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Home My WebLink AboutPermit Electrical 1996-2-26 , bmltted has the folio The lollowlng project as au. ''''"'ilie lend use zoning, and dOG9 not reqUire "'l"""'~ approvel. ' ZonlngJ-- "D ~ ELECTRICAL PERMIT APPLICATION 97477 Data 'l~' :2~ Iq lo 726-3769 --r" (:) Ci tv ':T"b Number 9~~?/)/ Authorized ignature -=, \ 3. COMPLETE FEE SCHEDULE BELOII 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 1. LOCATION OF INSTALLATION .7 2. 3A+-/A'~k) LEGAL DESCRIPTION /7/)J 2.7 <;%" tJ/~2- JOB DESCRIPTION C/Wtdq'" cAftt'~ ~ &"~ Permits are non-transferable and expire if vork is not started vi thin 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor ~;/~~~~ Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners Name Jet!:ur 7i6~) Address 72.,~ ~~/,*..tJ.~.. Ci ty S~ Phone '7#-/7~ / OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Owners Signature: Xi:Y/~?c-_;'~ ~ ~- -~-------------------------------- D E:_ -;?~t:::,..?~_ RECEIPT 1I: "2c<-/93 ~ RECEIVED BY: c? :--~----e ~ A. Nev Residential-Single or Multi-Family per dvelling unit. Service Included: Items Cos t Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dvelling Service or Feeder $ 85.00 '$ 15.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to '600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps" 'or less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts see "B" above D. Branch Circuits ." Nev, Alteration or Extension Per Panel One Circui t /.-- $ 35.00 -55:"'"' Each Additional Circuit or vith Service or Feeder Permit I $ 2.00 2-00 E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) 5. $ 40.00' $ 40.00 $ 20.00 $ 36.00 :1 7. d<' ;.~ /.// 3f,'?6- SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL . . Permit #: ~e 2..lJ I Address: 7..'_ 3 f7f.7~///~J , - Issued by: ~~ Date: 1A O/,.~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction pennit appli- cants who are not registered 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 pluinbing penn its. Licensed architect and engineer applicants, exempt from registration under ORS 70/.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 0' ~ D 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My 'general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR % 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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 Pr>i)erty Owne~ ab~ut Construction Responsibilities on the reverse sid.e of this form. ;X V pj~CcY'f:-- ' J- ?2 -]{. I {" / (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . JIniormation Notice to Propeiiy Owners Abol,lt .(;onstruction Responsibilities ," . .;;'.,\.". . ''Nf!te: This Informatioll NO!lce to Property OWllers about Construction Responsibilities ivas developed by the Construction Contractors Board ill accordance with ORS 701.055(5). 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 areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure. you will, in most instances, be ruled to be an employer and the people you hire will be employees, As 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 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 more information, call the Oregon Dept. of Revenue at 945-8091. 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 infonnation, call the Oregon Employment Division at the Department of Human Resource, at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insur~ce for your employees. If you fail to obtain workers' compensation insurance. you ll1ay be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more informl}ii\:'~ call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. 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 more information, call the Internal Revenue Service ' at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code requirerrents 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 accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor. to coordinate the work of rough-in and finish , trades, and to notify building officials at the appropriate times so they can perform ~he required inspections. .... . If you have' additio!}al que'~tions, write or call the Construction ContractorS Bwcr (P()'BQ~ 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem, prop-own.pm4 1/94 Page 1 RESIDENTIAL PERMIT APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION BUILDING SAFETY Job Number: 960201 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location of Proposed Work: 723 FAIRVIEW DR Assessors Map #: 17032742 Lot: Block: Tax Lot #: 01802 Subdivision: Owner: JEFFRY THOMPSON Address: 723 FAIRVIEW DRIVE Phone #: 744-1721 City/State/Zip: SPRINGFIELD, OREGON 97477 Describe Work: CARPORT TO GARAGE REMODEL Contractor Const. Contractor # Expires Phone General: OWNER 744-1721 QUAD AREA: 2RNW OCCY GROUP: M OFFICE USE LAND USE: 1111 ZONING CODE: LDR 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. REQUIRED INSPECTIONS --- FOOTING - After trenches are excavated. FOUNDATION - After forms are erected but prior to concrete placement. ROUGH ELECTRICAL - Prior to cover. FRAMING - Prior to cover. FXNAL ELECTRXCAL - When all electrical work is complete. FINAL BUILDING - When all required inspections have been approved and the building is complete. Garage N 18 Setbacks S W 6 E Item Main Garage ENCLOSE CARPORT Total Value BUILDING PERMIT --- Square Feet x $/Square Feet 348 5 Value 0.00 0.00 1,740.00 1,740.00 Building Permit Fee Surcharge/Admin 29.50 2.37 TOTAL FEE (A) 31.87 --- MISCELLANEOUS PERMITS --- Surcharge/Admin ELECTRICAL PERMIT PLAN REVIEW FEE 0.00 39.96 19.18 TOTAL MISCELLANEOUS PERMITS (E) 59.14 Job Number: 960201 Page 2 (Excluding Electrical) unless otherwise noted TOTAL AMOUNT DUE (A, B, C, D, and E combined) 91. 01 --- BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT --- This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Received By: Plans Reviewed By: DON MOORE Date: 02/23/96 Building Site Reviewed By: LISA HOPPER --- ADDITIONAL COMMENTS --- 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 701.055 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. , G./! /' ; :7~~J- Signaturel//" . ,2-d..fo.q~ Date --- VALIDATION --- Date Paid: ~ ZtJ'&.7 -:? -2r.:~~ q/.~I /7 A"'2:' ,.. . ~V" Receipt Number: Amount Received: Received By: