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Home My WebLink AboutPermit Electrical 2005-12-2 225 FIFTH STREET. SPRINGFIELD. OR 97477 . P't(541)726.3753 . F ELECTRlCM PERMIT APPLICATION City Job Numb~-?6lJ5 -0/ t#f? V , f I.'ioc'Al-[ON OF iNSTALLAi'ION.~;';\:: ,'t ''''^"~"",,,'''''', ',..,."....",. ci 'f'"'' .~,..."..,.....', '-tlfyq :fa" p.v PO LEGAL DESCRIPTION / YO,). 05 24 () I ;:)oL/- , JOB DESCRIPTION / Installation, Alteration or Relocation 2Nio.~ 6t less' $ 50.00 2QH+&,P!BRM1<1' ~LL EXPIRE IF THE ?ffiRK 4~OOfllll19~~ER THIS PFRMIT 181m ~QMMIiWIPEt} OlOdS'ABMlOONhi9"f.OR D. ~ttN~n).~~~'i'{~,EI{IOD't.~~ii1fiff,J:~~f._:;M:oo.;~t~2t,"~ ,,__.c . .._....."O;:';'<............r'"~~.~.~"">.:~_......r<"J..,.,'~:.'1~.....~~~U"~'!:~~'1D New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with -J n L, Q, '__ nO_ Service or Feeder Permit Owners Name nQ.((v 1- \'R.ll\C.l<=<- l),I..(f\lll'fC ' _ ~ .. I':~'" . ,_\,:.r<;;~;.f. :,..:'-,: :;;!}..\/:.t.,;~.f.-lf'~-.,t:',~,_~;I)..":.1 D.o\~r' ,t:{;'it.;L-'f:'::.'';'t~_''l.;;'''',:~-:' ~;;'~}'>( :-::,O:',"::;ll~! Address 444C\ "'It:W fk/ Qd ' E. :,,~~iic,:!I~,~e2~~ ~St;~!~.g{[~i~~r:.~~!)~~k."~~~:~~~~~},1~t~!,lf~i~r;~ Cily ~((\~hn.Rcl Phone S<i'-I"f~,CNlol I'll I I' .~ wvo..~e. Permits are non-transferable and expire if ""'ork is not started within 180 days of issuance or if work is Suspended for 180 days. l~;",,- .-........,.t...~~'+.t..:::.~;:,.. ')'~i'.,~,.. ,-"-,,,-. ....~....,,~,...."",:.:.,>:;Q-~""">'.... ," "'COm-RACroRINSTALI.:A;dON (j};'LY / 2. ~1oi: ,':..';ol'~'i;.1"t~.;:.::,;,;:,;;",n:.;;~:::,~.:~'~,:i~::"":',i..~<.. ,'; ~t<:<::;t-d..:;..;,it;;jM/;;:;':'V\-' / City Expiration Date Signature of Supervising Electrician OWNER INSTALLATION The installation i's being made on property I own which is not intended for sate, lease or rent. .gnalurYhJ{e ,. Inspection Request: 726-3769 OjeC!@;fWl>milledll1aSlhe"d"owin 5 n~_t rSHY,lre specifj.c_~land use 9 > _ ~_:t'-4);-.~~..r-~.f~::J'::(;'T~ X: (541)7~6~~g ~~~~:~~'_ ~~l:i{ Date , '. "~,.,"",..:;:,,. r'J./s /03' ~aJ.e.o/zfi/P~!-e) . ' :J ". '." "..,/." '''''',.''>C., '.,.' "",,_ .r "'''''''?'/''"'''-''.''''''?'~! .. 3.,\ c::Oll.ll~LET.f: FE, I>,$CHEQULElIE"Lq~\~;l1;.i:Jj\,:;.g;:S'j't"r,.;r:<<i~~ ;~.. . :.,,' . ....~..,.". '. .,..' " _'. '" ."."'.~,'.~ _ 1>""\,,,_" . >"~'. ' ","_"""'~".,>_""l'"""'-_"".l.~u""",,,,..._...,.,jj',,..,./.'. '" "t_..;;" : """", '. .. ," .Y.l\;'i.'.~:~~,.\~'~'''':'':;'''""''''~'' <~_ ..I'!!:r.>~",,;S'l'}f:;;c.:..::;r!:'_~'i';.;,t;\}"r.:":"""""-=' A. ", ~ ew ~esi.dentia.I).::_' SJngl~,iit)~.~~ lti.~.~lini!{'pe-r,_:d~~~lIirig:u 'ri.it:,~~q "';,', '.,.' ',' .~..:...' ',_,; _c,,"'" ._"'..... _'~",'"'''''' .~."," ....,-.L"': ....Ko.;...___.._..;...,....:t',.....~>.'''..4_.'.....,;:il:=r~<. Service Included 1000 sq, ft. or less ' Each addilional 500 sq. ft. or portion thereof Each,Miiiii:ifa:Ct;d)Home6r~On law requires you to Mod~!arJ?>>,,!li~g ?~i~i,ge,oi by the Oregon l~~jjWo Fe~~i(f:aication Center. Those I Ul"C.:l 0.1 G ..;)et rortn ''~~f'!'AR',g=iO~1~.'ffl..thr;;)l.1atl.6AB!~52:j,001':c'A"ii'~':~':ii.:;;; B. {Servlc~s-.o r1'eeders .--:J nst~lIah!l.!l,1 ,_.~1terat!ons Rr.-R~lo.~at.1O n.:~'! '~'eooe\"YOtl'ffia>f00talf.l'OOf}"""",I'me.rUIt;,"IJY''''''''''''M'~.'' 