary Services or Feeders' " , ' Expiration Date / ~ Installation, Alteration or Relocation // "" 200 Amps or less $ 55.00 Constr. Contr. NumJ?ef nO){CE: 201 Amps to 400 Amps $ 76.00 / T!~!S PL-8MIT ~Mrt!l~X<9mG~pklE WORK $110.00 : I ~ -! ':" RI. D b~ ~80 ~s~ ~Mol\J~&J ~1 "B" above. ( "I:','~ [ill C . i~A~lmmn:fl FO~ :"" . . i :\1 "I &0 DAY PlOD. New Alteration or Extension Per Panel One Crrcuit ).c Each AddItIOnal Crrcuit or with Service or Feeder PermIt , . 1. LOCATION OF INSTALLATION: / 7 tJ 2, .2 yJ J,~ b ') el.l u LEGAL DESCRIPTION: -90'-\ T Si ~~6+;eV~ JOB DESCRIPTION: Ci2 ~7'f j, f " r _ . I U..::t. l\'" b n i\ W \ ( \ Y\-l\ ~ ;; Q T1 D r r /....:. bq f . 't'::ur~ 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 City ExpiratIon Date / Signature of Supervising Electrician Owners Name ~ 4?~' /V\\'tt L~'l rJ-.e.r Address '?? () L/ T > 1- CIty ~(\'_~ ~ \.fi [.J.. Phone 4c;'-(-'K;;y() OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. o~labue: --- /7/J L.A .I' _,~ :--- ~~ (I l ' Inspection Request: 726-3769 3. COMPLETE FEE SCHEDVLE BEWW 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 $117.00 $ 21.00 $ 48 00 $ 4.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 55.00 Sign/OutlIne Lighting $ 55 00 Limited Energy/Residential $ 28.00 Limited Energy/CommercIal $ 50 00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges 50 (]V ~ .,50 &;; .O() .5 ' tJO t7 / ? 50 TOTAL D <u.~. Shared Dnve(T )/BUlldmg Forms/Electncal Permit Apphcatlon 1-08 doc 4. SUBTOTAL OF ABOVE 12% State Surcharge 10% Administrative Fee 5% Technology Fee 225 Fifth Street Springfield, Oregon 97477 541~726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00302 COM2008-00302 COM2008-00302 COM2008-00302 COM2008-00302 Payments: Type of Payment CredltCard cRecemt I RECEIPT #: 3200800000000000145 Date: 03/03/2008 DescriptIOn Add, Alter, Extend CIrc Mmlmum/AdJustment Electrical + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By JEFF MITTLEIDER Item Total: Check Number AuthOrizatIOn Received By Batch Number Number How ReceIved nJm 078976 In Person Payment Total: Page 1 of I 1:59:58PM Amount Due 4800 200 250 600 500 $63.50 Amount Paid $63 50 $63.50 3/3/2008 . · C'onstruction 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 - Penrut (LJIh'2-tn'0 - 0636;2.. Address. roq 'r ~ Issu,d by:1LZ11{~J; U Date 3/05/0Y Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires reszdentzal construction permit applzcants who are not licensed wzth the Construction Contractors Board to sign the followzng statement before a buildzng permit can be zssued. This statement is required for residential buildzng, electrlcal, mechamcal and plumbing permits. Lzcensed architect and engineer applicants, exempt from lzcenszng under ORS 701.010(7), need not submit thzs statement. This statement wzll be filed with the permit. FIll in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. o 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 [2i 3B. I will be my own general contractor. (GL13cre; (A-L- ) tV M 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 ofthis form. Ilh- ,<.:._?~ s-~DR (Si~t&~fpermit applicant) (Date) (Whzte copy to zssuing agency permit file, pznk copy to applicant.) Property_owner doc 06-01:'04 Acting' as' Your 'Own General Contractor? . . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CON~TRUCTION RESPONSIBILITIES \ .J NOTE. This Information Notice to Properly Owners about Construction Responsibil1ties was developed by the Construction Contractors Board in accordance with ORB 701.055(5), passed by the 1989 Oregon Legislature. . 1 If you are actmg as your own contractpr to construct a new home or make a substantial improvement to an eXIstmg structure, you can prevent many problems by bemg aware of the followmg responslbilitie.s and concerns. Employer Responsibilities - You WIll, m most ipt>tances, be ruled to be an."employer" and the contractors you contract Wlth WIll be "employees" If you use contractors not licensed Wlth the ConstructIOn Contractors Board to do labor m constructmg or to a$SIst m the constructIOn or improv.ement of a resldentlal struct~e. .As th.