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Home My WebLink AboutPermit Electrical 2003-5-16 . ~ CITY OF S()NGFIELD, OREGON .() ~.o'? ~;s. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number El.e,?:OOJ -CC>lzg Date B. 20::::~0~~;::~~~~::aIl~tio~'vt:~:;:; Reloe~i~',: ~O 201 Amp~~~P91Rmp's~\ \.0 0'1 $ 75.00 O,'4ofA~P),;ttb 600~~P'~s,,~\j "", $125.00 . ,'" - 0 Vl I,}\"'- Y'\"J !:> Y ~\ p~' oo~66\~P~tbr!p60!>Amp.s 1,}\0\\e $163.00 ",-(\'(;: ,,}\0!:>~e\\\0verriQOO')~~~srV;~~~i\\0 .\0\\ $375.00 ~, G ,('\,\V ,,!"I'C- \\:>' "C'O.' \0\\0 \\0\\ O"\Reconne.ct 0nly\'(\e _\o'i.\\~ $ 50.00 \~\c'Oo S~<J .0'0\'00" i'SAo\6' "\\'l \~ '\ . ~O" ~ 9 \\'lr.-'1\7' -\ \\\\J. -",ri"+'--- ------- -- -- '.<'\ Oil' -{Ol,} ~1i ceT~O~,g~a~:~er,y~<:.s-O!-!':eede...! __._ __ __ _, OO~v' ~\\\\l:JJ (\'(\e __ '\ _~CJ C~ :oe\ \Olnstallation, Alteration or Relocation v\\\ Ge\ ,,- \\ 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 ~"er~O.Q.A,!,p~,,-o! 1000_~?!~~e~{~t~~_ ____ _______, D. I Brallch Circuits \In\?.t \~ \" ~a\ ' "P~~~.\Io~~~~;~~a-~t~~I'Q?'- .- -- ---- . i~i~i!tQ \l~~ \S II.~II.~Q $ 43.00 ~~g~:~~~\lt~:"ith IV $ 3.00 l:(l, ()~ ~;~dt~. <6~ rll.~'------. .-----.-----.......----- E- L~~~seeIlaneous ~erv~~':"..de.':..'~o'- i~'clude~~:_:~ch !'IS!."~aH~n i I. LOCATION OFINSTALLA'l10N I 0 '-f4 O';"'deo,-' "S-t-~" -- LEGAL DESCRIPTION I ROZ.6b( 3. JOB DESCRIPTION S€-I/C '"^ p~t: c1 12 c'\,(,L",::h; Permits are non-transferable and (xpire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 06/00 2. ~C~~Ri.c:r~#llj~T~~!!O~ (JNLY_! Electrical Contractor Address City Phone Expiration Date _ -"IV J ~v n" Supervisor License Number Constr. Contf. Number Expiration Date Signature of SupeIVising Electrician 'K'-'-6,\-"Jtes Lov<?M. CQ! Owners Name Address I ~ 4-- <f D l1!l d CUi.. CitY~"'v~t~~[d' Phone 1'+1 '1' ~~31 OWNER INSTALLATION The installation is being made on property lawn which is not intended for sale, lease or rent. /~~<~ Inspection Request: 726-3769 ~;lYD 3 COMPLETE FEE SCHEDULE BELOW 3, " r A, , New Residential- Single or Multi-Family per dwclliug unit. _.- - . Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or . Modular Dwelling SeIVice or Feeder $106.00 $ 19.00 $50.00 Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges --- -~------'---_.~--- ._~-_._- ~--. '77 {P.43 '7/0 1/ )'8::::' 4. SUBTOTAL OF ABOVE , , ' I 7% State Surcharge 10% Administrative Fee TOTAL Shared Drivc(T:)/Building Fonns/Eleclrical p(..'f1nit Application 1-03.doc . . City of Springfield Electrical Permit Attachment ... Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO,: ISSUED: APPLIED: EXPIRES: ELE2003-00128 5/16/2003 5/16/2003 11116/2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: 1044 DONDEA ST 1802061308100 Springfield TYPE OF WORK: TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Service upgrade and add 12 circuits OWNER/APPLICANT: KNOWLES LORENCE & SANDRA 1044 DONDEA ST SPRINGFIELD OR 97478 ELECTRICAL CONTRACTOR: OWNER '0~l.IlleS '10\1\1\':1 , \ \ ,3;/'1' Ole~O(l a\ \0(1: 0\090 ,,\na ~laS ,,00', ,0,-1. CG:B\W' lU\aS Expiration Date: , \ to.\'o\ 1 _ ",601" .,."o",e ~ 0....' - ",\a~ ~. P' l\l'- (II"'" .~lOV'" ~ II'U (la Amount Paid~\\O~ .' 0(1 Ca DatiPald ,,\a'" 0 \e9nO., .Receint Number . '~C'O.,I 00'1-- '"Ij-.ly 'na\a " '0.\1'- 9,90 \'1.0\11 <i\9S?'- 'l0:S1f6/2003\8"\, \'I.O\I\IC 1200200000000001230 6,93 $lOf>' '{ou r\I~\05/.r6Iio6j, $\\\\\1'.3AA)' 1200200000000001230 36,00 0090 '\\I(I~ \na ~~!r6t2@~'J!82>'2.' 1200200000000001230 63,00 C~d\'oal ,-Ol~PJ.{!&12003\ 1200200000000001230 Descrlntlon + 10% Administrative Fee + 7% State Surcbarge Add. Alter. Extend Circ Ea Add Penn ServlFdr 200 amps or less ,.~ \...''''' 