200 A~~llin"l the center. (Note: the telen$h6one mps or~ ess .' .. 3.UO 201 .!1l1mhe40fo"!A.lhe Oregon L)lllil~ iwlil.!'7~tlill1 f""7,SC9_ AmpS'l(j ,rt1ps 003"--J"..,$ .00.;....: 401 Amps to 6dO'Wffi~ls 1-8 - ,w,...~~J.$125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 f7S,.,~';'!.:<;;":,y",,,,,\.,.,.'~<F~:::.t!~~-.':~""..'f"+;~W:<:r;~6.~.',~?t4~,:t.\"\"'~:~~~~~'*:tf..::"!b,;~,,;y.;rn: c. flri~~'10!,;1!r~~!~\~5!~~~J!~t(,~s~~i_1~ $ 43.00 $ 3,00 Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25,00 $ 45.00 l\-1inirnum Electric Permit Inspection Fee is $45.00 + Surcharges 4, f~o~~g~t1€,~f~?,~r:;!;,\~~rt1~'~~-r.4 75 _ OC> 7% State Surcharge 10% Administrative Fee _~'dS 7,5U X'7 75 TOTAL <it Shared Drive(T:)/Building FonnslE1ectrical Pennit Applic::ltion I.03.doc ,. -. , , \. ../ "', ..' 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 Permit #: ('5 -- {Y ~ %' f Address: ~ l"\ )()..sQR ~ to.J-- Issued by: Nd/Y1V.1 f)f ~ Date: /'1 1rY.J.. / () J-- J / U 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 befi/ed with the permit, Fill in the a.......v...,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: I8l 1. o 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. 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 'gj 3B, I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, If! 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 ~,.~ Ow:; ;;~' ~~,.bllitl~ ,.... ~ ..;::'~: 5 (Signature of permit applicant) / (D~te) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner ,doc 06-01-04 ... . A~~nll1l~ ~~ 1{ @1Ulll" (())wrrn Gtell1ltell"~n C@ll1l~ll"~<C~@ll"? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . " " . . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed 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, JEmllJHoyell' lResllJoID.si1bilities 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, As the employer, you must comply with the following: " Oregon's Withholding Tax Law: As an employer, you must withhold iricome 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 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 all employees, For more information. call 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 BIN, call 503-945-8091 or www.dor.slate.or.uslformsnav.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 and be liable for all claim costs if one of your employees is injured on the job, For more information, call the Workers' Compensation Division at the Departmenl 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 actually withhold the tax, For a Federal EIN number. call1he IRS at 1-800-829-4933 or visit their web site':!t www:irs.I!OV, Otllner ResjpollJl.silbiniHes am:ll Areas of <CoBllCeIl"BllS Code Compliance: As the permit holder for Ihis 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 punctures, fire or work that must be redone, Time: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the skills to act as yoUr own gerieral contractor. to coordinate the work of rough-in and finish trades, and to notify building officials as the app. up' ;ate times so they can perform the required inspections. If you have addilional questions call 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 . 