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Home My WebLink AboutPermit Electrical 2006-3-1 .1. SPRIN\~]~ . 225 FIFTH STREET 0 SPRINGFIELD,OR97477 0 PH:(541)726,3753 o FAX: (541)726-3689 ~~}~,<.' ELECTRICAL PERMIT APPLICATION " ~'S",..n" d. City Job Number C.OM. e.oo b _ CTc::> 21.( l. Date -y.,,~r.;,~-6 b "o.",!.('~':) .././ I 3. I COMPLETE FEE SCIf~ii,'i;IL'E BErpW'/ ./ ,,\'(\";:-,,""'~'~' f::,\'<'''J/,/ 0'''' 0..). .,0 <I,.:, s" v .0 A. I New Residential - Singii,' or i\Iuly..far~lij;l;er dwelling unit. ,0 eO' (J'lJ.' ~~ ,\'v \..-> 1. I LOCATION OF INSTALLATION .JZ'R 6 .f.6,;..t/J./~Y' r;-f. LEGAL DESCRIPTION 170J 27'J I o l( 7Dc.> Service Included A~\\ Z- c'..\.V"'~"'" '.t " 1000 sq, ft, or less Each additional 500 sq, ft, or portion thereof $106.00 JOB DESCRIPTION $ 19,00 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 CONTRACTOR INSTALLATION ONLY! Each Manufact'd Home or Modular Dwelling Service or Feeder $50,00 City Phone ,B.\ Sen'ices'or Feeders - installation, Alterations or Relocation: , . '- ,.,; IIUI~: Oregon law r ' '.J O\200'~mps:o.!~~~sJ b eqUlres you to $ 63,00 "otlfIC;2b]lrAmPstOJ~oq'~!pj~e Oregon Ulilitv $ 75,00 In OAR40l<'Mnpito,600 Am"ps ules are set forth $i25,00 0090 " . c, v """f1Jgh OAR . " '~i ~mjis(toHOOO(hJ)!p~s of ~o2-001- $163.00 ,ca'linoJe1fIOOOWmp!\Wolts. the tth,e IUI.es by $375,00 numb-, f 'I.. 'v.v, e e Reconnect QnlYgon Utilit N ' fJllune $ 50,00 Genter is l.:BOO-?~'l 1- ot.flcallon I "'''-.. "..k C. Temporary Sen'ices or 'Feeaers Electrical Contractor Address Supervisor License Number I .~~\V Constr. Contr, Number a v Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps $ 50,00 $ 69,00 $100,00 Expiration Date Expiration Date Signature of Supervising Electrician Over 600 Amps or 1000 Volts see "B" above. . D. I Branch Cfrcuits .,New Alteration or Extension Per panel/, J J NOTICE'One c;:j~'t ~IRE If 'THE WO~l(. $ 43.00 .., THIS PERMi'J, i-\' '~Mil\l IS NOil -;I t-. /. J f, AU1HORIl!~@iU!'l.f) d 'NrO "EO "0\, $ 3,00 Owners Name s:.L;tr #At4e f Wf?-I ~..... OMM~NGfD-OR,'s..AB" . \. r . ' Address 17 S b f=I;\,,-\~AvFiV ~.NY 16\:J blW.sPl!'i\\lMks (Sen'ice/feeder not included)-Each Installation' City ,St>":~ Phone 'f'(-';/,,3 Pump or irrigation $50,00 Sign/Outline Lighting $ 50,00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45,00 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~~a'L _ ~/ty'- 4.\ SUBTOTALOl"ABOVE I l(b -:J6:!. l/ 6- SCf Z. ~ 8% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:YBuilding FonnslElectrical Pennit Application l-06.doc . Status: Issued 225 Flfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . '1 ..I CITY OF SPRINGFIELD~ Building/Combination Permit" . PERMIT NO: COM2006-00242 ISSUED: 03/01/2006 APPLIED: 03/01/2006 EXPIRES: 09/01/2006 VALUE: SITE ADDRESS: 1786 Fairhaven ASSESSOR'S PARCEL NO.: 1703273104700 PROJECT DESCRIPTION: Add 2 circuits Owner: ERIK JAMES WHEDON Address: 1786 FAIRHA VEN ST SPRINGFIELD OR 97477 . Contractor Type Electrical Contractor OWNER # of Uni1s: Primary Occupancy Group: R-3 Secondary Occupancy . P'rimary Construction Type VN Secondary Construction # of Bedrooms: ,~Frontyard Setback: Side I Setback: , Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: . Speclallnstruction: Notes: , Description . .' Tvpe of Construction Springfield TYPE OF Electrical Work Only TYPE OF USE: Addition Residential Phone Number: 541-684,9133 " , es VoU to l~.~, rpn\l\f -! '~., r ~~""J: v1v\::r......: II..."" ()regon UUIl~" I CONTRACTOR'INFORMATlON,lare set forth , , 'ation (,;el1l"" ",_. oh OP-R 952.001, I' Jtll'~ 1 001 0 'jl~()U '" ' . '''tl D t Ph . OP-R 952-00 - ,L<lcense.)lthr.,;Xpua on a e one III V obtain co\.)\"~ \ hone "~~,, V"'l ma .. ,_.". thp Ie eo I Bull.DING,INFORMATiONlltiliW Noti\lcallUII numu'" '~"., 800-332-2344), S ''''~nler\s1- # of tones,' Lot Size: Height of Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: ' Range Type: Sq Ft Garage/Carport Energy Patb: Sq Ft Other: Sprinkled nla Occupant Load: . I DEVELOPMENT INFORMATION I ' il'lE ~UlRED PARKING over~~E.: SI'I~ll E'j,,\l\?E ~~,,^Ii \S~W;: # Str~~?,,^li \I~QE? il'llS \l O~EQ fORandicapped: . Paved 1JJ\,y,q\i':EQ Op. IS ~B~~Q Compact: % OfLCdi-l\~\'!