The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2008-3-28 ZON l....~ INITIALS - N yV\.1 ., DATE \.{ ~-,-1f{ ~ SOURCE ~ P Date :>~8/c> Z I / COMPLETE FE'E SCHEDULE BELOW 2'25 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION l , CIty Job Number Lc>"cA enO (; - 0 C L( Z i 1. LOCATION OF INS1'ALIA110N: q/ D L- Sf LEGA/7s8:fzoZ C{ 3 3. C>50CO A. New Residential- Single or Multi-Family per dwelhng unit. Service Included JOB DESCRIPTION \V\S~.h\Jj ~Vlu.. Tv OLd-01AA.~t\ ~'j PermIts are non-transferable and expire if work IS not started within 180 days of issuance or If work is Suspended for 180 days, 1000 sq ft or less Each addItIOnal 500 sq ft or portIOn thereof Each Manufact'd Home or Modular DwellIng ServIce or Feeder $117 00 $ 2100 $55 00 2. CONTRACTOR INS1'ALIA110N ONLY B. Services or Feeders - Installation, Alterations or Relocation: CIty Phone {~ ~'(, nj V 200 Amps or less ' / 201 Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts ! ~ - c,~C,QQ.(les Only d , C,\ IIUN' regon law requires you to bio\'I rules adopteciP1.the OrfifloJj1 v.J!lity r\h)lIfIGltlolleel:HWE~P.'Yfllt'tls~cmlg~ t:ir~ s~t forth in OAR 952.001-0010 through OAR 952-001- 0090. Ybu~lJlb~H~lutaMtOOfJle!J 6f tR~~aM!PBy cal/in~o~~~t@f"e~ote: the telephone numb~r~\Rh9~~f ~ty Notification 40 Y'l~p~Sto foq Ji\mps2344). Over 600 Amps or 1000 Volts see "B" above D. Branch Circuits $ 70 00 $ 83 00 $138 00 $180 00 $413 00 $ 55 00 70 ElectrIcal Contractor Address Supervisor LIcense Number ExpIratIOn Date Constr Contr Number $ 55 00 $ 76 00 $ I 10 00 ExpIration Date SIgnature of SupervIsIng ElectrIcIan /:;~B-t ,(hA_ C) OU Owners Name 'T~~Bu.~ Address <i I 0 l__ st Clty~I)Y-\Vj~dJ Phone '64-4--~Pf3 NOT'C~R.p[I)\t~0fXl"RE 'fi\-\EWO~~ $ 55 00 lHIS P~p~tju ~D~~hffl!'S PERMIT Is-M $ 55 00 OWNER INST ALLA TJON AUiHOS ~~f~ ~8!lAtB~aNEO FOR $ 28 00 The InstallatIOn IS beIng made on property I own whIch COMM5-\'hYt~~lffwW~mmerclal $ 50 00 IS not Intended for sale, lease or rent A*YniYM\nOf)ectric Permit Inspection Fee is $50.00 + Surcharges 4, SUBl'OTALOFABOVE 82- '18# gzc::::> tllO lOt( I!L New Alteration or Extension Per Panel One CirCUIt Each AdditIOnal CIrcuIt or WIth ServIce or Feeder Permit $ 48 00 '5 $ 400 /2 E. Miscellaneous (Service/feeder not included) -Each Installation 12% State Surcharge 10% AdmInIstratIve Fee 5% Technology Fee Inspection Request: 726-3769 TOTAL Shared Dnve(T )IBUlldmg FormslElectncal PermIt ApplIcatIon 1-08 doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 910 L ST ASSESSOR'S PARCEL NO,: 1703264303000 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00424 ISSUED: 03/28/2008 APPLIED: 03/28/2008 EXPIRES: 09/28/2008 VALUE: Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: AdditIOn PROJECT DESCRIPTION: Add service and circuits to accessory structure Owner: RICHARD GLOVER Address: 910 L ST SPRINGFIELD OR 97477 Owner: TABITHA BUZBY Address: 910 L ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: U Secondary Occupancy Group: Primary Construction Type V A 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: Residential Phone Number: 541-844-8073 : " ,". --'iln:~"'''' ,\,,,11 tn All eN I IVI"!. VIC'i:j"''' "".. 1_'1---" , ,. - . . t:.- tl:;;:! ("\n.gon Utility I C({):NIFR.A~'F~R~P~M11J.~1e set forth NOllllliClllUl1 v....,.L~.. ! I 2 001 , OAR 952-001-001 0 th~ gh OAR 95 - ., Phone In , t'P..I1,l;:Pthe r~hrntlOn Date 0090, You may obtatnT1:r.'vt' U)" ___II:...\", +ho I"ont,ar (Note: the telephone BuiMlriGImF(J~oW~~t2Y'l~~)1:nCl;\UUII \Jl:lIIl';;t ~ ~ # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building n/a Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING ove.M~riiISE~ E If THE Wl'lmtl: # Str'f~Il)rf\6~nT SHAll EXP1R IS kfeTiicapped: Pave~mW~R~D UNDER THIS PERMIT <=:ompact: % oftOMf~~~ OR IS ABANDONED FOR ANY 180 DAY PERIOD. I PUBLIC IMPROVEMENTS' Sidewalk Type: Downspouts/Drains: Pal!e 1 of 3 Status Issued CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2008-00424 ISSUED: 03/28/2008 APPLIED: 03/28/2008 EXPIRES: 09/28/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project ~ Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $8.20 3/28/08 2200800000000000372 $9.84 3/28/08 2200800000000000372 $4.10 3/28/08 2200800000000000372 $12.00 3/28/08 2200800000000000372 $70.00 3/28/08 2200800000000000372 Total Amount Paid $104.14 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. ~e(]uiredJnsDections , Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Pa!!:e 2 of3 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: COM2008-00424 ISSUED: 03/28/2008 APPLIED: 03/28/2008 EXPIRES: 09/28/2008 VALUE: 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 descnbed herein, and that NO OCCUPANCY will be made of any structure without permission ofthe 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 aU 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 ofthe property, and the approved set of plans will remain on the site at all times during construction. .