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Home My WebLink AboutPermit Electrical 2008-3-20 ZON INITIALS DATE SOURCE 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEl.aKlCAL PERMIT APPLICATION City Job Number ('1) m 2.O0~ - rD::s <g?- Date 3/2DJO& , t ~ "l'f'df'W-0>>"" //; "" 1. LOCATION OF INSTALLATION: "',:::i <, ~ n-'-\" ,;!l< ' ~"",ifN ," ~" ~ , ~Og~ \fn~ I LEGAL DESCRIPTION I,Ol..\Cj 32Dll(j1) JOB DESCRIPTION: , "' <~ iiWHd ' , ~ 3. CQM~IErE FlJE SCHEDULE BELOW t. "t....M1<3J"..3-..}h~-"r~-<' / "" /~ f <:"'!'~l >>> >~ A. f:,~ew: ,e,sidential':" Single ,~~ ,'Multi-Family' per dwelling unit x,,,,,,o<...004.<<<<?" / ,,-:>," <~ ""'" ~:J(> - So j/"1'V (/rc;iA fJ,~ A>c c:.lc/Jf;;'p1ti v Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Service Included 1000 sq ft or less Each addItlonal500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwellmg ServIce or Feeder $117.00 $ 21.00 $55.00 2. , (' \ "fm,"'" > , " CONTJlACTOR'INSTAL~TIONONLY " ~ h', <" , HiiH~ <>!"~ > , i ~ >~ ,> > > B. Serviccs'or Feeders - Installation, Alterations or Relocation: ~" '/ '\ > 'i" <) ~>Nmii~j,^,,~ Electnca1 Contractor Addr~" / 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 70.00 $ 83 00 $138.00 $180.00 $413 00 $ 55.00 Supervisor License N , > ',' iiP>~",I)~ (1 / C. ii:LI~,~porary Services or Feeders ( , 'I ',} ','. City / S)~ature of Supervising Electrician .~ ~ \ Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 55.00 $ 76.00 $110.00 Constr. C09tr. Number / / I ExpIr}ltion Date Over 600 Amps or 1000 Volts see "B" above. j./; _"1 '/ /' j "H D. Branch Circuits .' New Alteration or Extension Per Panel / One Circuit V $ 48.00 4$. DO Each AddItional CIrCUIt or with R ell I- Service or Feeder Permit $ 4.00 Owners Name P/>1/-/~-/ III/'Ii Address "30 J'J Yo It, J1 J~ A tJ e ' E. + Mi~~II~~~~~~' (Service/feeder not included) -Each Installation CIty 5f)J-Jl1/;tC/;~/' Phone 7t;t;-ct tJJ' Pump or lITigatio: $ 55.00 " -; A, ~f\fUO~' .Qreqon law requires YOll to Sign/Outline LIghting $ 55 00 OWNERt61~lRhlrN~HOi:>ted by the Oregon L'tl!lty Limited Ener~(Res~dentia1 $ 28.00 The insta~1.lil1lIlIg:amer.oiflp~fijll::OWn\~fik!I9rth LImited ~DgyG~ercIal $ 5000 is not mt~I9OObOlii1gei2l.~6illiough O,'l.R 952~001- Minimum ElecTm~friP.Mbki~~PsI~J5o~)4!i~s 0090. You may obtain COplOS of the rule,s by , " ""'%l~"i:' '~~I~.tlBIj,D.. flER fHtS PERMIT. IS own~rs SI . ~;,nter. (Note: tbe telephone 4. .. SUB~~~~~ tS ABANDONED (:(1 I (f[) ~ U ~~e. Ore9on ~~t~l~ Notlr:cdtlon 12% Stat S>111/CIn . -.. f.:,. ~V . - 'enter IS Hl00-vv.::.-.::.(44). 100/ Adm9\l'fT T~eoFAY PERIOD. ~ /0 mIstratIve ee S . () D 5% Technology Fee :;;;l. ~ Inspection Request: 726-3769 TOTAL to~ ,57) Shared Dnve(T )lBuddmg FormsfElectncal Permit ApplicatIOn 1-08 doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2008-00382 ISSUED: 03/20/2008 APPLIED: 03/20/2008 EXPIRES: 09/20/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3083 YOLANDA AVE ASSESSOR'S PARCEL NO.: 1702193301100 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: 1 Circuit for air conditioner Owner: ELLIOTT BRADLEY S & CANDY E Address: PO BOX 70741 EUGENE OR 97401 Phone Number: 541-744-0698 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORM A TION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION. Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' Stre~~;rJ,~e.RU~gon law requires you to Sidewalk Type: toli6wrures adopted by the Oregon Utility St~tB~roA~: Those rules are set forth Downspouts/Drains: Spfl'lililAlYB95R-Mrt:-0010 through OAR 952-001. NOTICE: 0090. You may obtain copies of the rules by THIS PERMIT SHALL EXPIRE IF THE WORK Note!Calling the center. (Note: the telephone AUTHORIZED UNDER THIS PERMIT IS NOT number. for the Oregon Utility Notification ('f'lnnnnqlf\rt' C"fl .p ^ ['I,A ~1f'\C'~IFf' f"n \.IemerlS I-OUU-"''''~-~'''44). - ..-11111_. --- -...- .Ie.\.h.__.......... oJ I I Valuation Description ,NY 180 DAY PERIOD. Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2008-00382 ISSUED: 03/20/2008 APPLIED: 0312012008 EXPIRES: 09/20/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project l Fees Paid' Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $5.00 3120/08 2200800000000000338 $6.00 3120/08 2200800000000000338 $2.50 3/20/08 2200800000000000338 $48.00 3/20/08 2200800000000000338 $2.00 3/20/08 2200800000000000338 Total Amount Paid $63.50 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. ReQuired InsDections . Rough Electric: Prior to Cover 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 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 Paee 2 of2 Construction Contractors Board 700 Summer St NE Suit~ 300 PO Box 14140 Salem OR 97309-5052. Phone: 503-378-4621 Web Address: www.ccb.state.or.us Penmt #. COm zco8-C032d-. 