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Home My WebLink AboutPermit Electrical 2008-3-4 Date ; "225 FIFTII STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COVV\ z..O c::::::> ? -- 00 :SO 7, 1. 3. 5Pr l~-neLl,(jK f , A. LEGAL DESCRIPTION: 1702- I ,~ I JOB DESCRIPTION: cLecTvii'c;T'I (tJ DO 70 c; Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $117.00 ~hed $ 21.00 Permits are non-transferable and expir<<'A~~lCN: OregonIt&<Via M~ootYbU<tQile or not started within 180 days of issuance fo1lijwcn:JlEjs adopted t$~~~~ice or Suspended for 180 days. Notification Center. Tl1&Jslmles are set forth 1-0010t y obtaJh ca Ing e center. ( 0 e: e e ep one Electrical Contractor number for the OregcmdJMHtlfsN01J.ilUiation ~. , !C~er is 1-8qg,.~~4~MOOAmps Addre / . 401 Amps to 600 Amps / 601 Amps to 1000 Amps City , 'Phone Over 1000 AmpsN olts .. ~ /. ' Reconnect Only SupervIsor LIcense NumB6X ' ' C. Expinrtion D.te" , ~ Inst.Datioo, Alterat;o'Wti~ocation / "" NOllt;t: ~~~~'P~~\i ,"t ~O't Constr. Contr.~ N7b , ~ TH\S PERM'1't ~,:~,t9 ,~1JS" . ).u.1HOR\ZED ( ~~~~~;fsO Expiration Date I'(\MtV\ENCEO 0 . . {} Am '1000 V Its "B" b . L ,'" - "OJ\'l :' S or 0 see a ove. Signatur7e of Supervising Electrician AN'l 180 D. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with . Service or Feeder Permit $55.00 2. $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 Owners Name Tf> F P Fe v,<; U ~ aU v Address 2. ~4f' ~3 rd )/. , City SPV'(^5 p,.~ldl ~hone 9 8~ ~ 15"'D -; $ 48.00 $ 4.00 22 E. OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Pump or irrigation $ 55.00 Sigr1l0utline Lighting $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges Inspection Request: 726-3769 ~ ,J 12% State Surcharge ( / 7'- 10% Administrative Fee ~ IJ (;) 5%:rechnology Fee If 10 TOTAL / 2lf ifJ. Shared Drive(T:)/Building FormslElectrical Permit Application 1-08,doc 97:e~:~e~ f:;/Y;1p-5.r), ~A~) .......... Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00307 ISSUED: 03/04/2008 APPLIED: 03/04/2008 EXPIRES: 09/04/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line' SITE ADDRESS: 264833RD ST ASSESSOR'S PARCEL NO.: 1702193100909 Springfield TYPEOF WORK: Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: 100amp service and 7 circuits to shed Owner: FERGUSON JEFFREY B & SAMANTHA J Address: 2648 33RD ST SPRINGFIELD OR 97478 Phone Number: 541-988-0150 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER, License Expiration Date Phone BUILDING INFORMATION I # of Units: . . ' # of Stories: Primary Occupancy Group: U Height of Structure Secondary Occupancy Group: Type of Heat: . Primary Construction Type VB Water Type: . Secondary Construction Type' Range Type: # of Bedrooms: A!TENTION: OregonEit'M-~ItlS you to fo(I,~W r~les adopted IBlS/.h#k~~Utgity NotificatIon Center. ,Thn~j:1 rllloCl~ro ",,,t frrtla. In UAH 952-00~~^~,,"'6P1YiIDPnli~fIW.~TION I 0090 You ma -...... I ' . _u, vVfJ "'... ",. <"g' I UII;I~ u, calling the center. (Note: the telephone number for the Orego6tMiUt~ JilbUfication Center is 1.800'-S~sRqd:' Paved Drive Rqd: % of Lot Coverage: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: REQUIRED PARKING Total: Handicapped: Compact: . Ii-"; , , I PUBLIC IMPROVEMENTS I . Street Improvements: Storm Sewer Available: Special Instruction: ';"!l.f,;:{", . Sidewalk Type: Downspouts/Drains: Description Type of Construction .,: Square Footage or Bid Am,ount Value Date Calculated Notes: Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00307 ISSUED: 03/04/2008 APPLIED: 03/04/2008 EXPIRES: 09/04/2008 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 Add"Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $9.80 3/4/08 2200800000000000282 $11.76 3/4/08 . 2200800000000000282 $4.90 3/4/08 2200800000000000282 $28.00 3/4/08 . 2200800000000000282 $70.00 3/4/08 2200800000000000282 Total Amount Paid . $124.46 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before7:00 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 . ' Rough Electric: Prior to Cover Electric Service: Approval required'prior to utility company energizing service. 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 struc~ure without permission of the Community Services Division, Building Safety. I further certify that only contractors andemp,loyees 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 r.eadable 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: Wf!. (},,- .- . '/ . ~ ~~ owneU 10 tractors Siro;1ture ' , 3-4- o? 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 Permit #: COv1'1 ZO c> g- - 0 0::5 () 7 Address: L 6q t' ,S~ 3 A. cd ~ 1- Issued by, piS Date'. ?/y6? , ( . Statement: Information Notice to ~roperty Owners .Abou,t Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constructionpermit applicants whoare,not licensed with the ConsfrUction Contractors Board to sign the following sfatement 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 1 and 2, and ,either. box 3A or 3B: 7l. ~. I own, reside in, or will reside in the completed structure. 1 understand that 1 must become licensed as a construction contractorifthe structure is sold or offered for sale before or on completion. D 3A. My general contractor is (Name) (CCB #) I will instruct my.general contractor that all su~contractors who work on the structure must be . licensed with the Construction Contractors Board. . ~~ OR ' J2r 3B. I will be iny 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 abave infarmatianis carrect and that I have read and do. understand,theInformatian Natice to. Praperty Owners abaut Canstructian RespansibIlities an the reverse side af this farm. I1/H~~ '5--<-{-o~ C/ /eBfgnature ofts'ermit applicant) (Date) (Whfte copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 . ~. ~A~ting) a~ Your . 'INFORMA TIONNOTICE TO PROPERTY OWNERS ABogr CONSTRU,CTION, RESPONSIBILITIES General 'Contractor? " ". . _'I'.. " ~ " ,. '4. .: ,-----""----_.---~ ' NOTE: This Information Notice to Property Owners about Construction Re~po~sibilities wa; dev~Joped by the Construction Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature. If you are as your ovvn 'contractor t~ "i new structure, you can problems by being aware or make" a substanti~l improvement to an existing following responsibilities and concerns. be., ruled to be. an lice~st;d wit~' th.e Con$~ction a residential >", ' c.ontractors you contr~ct,with will be "employees" if B'oard to do.1aborin co~~till.cting or to assist in the . you mns~. ' w~tlithe following:' . '.. ."l 01: 1.A1W: As an you i~come taxe~ fro\n employee wages at the time will be liable for the tax payments even you ,don't actually withhold the tax from your 'can the Department at 503-378-4988:" . ...., tax for unemployrnent insurance purPoses , Employment Department at 503-947-1488.'_" "-, . . , ".< '''''-- numper for botb, Orego~ Withho}ding and' or \v\v\v.dor.state.or.us/formspav.htmll for the on As an employer, you For more information, , '.'.;, ~ ~ ~,~:. .. Identification.]'i1umbe.r: (BIN), is a, Tax. To file for a BIN, call , ......- '_ .J.~' In:m:ra.nce~ As an cornpens~tion i~suranc~ . subject p-enalties , cal1.the Workers',. Compensation yo~~ are subject to the Oregon Workers' COnlpensation Law, If you fail to workers' compensation if one of your employeeS is injured on the the Depaitmen't of ConsUmer and Business Services at 503-947-7815. u.s. You will be liable IRS 'at 1..:800-829.4933 As' an .employer, you must even if you. their:web site at . '" federal inconle tax from employees' wage~ the tax. For a Federal EIN number, call the , . .', "-... -. ~ - ... , such as falling are responsible for resolving any failure to meet code "'-".." ' As the permit holder for this to your attention . 'r Code require.ments . ,~ ..T", -' agent see if you':have 'adequate insurance over spray, water damage from pipe punctures, fire or .~"'. . to the skills' to act as' ' building officials as to coordinate the work of so they can perform the required can the Construction 97309.,.5052. (503-378-4621) or the agency at ," .... Property- owneLdoc 06-01-04 225 Fifth Street Springfield, Oregon 97477 54t-726-3759 Phone " Job/Journal Number COM2008-00307 COM2008-00307 COM2008-00307 COM2008-00307 COM2008-00307 Payments: Type of Payment CreditCard cRecei.ntl RECEIPT #: Description Perm Serv/Fdr 200 amps or less . Add, Alter, Extend Circ Ea Add +5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By JEFFREY FERGUSON City of Springfield Official Receipt Development Services Department Public Works Department 2200800000000000282 Date:. 03/04/2008 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 025760 In Person Payment Total: Page 1 of 1 9:22:S2AM Amount Due 70,00 28,00 4.90 11.76 9,80 $124.46 Amount Paid $124.46 $124.46 3/4/2008