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Home My WebLink AboutPermit Electrical 2008-3-19 ZON L<ttf_ INITIALS I' Hll . DATE '~ \c.; 10 ?( SOURCE 'm (->Sp--:7 Date l )// (r;/ () Y 225 FIFlH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEt;lK1CAL P!~IT ~PLICATION CIty Job Number (nm UJ-{J?" - ()03-7& Installation, Alteration or Relocation 200 Amps or less $ 5500 201 Amp~ tQ 400,Amps _, $ 76 00 /, ' r {' '"l 'I "I'C':).fri 401 Amf~!tP~qQ,~P~" -'I) '\'~ \' ", - ,W ~()~n.RtHry Over 6~:~ rori1 Otro1V..(jltsr~oogfBr1jabt>'itf.e set forth D. B~ . t~l,r,p~~:~ OAJ1-~~?001~, . ou'may tam copies of tHl:frules'by New Alttlt8~dtlt:xan*n ~oealikl~ telephone One Crr.-nber for the Oregon Utility Not~~tmn ~ Each Additional Q~ Jl;JtiOO-~~,-,~). I Service or Feeder Permit $ 4.00 Owners Name ,,:::LLY OA-R- D F'/ " ~<<( "" /(, v' ~ ~ Address 13 ~o Din':; II S'T. E. Miscellaneous (Service/feeder nT~dt,,~,~I~~~~)7"Each'tnstallation City _ S~ ~ Phone 5':JL.f-3~NOTIC~porirrigation VORl< $55.00 THIS PtRMW18W6;UlJ~kRE IF THE V OT $ 55.00 , {I U TH () ~>>m@dJh\l~inU~R~ M IT Is--I"t $ 28 00 'r'Ci: ~HfJt'Q@titM~f1e~~~f6~fD FOR $ 50.00 ; \: Mill~nudilPE1~@fd lPg..mit Inspection Fee is $50.00 + Surcharges , " -, 0' cJ1..:l 4. SUBTOTAL~IlABOVE" ' ',,'I'., '" /0 .. 12% State Surcharge -5 .50 10% Admmistrative Fee 0 - y Q 5% Technology Fee / _ au TOTAL J1 ()r0'~ 9 (.) Shared Dnve(T )/Buddmg Forms/Electncal Permit Kpphcatlon 1-08 doc ~~ ,......,~i~~... / 1. LocATION OF INSTALLATION: 'I <" ' .<,,~ /~m' j-7()A5S2 z.( 0 dO'O 6 LEGAL DESCRIPTION: ):;80 ~ Sr /Sffkb, CJ1[l? JOB DESCRIPTION Z {J-la ~ -0_ ~,ed ~CWl~1 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ", i ", ,'" x>: 2. Cq~!<<CTOR INS~AL~!lON O~Y; , Eie,<tncal Contractor / ~........ / -........ Address ',,- ........~ ~ne /~ SupervIsor L,~~~nse Number "'" ExprratIon Date "'" City Constr. Contr. Number Expiration Date t: SIgnature of Supervismg Electncian Inspection Request: 726-3769 3. ,1 /'1 i~ft' ;=r ~ , -"'-''f:q~ COMPLETE FEE $,CHEDULE BEWW ~,,,,,<<~~,, ,~", ii' ,~i ~ / "",,,m "{~"'~' ~ / i~?'%Vj.K;lliW!iL,~>) "I', h / ,':'m#)f('T~ i'i(' A. New Residential- SinglMir Multi-Family'per dwelling unit: nS'#f'~&~M,>,>> ' /~" m~,<~h--, "' ~ ~ < ~%lli i, Service Included 1000 sq. ft orIess Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwellmg Service or Feeder $117.00 $ 21.00 $55.00 ~r'Y4WT, ':i ' <' .:Fl%~/ > ... B. Services' or"Feeders - Jnstal1atiori~,:Alteraiion~ or Relocation: , I;;> ' l' ~ ~iMillj~L,~ l j ~~' 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only / $ 70 00 $ 83.00 $13800 $180 00 $413 00 $ 55.00 -"'h ~%%\> C. Temporary Services or Feeders "'.<>1V<./,d<, ~~ <"i v' "- >" ,+11<1/ ' f ... ~ "' ~ .' . . -. .... Construction Contracto'rs 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 - Perrmt#. ('/;072 ffl) Q'- 0057~ ,Address ig>?D Jm ~S( ./ ,-Sf ISSUedby/'h;n!1/Jt.! Date: 8};c;/o;r /u Statement: Info~ mation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentzal constructzon permzt applzcants who are not licensed wzth the Constructzon Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrzcal, mechanical and plumbzng permits. Lzcensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submzt this statement. Thzs statement wZll be filed with the permzt. Fill in the appropriate blanks and initial bo~es 1 and 2, and either box 3A or 3B: ~ 1. o 2. I own, reside in, or will reside in the completed stiucture. :- .> 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) (C~B #) - , ,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. C gL.~~!eI(,A-4 j"': 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 he abo information is correct and that I have read and do understand the Information Notice to Property wn r about Construction Responsibilities on the reverse side of this form. '4 . 