30&s 'foUA:N~ Date: "31 ~ l tf6 Address: Issued f?y: 'J:::>.Jr . ~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires resldentzal 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 buildzng, electrzcal, 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 penn it. - . FIll in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: . 6-1. I own, resIde in, or will reside in the completed structUre. ~2. 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 ~ 3B. 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, l'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/#O (Signature of permit applicant) :J -;)0-0 f (Date) (White copy to issuing agency permit file, pznk copy to applzcant.) Property_owner. doc 06-01-04 , . Acting' as Your i- " t (' , lNFORMA TION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES wn General Contractor? . 1-- 1"" -'.... p--.-- NOTE This Information Notice to Property Owners about Construction 'Responsibilities was developed by the Construction Contractors Board in accordance with 701055(5), passed by the 1989 Oregon Legis/ature, If you are actmg as your own contractor to construct a new home or make a substantlalImprovement to an eXlstmg structure, you can prevent many problems by bemg aware followmg responsIbIlities and concerns. Employer You WIll, m most mstances, be ruled to be an "employer" and you use contractors not licensed with the ConstructlOn constructIOn or Improvement of a reSIdentIal structure. contractors you contract With w1l1 be "employees" If to do labor in constructmg or to aSSIst m the yo~ must with the fonowing: Oregon's employees are employees. As an employer, you must mcome taxes wages at the tIme liable for the tax payments even you don't actuany Withhold the tax from your can the Department at 503-378-4988. ./ Tax: As an employer, anHcqmred to pay a tax for unemployment msurance purposes on wages of all employees. more mformatlOn, call Employment at 503-947-1488. Oregon Busmess IdenhficatlOn Number (BlN) IS a Unemployment Tax. To file for a BIN, can appropnate forms. number f~r both.: Oregon. WitPholdmg and or \vww.dor state.or us/lormsDav.htmll for the Workers; Compensation In~llrance: an employer, you are and must obtam workers' compensatIOn insurance for your msurance, you could subject to penaltIes and be hable for Job For more call the Workers' CompensatIOn ServIces at 5 to the Oregon Workers' Compensahon Law, If you fail to obtam wor!cers' compensanon costs If one of your employees IS 1ilJ1:lred on the at the Department Consumer and Busmess u.s. As an employer, you must You Will be the tax payment even if you IRS at 1-800-8294933 or V1S1t the1r web SIte at \CVV"W.1rS._g(~y. federal mcome tax WIthhold tax, For a wages. EIN number. call the Code Compliance: As the permIt holder for thIS requm~ments that be brought 10 your attentIOn , , you are rcsolvmg any fallure to meet code Insurance: Contact your msurance agent to see If you'have msurance coverage for accldents and omISSIons such as fallmg tools, over water damage pIpe punctures, fire or work that must be Make sure you have suffiCIent time to supervise Expertise: Make sure you have the skIlls to act as and fimsh trades, to notl bmldmg offiCIals as own contractor, to coord mate tImes so they can pcrfonn of rough-m mspectlOns. If you have Box 14140, questiOns can the ConstructIOn 97309-5052. (503-3784621) or wrIte the agency at 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00382 COM2008-00382 COM2008-00382 COM2008-00382 COM2008-00382 Payments: Type of Payment Check cRecelOt I RECEIPT #: 2200800000000000338 Date: 03/20/2008 DescriptIOn Add, Alter, Extend Clrc MInimum/AdJustment ElectrIcal + 5% Technology Fee + 12% State Surcharge + 10% AdmInistratIve Fee PaId By BRAED ELLIOTT Item Total: Check Number AuthorizatIOn ReceIved By Batch Number Number How Received ddk 2457 In Person Payment Total: Page 1 of 1 3:03:02PM Amount Due 4800 200 250 600 500 $63.50 Amount Paid $63 50 $63.50 3/20/2008