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 working day, Reouired InsDections: 1 Rough Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service, 3 Final Electric: When all electrical work is complete. WOR\<. ".,ri:' "o\p.~Jf i\'\E ,. By Signature, I state and agree, that I have carefully exami~dltbt'cmnP~~ed.I'\"J!.liclinon '0 dOJ~~rt!lyiDFtify that all information hereon Is true and correct, and I further certifY1~~,€;iIl)'.~i1\alfn:o~'tP'effc\'ro'in~ d,n!",lj ~~l~ne In accordance with the Ordinances of the City of Springfield and the laws of the S~t,,\,~~lf~n'jlfr~inj~gr~i>\Ih~IWoYk aescribed herein. I further certify that only contractors and employees who are In comp~'nce r.1!\1IORS irOi. i55~ill be used on this project. I further agree to ensure that all required Inspections are requested at the prbp~\~'time.3 t!J(iileli'~ 11i.)!"'ess is readable from the street, and that the approved set of plans, If applicable, will remain on the sitelDt'llll \~mes during construction. Owner or Contractors Signature Date Pa~e I of I . .. . 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 e. . . . . \" ,./ " ." Permit#: B:E"zoc,~ COIZ-Z Address: ;0 Lf l.f Cb--. ~ e-A n~ Issued by: ~+ 5/16/03 Date: , , Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement 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 "pp.vpriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~L X2. 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 ~ 38- 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 will immediately notify the office issuing this building permit of the name of the contractor- I hereby certify that the above' rmation i orrect and that I have read and do nnderstand the Information NotiC~~ ut Constrncti Responsibilities on the rever~e;;:forib I j,/}if] (Signature of permit applicant) -(j--f-{ (I)'ate)/ (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 03/1 1/03 ." . Acting ,as. ,Your, Own 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 acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As tbe employer, you must comply with tbe followiug: Oregon's Withholdiug Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ill number,-call the Business Information Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-]488. Workers' Compensatiou Insurance: As an employer, you are subject to the Oregon Workers' Compensation LawL and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78] 5. U.S. Internal Revenue Service: As an employer, you must withhold federal income 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 866-8] 6-2065 or fax them at 801-620-7] 15. . Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are reSponsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water d3mage from pipe punctures, fire or work that must be redone. . Time: Makt; sure you have sufficient time to supervise your employees. . '. I - -. . . , . Expertise: Make sure y~)U have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to tiotify building officials as the appropriate times-so they can perform'the required inspections. If you have additional questions call the Construction Contractors Board (503-378-462]) or write the agency at PO Box ]4]40, Salem, OR 97309-5052. Property _ owner.doc 03111103 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00128 ELE2003-00128 ELE2003-00128 ELE2003-00128 Payments: Type or Payment CreditCard 5/16/2003 City of Springfield . Development Services Department . Public Works Department' Official Receipt " Receipt #: 1200200000000001230 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge Paid By LARRY KNOWLES 3:01:47PM Date: 05/16/2003 Amount Paid Item Total: 63.00 36.00 9.90 6.93 $115.83 How Received In Person Payment Total: Amount Paid . Received By (;heck Number (.;onfirm No djb 000070 024952 115.83 $115.83 . Page I of I cReceiptrpt