3/;'lhf ( i-' ture ~it applicant) / /(Date) , (White copy to zssuing agency permit file, pznk copy to applicant) Property _ owner.doc 06-01-04 ontractor? INFORMATION NOTICE TO OWNERS ABqUT CONSTRUCTION RESPONSIBILITIES NOTE. This Information Notice to Property Owners about ConstructIOn Responsibilities was developed by the Constf1iction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. are as your own contractor to construct a new home or a substantial improvement to an eXIstIng you can many problems by bemg aware of followmg respomnblhties and concerns, Employer Win, In most Instances, be ruled to be an "employer" and you use contractors not hcensed \V1th the ConstructlOn constructlOn or of a reSIdentIal structure. As contractors you contract W1th will be "employees" If to do labor m or to assist In the you must the following: I..aw: As an employer, you mu"t You WIll be liable for the tax more mformatlOn, call the mcome taxes from employee wages at the tIme even If you don't actually withhold the tax from your at 503-3784988. As an employer, you are For more mformatlOn, call to pay a tax for unemployment insurance purposes Employment Department at 503-947-1488. Oregon IdentificatIOn Number (BIN) is a number for both WIthholdmg and ~ Unemployment Insurance Tax To file for a BIN, caB 503-945-8091 or \\'\'\'w.dor.state oLus/formspav.htmll for the . appropnate \Vorkers' Compensation Insurance: As an employer, you are must obtam workers' compensatIOn Insurance for msurance, you could be subject to penalties be li~ble Job more mformatIOn, call the Workers' Compensation at 15. to the Oregon Workers' CompensatIon Law, you fall to workers' compensatlOn costs If one of your employees IS mJured on the at the Department of Consumer and Busmess Internal Revenue Service: As an employer;"you must federal mcome tax from employees' wages,' You w1l1 the tax even If you dIdn't aerually Withhold the tax. For a F eoera1 EIN number, call IRS at 1-800-8294~33 or ViSIt their web SIte at \'V'Ww.l1~S.goY. Concerns As the may holder for to your attention you are responSIble for any fmlure to meet code and Damage Insurance: Contact your msurance ta see omiSSIOns such as tools, over spray, water you have insurance punctures, fire or coverage work that must Make sure you suffiCIent tIme to supervIse your sure you have the SkIlls to act as your ovvn to bmldmg offiCIals as contractor, to coordmate the work of rough-m times so they can perform reqUlred mspectIOns. the ConstructlOn (503-378-4621) or the agency at PO doc 06~O 1-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00376 COM2008-00376 COM2008-00376 COM2008-00376 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 2200800000000000334 Date: 03/19/2008 DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By KELLY HARTLEY Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received nJm 853169 In Person Payment Total: Page 1 of 1 2:39:19PM Amount Due 7000 350 840 700 $88.90 Amount Paid $88 90 $88.90 3/19/2008 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00376 ISSUED: 03/19/2008 APPLIED: 03/19/2008 EXPIRES: 09/19/2008 VALUE: SITE ADDRESS: 7380 DAISY ST ASSESSOR'S PARCEL NO.: 1702353402800 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Changing out the panel Owner: DOWNES JOHN Address: 7380 DAISY ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction TYPE OF USE: New Residential I CONTRACTOR INFORMATION I BUILDING INFORMATION I # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building License Expiration Date Phone n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Pae:e 1 of2 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00376 ISSUED: 03/19/2008 APPLIED: 03/19/2008 EXPIRES: 09/19/2008 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 I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 $8.40 $3.50 $70.00 3/19/08 3/19/08 3/19/08 3/19/08 2200800000000000334 2200800000000000334 2200800000000000334 2200800000000000334 Total Amount Paid $88.90 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. L Reouired Insnections . Electric Service: Approval required prior to utility company energizing service. 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 Pa2e 2 of2