~ ~ -:- ---- --- Owner or Contractors Signatu Pa!!:e 3 of3 312J%~ Date > 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 Address. PermIt #: C CI/IA eo a g' - 00 Lll- \.-.{ I/O L ~+- D~ Date: I 3k~ Ap- I / ,~ Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note. Oregon Law, ORS 701.055(4) requires residential construction permzt applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement zs required for residential buzlding, electrical, mechanical and plumbing permits. Licensed architect and engineer applzcants, exempt from licenszng under ORS 701.010(7), need not submzt this statement. This statement wzll befiled with the permit. . . Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 71. fr2. I own, res~de 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. IfI 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. /~! p-=> -~--' 3/~!O~ d (SignatubO'f rmit applican~ (Date) (White copy to issuing agency permit file, pmk copy to applicant.) Property_owner. doc 06-01-04 - Acting as .YJour General Contractor? J ' . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTiON RESPONSIBILITIES 'f NOTE. This Informatfon Notice to Property Owners about Construction Responsibilities was developed by the Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are actmg as your O'INTI contractor to construct a new home or make a substantlalImprovement to an eXisting structure, you can prevent many problems by bemg aware of the followmg responsibIlitIes and concerns. Employer You WIll, In most be ruled to be an "employer" the contractors you contract With wIll be "employees" If you use contractors not licensed With the ConstructIOn Contractors Board to do labor m constructIng or to aSSIst In the constructIOn or Improvement of a residential structure. As you must comply with the following: ( Oregon's employees are employees. Tax Law: As an employer, you must mcome taxes from cUijJloyee wages at the tIme You WIll be .liable for tax payments even If you don't actually Withhold the tax from your more InformatIOn, call the at 503-378-4988. U nemploymellt on wages of all Tax: As an employer, you are more mformatlon, call to pay a tax for unemployment msurance purposes Employment Department at 503-947-1488. Identification Number (BIN) IS a number for, both Oregon Wlthholdmg and Tax. To file for a BIN, call 503-945-8091 or \vww.dor.state.oLus/fonnsnav.htmll for the The Oregon Unemployment appropnate forms. Workers' Insurance: As an employer, you are to the Oregon Workers' CompensatIOn Law, and must obtam workers' compensatIOn Insurance for your If you fail to obtaIn workers' compensatJon Insurance, you could be subject to penaltIes and hable for costs If one of your employees 18 injured on the Job. more mformatIOn, can the Workers' Compensation DIV1sIOn at the Department of Consumer and Busmess Services at 503-947-7815. U.S. Internal Service: As an employer, you must Withhold federal mcome tax employees' wages. You \vill be liable for the tax payment even If you didn't actually WIthhold tax. For a Federal EIN number, call the at 1-'800--829-4933 or VIS]t theIr web SIte at '....., Concerns Code reqmrements As the holder for thIS proJect, you are may be brought to your attentIOn through for resolVIng any :failure to meet code Insurance: such as to see if you have adequate insurance water damage from pIpe punctures, fire or sure you have suffiCient tIme to supervIse your swe you the slalls to act as your own to notl fy bmlding officmls as contractor, to coordinate work of rough-m so they can perforrn the required InSpectIOns. can the 97309-5052. (503-378-4621) or wnte the at PO 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 COM2008-00424 COM2008-00424 COM2008-00424 COM2008-00424 COM2008-00424 Payments: Type of Payment Check cRecemtl RECEIPT #: 2200800000000000372 Date: 03/28/2008 DeScriptIOn Perm Serv/Fdr 200 amps or less Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By TABITHA BUZBY Item Total: Check Number AuthorizatIOn ReceIved By Batch Number Number How Received dJb 1547 In Person Payment Total: Page 1 of 1 2:56:46PM Amount Due 7000 1200 4 10 984 820 $104.14 Amount Paid $10414 $104.14 3/28/2008