'Status: Issued , 225 Fifth Street, Springfield, OR ..541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 4449 JASPER RD ASSESSOR'S PARCEL NO.: 1802052408204 PROJECT DESCRIPTION: Garage . Owner: Address: . CITY OF SPRINGFIELD. Building/Combination Permit' PERMIT NO: COM2005-01684 ISSUED: 12/02/2005 APPLIED: 12/0212005 EXPIRES: 06/0212006 VALUE: Springfield TYPE OF Electrical Work Only liYPE'OF,-USE: Addition Residential " ,~" vregon, follow rules ~doPted b aw requires you to Notlflcatinn r^~.._ _, Y the Ore~lOn Utilit" In UAR 952-001-001 0 'th~" rUles are set forth 0090. You may obt' rough OAR 952-001 . am copies f h . ~~~~ng t_he center. (Note: th~ L:!,U/es by - -'.'V' "'" uregon Utilit ,'. .', ,- I CONTRACTOR INFORMA TION,.'er is l'800'332.J3~~t.lflcatlon License Expiration Date Phone BURNETTE PATRICIA L & BARRY P 4449 JASPER RD SPRINGFIELD OR 97478 . Contractor Type ~ Electrical Contractor OWNER # of Units: PrImary Occupancy Group: Secondary Occupancy PrImary Construction Type Secondary Construction # of Bedrooms: . Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: ;. SoIar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description Type of Construction I BUILDING INFORMATION' # o~Stori~mTlCE: Lot Size: ~;~~h~t~kl;Jl[> PERMIT SHALL EXPI~ ~i~~K Water Ty~l,!THORIZED UNDER THIS~\bdlh.MQT Range TypQMMENCED OR IS ABAN~m:O~Carport Energy Plitl1!f 180 DAY PERIOD, Sq Ft Other: Sprinkled nla Occupant Load: . I DEVELOPMENT INFORMATION . REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Paved Drive Rqd: "10 of Lot Coverage: !pUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains I Valuation Descrintion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 . . CITYOFSrlU.L~GFIELD Building/Combination Permit PERMIT NO: COM2005-01684 ISSUED: 12/02/2005 APPLIED: 12/02/2005 EXPIRES: 06/02/2006 VALUE: Status: Issued 225 Flfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project . ~ FP.es Paid I :~ Fee Description + 10% Administrative Fee + 7% State Surcharge Perm ServlFdr 201 to 400 amps Amount Paid Date Paid $7.50 $5.25 $75.00 1212/05 12/2/05 1212/05 Receipt Number 1200500000000001774 1200500000000001774 1200500000000001774 Total Amount $87.75 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. , 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 bI accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herebl, and that NO OCCUPANCY wiD 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 oUhe property, and the approved set of plans wiD remain on the site at all times during constructlolL Owner or Contractors Signature Date 2 of 2 II 2 Street Sp ngfield, Oregon 97477 541-726-3759 Phone . 8....~IH'!..,"!oD, .... ,.. .. Wic' .: .._~_.. ' . .ty of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 1200500000000001774 Date: 12/02/2005 2:50:25PM Job/J...mal Number COM2005-01684 COM2005-0 1684 COM2005-0 1684 Description Penn ServlFdr 201 to 400 amps + 7% Slale Surcharge + 10% Administrative Fee Paid By PATRICIA L. BURNETTE Received By NJM Item Total: Lheck Number AuUlonzation Batch Number Number How Recelvcd 515307 515307 In Person Payment Total: Am...nt Dut 75,00 5,25 7.50 587.75 Payments: Type of Payment CreditCard Amount Paid $87,75 ' . 587.75 ,I 'fl. " I :n 2 '. ~j-' 12/2/2005 1 of 1