\ii&t.Q E?IOQ. ~N'I \80 Q~'{ \l IPUBLlC IMPROVEMENTSI Sidewalk Type: DownspoutsIDrains I Valuation Descriotion I ~ SPerSqFt or multiplier Square Footage or Bid Amount Value Date Calculated I of 2 . . CITY OF SPRINGFIELD . Building/Combination Permit PERMITNO: COM2006-00242 ISSUED: 03/01/2006 APPLIED: 03/01/2006 EXPIRES: 09/01/2006 VALUE: . Status: Issued 225 F1fth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line "'--. Total Value of Project Fees P,llidJ Fee Description + 10% Administrative Fee + 8% State Surcharge Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add Amount Paid $4.60 $3.68 $43.00 $3.00 Date Paid 3/1/06 3/1/06 3/1/06 3/1/06 Receipt Number 1200600000000000223 1200600000000000223 1200600000000000223 ,1200600000000000223 Total Amount $54.28 I Plan Reviews I . " , To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. Rough Electric: Prior to Cover Final Electric: When all electrical work Is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do herehy certify that all , Information hereon Is true and correct, and 1 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 wiD be made of any structure without permission ofthe Community Services Division, :: Building Safety. 1 further certify that only contractors and employees who are In compliance with ORS 701.005 will be used' on this project. . I ,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 wiD remain on the site -?~~=~~2 3/~C Owner or Contractors Signature Date 2 of 2 ~. I _.i \. .:' -'. ,,' '. ..' . Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit#: COMZ_G - OOz.<{l- Address: \7 gb 'F.4,r,^..A-vc...( Issued by: 'f'-..-:( Dale: -:s;/t /0 b t. .' ... 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 app.up.:ate blanks and initial boxes 1 and 2, and either box 3A or 3B: m-1. ~ 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. 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 ~ 3B. I will be my own general contractor. If! 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. a:J~ JlL ~ ~Ir't (Signature of permit applicant) . (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 06-01-04 AC'd~g as -,'nr'Own General C!tractor? )..- j" 'IN'FdRMATlbN 'NbTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES c. (_._ . . .., ,. .~, NOTE: This Information Notice to Properly Owners about Construction Resjj~nsibilities was d~ve/oped 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. "'"S the employer, you must 'comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at tbe 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 more information, can 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 an employees. For more information, can the Oregon Employment Department at 503-947-1488, '.... The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and ' Unemployment Insurance Tax, To file for a BlN, can 503-945,8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties imd be liable for ali claim costs if one of your employees is injured on the job, For more information, can the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. 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 actuany withhold the tax. For a Federal ElN number, can the '.J IRS at 1-800-829-4933 or visit their web site at www,irs.l!ov. 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 damage from pipe punCturl~.s, fire or work that must be redone, \ \ '.... '..... -.\ ",,\. \ : ." '4 '\' \" .....-<~~.....:, 4-.':""~\ '~.. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the'skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions can the Construction Contractors Board (503,378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner,doc 06-01-04 225 Fifth Street Sjlriiigfield, Oregon 97477 541-726-3759 Phone Job/Joomal Number . COM2006-00242 COM2006-00242 COM2006-00242 COM2006,00242 Payments: Type of Payment CreditCard 'I- 4 :1 'I- 4' :t. '1- 4 3/112006 . RECEIPT #: iIi~~ it/iiity of Springfield Official Receipt .velopment Services Department Public Works Department 1200600000000000223 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + 10% Administrative Fee Paid By ERIK JAMES WHEDON Received By djb 1 of 1 Date: 03/01/2006 Item Total: l;hecl< Number AuUJorizatlon Batch Number Number How Received 001539 In Person Payment Total: IO:51:59AM Amoo nt Due 43.00 3.00 3.68 4.60 $54.28 Amount Paid " I . $54.28 , : . $54.28 .. )