~ employer, you must, comply :with the following: , . Oregon's Withholding Tax Law: As an employer, you must withhold mcome taxes from employee'wages at the time employees are paId. You WIll be hable for the tax payments even If you don't actually WIthhold the tax from your employees. For more mformation, call the Department of Revenue at 503-378-4988. . Unemployment Insurance Tax: As an employer, you are reqUired to' pay-a tax for unemployment insurance purposes on the wages of all emPloy:ees. For more informatlOn, call the Oregon Employment Department at 503-947-1488. The Oregon Busmess IdentrficatlOn Number (BIN) IS a combined .number fqr both Oregon Withholdmg and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or 'Wvvw.dor.state.or.us/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtam workers' compensatlOn msurance for your employees. If you fall to obtam workers' compensation mSUrance, you could be subject to penalties and be hable' for all claIm costs if one o{your employees IS injured on the Job. For more mformatlOn, call the Workers' CompensatIOn DIVISIon at 1he Department of Consumer and Busmess ServIces at 503-947-7815. \ r ~ _. I , U.s. JIntemaR Revenue serviee~' As an-e'hiployer,' you iliust,Wtthhold federal mcome 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 1-800-829-4933 or Visit their web site at WWW.lfS.l!OV. O~lh1ei lRe~poill~!bini~lie~ ~illd Arrea~ .of CCOll1ltCeX'illS Code Compliance: As the permit holder for thIS proJect, 'you are responSible for resolVing any f~nlure to meet code reqmrements that may be brought to your attentIOn through mspectlons. \, l.- _ ~ 1 .. ]Liability and Property Damage linslllIrancc: Contact your insurance agent to see If you have adequate insurance coverage for aCCIdents and omISSIOns such as fallmg tools, pamt over spray, water damage from pipe punctures, fire or work that must be redone. \ (:- 0 ... _ ~~ __ l _ . ,10 _ '- -~ -~,"" ~ ~... -...~~ '.. Tfime: Make sure you have suffiCIent tIme to supervIse your employees. Expertise: Make sure you h~ve the skills to act as y~ur o~ 'general contractor, 'to coordmate the work ofrough-m and finish trades, and to notify bUlldmg officials as the appropnate tImes so they can perform the reqUIred mspectIons If you have addlttonal questlons call the ConstructIOn Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner doe 06-01-04 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00302 ISSUED: 03/03/2008 APPLIED: 03/03/2008 EXPIRES: 09/03/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 804 T St ASSESSOR'S PARCEL NO.: 1703261307000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Wire hot tub Owner: MITTLEIDER JEFFREY & ANDREA Address: 804 T ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER I CONTRACTOR INFORMATION ~ ATTENTION: oregon law requires you,t.o follow rulJekens61ted lRiafilrgH1)\\>tj)~~~~rh Phone NotIfIcation Center. Those rules are se - _ _ -.1 "0""," Lh--"":lr nile QI;?-nn1- III J U.4l""\ '""l JL-\JV vv. e. ..n. --..!J BUILDING INF.QaMA,,]:'IO~~ obtain copies of the rules by calling the center. (Note:,~he tel~~ho~e # of Stories: number for the Oregon I!tnllMh!ptlflcatlon Height of Structure Center is 1-800-~~i~Ploor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Oc;~pant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMA TION , REQUIRED PARKING Frontyard Setback: Side 1 Setback: SIde 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: NOTICE: Total: # Street Trees Rq~i-i1S PERMIT SHALL EXPIR~qpdfff:PP~<bRK ~aved Drive Rqd~~UTHORIZED UNDER THIS ~fWmris NOT Yo of Lot Covera~tHVlMENCED OR IS ABANDONED FOR ANY 180 DAY PERlnn I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2008-00302 ISSUED: 03/03/2008 APPLIED: 03/03/2008 EXPIRES: 09/03/2008 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. Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $48.00 $2.00 3/3/08 3/3/08 3/3/08 3/3/08 3/3/08 3200800000000000145 3200800000000000145 3200800000000000145 3200800000000000145 3200800000000000145 Total Amount Paid $63.50 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. ~ Reauired Inspections. Rough Electric: Prior to Cover 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. Owner or Contractors Signature Date Pal!e 2 of 2