Loading...
HomeMy WebLinkAboutPermit Electrical 2004-1-9 .' ~:'_" ' CITY'Of,S>._,mGFlt:LD, OREGON' . () " 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 · FAX: (541y1!1l~1I project as submitted has the tollowin ELECTRICAL PERMIT APPLICATION ~ (. ~~~'r~~a~nd doas not require specific land use 9 CllyJobNumberC0l41zooLf-CO032 Date (- i 0 ( zoning---:.,.L'Dv<, ,.-----' -- --c-- ---, '--'l ' , ----,-~---Date-.------- -- --I-'I-c- O'f"-- ~) ZIo~Z ~ ;::~~1:;t;?;:V_~~I'~~C01l1PLETEPnE S~Ij~fz~:1;gt;;:;'t1 ----- -~~ ~ LEGAL DESCRIPTION A. [~~;:~~~id~~;i~ -:- Sing~_~!_~ul~~Fallli~'per,~,~..ni~~~~Jt: ' I &,oz..DbZ'1 03. S-O ( JOB DESCRIPTION St:fL\JlUC ~..w~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2, I CONTRACTOR INSTALLATION ONLY,! ' Electrical Contractor Address City Phone ~/ Supervisor License Number _ J if /' f)J~/ / Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name rf{'QY ~oc:.tE.<;;OpJ Address //c(o ~A/7 <!LcY City ~..e'1' /lIGr 16"4) Phone 7'.sG -/.5"C;Y OWNER INST ALLATlON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~1. ! ~L Inspection Request: 726-3769 Service Included 1000 sq, ft. or less Each additional 500 sq. ft. or portion tllereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106,00 $ 19,00 $50,00 B.I Services or Feeders ~ Installation, Alterations 'or Relocation: I, 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Am~olts ~ect On.!t-) $ 63,00 $ 75,00 $125,00 $163.00 $375,00 $ 50,00 s= -, - / c. I TI:IIIJlor~y' ~ervkes or Feeders Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps $ 50,00 $ 69,00 $100,00 Over 600 Am~s or 1000 Volts see "B" above, D. IBraf~1~~\~~:~~~igd~i~~b~:::~~'~~ New".;~tltliwXm" IWMVP.IfJ'lro:flY'ItJles are set fent One OiI61ltR 952-001-0010 throu(lh OAR19l9Q-oo ' Each:rolYlJ!oV\!J~iffiliI,l!!1:>Yi!lh copies of tp'3 'rl6tes I. ServIce '?!cEAYl!1'lPt~llnter. (Not..., tt,... te:fepnon" r;;;;::n umberiorthe'Oregon'l:Itlli!)1'Ng\iflcatlon " E. i. Miscellaneo~(~,.er.ric,tl.!f~Jfu1~':!l3~_'2\?4'4')' -E~c 1 Installation I Pump or irrigation $ 50,00 Rm'tt:~e Lighting $ 50,00 "fi!tmt'J9Emw~'l'rtf'J:PIRE IF T~~ ',~cfR1~,OO Mrlvrel'fn~l:{rME'RrqiI'lIS ppnm II: t-AAS,OO Mini.u@h1~I~eeOOld~EI} i4lf.bo + Surcharges 4, ['~~Yd}m9BtrE I L~~ ' 7% State Surcharge 10% Administrative Fee , >-0 3>= .>00 58:50 ,I " .-1 .~~, TOTAL Shared Drive(T:)/Building Fonns/Eleclrical Permit Application I-03.doc r Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY VI< I)rK11'1ut<lJ!,LD . Building/Combination Permit PERMIT NO: COM2004-00032 ISSUED: 01109/2004 APPLIED: 01109/2004 EXPIRES: 07/09/2004 VALUE: Springfield TYPE OF WORK: Electrical Work Only SITE ADDRESS: 1140 KINTZLEY AVE ASSESSOR'S PARCEL NO.: 1802062403501 Residential TYPE OF USE: Repair PROJECT DESCRIPTION: Repair service to garage ~ reconnect only Owner: HARRY ANDERSON Address: 1140 KINTZLEY AVE SPRINGFIELD OR 97477 Phone Number: 541-736-1564 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Gronp: Secondary Occupancy Group: Primary Constrnction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I CONTRACTOR INFORMATION I License Expiration Date Phone BUILDING INFORMATION I # of Stories: Lot Size: U-I Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: VN Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: N01\CE: Impervi~ps.Surf~~6^~a: "\".' I:vDIQI" r It1t: , DEVELOPMENT INFORMA<fiU~'IlN~ER 1H\S PERMI1 \~ '''u I f\U "'V' ",--' OR IS ABAND~~D PARKING COMMENCED Overlay Dist: 180 DA'{ PE.RIOD, Total: # Street Trees R~dl'{ Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: I PUBLI~.lMrJU)~ laW reqUires ~~~i~i~y, ro ,- ~ th Orello follow rules adopte y ~bq~'g'\I\<EJ~Dt:lor . enter Those rl .~..nn 'lotificatlon e '1 Q thro\J!llWiW'Pli'u\'srl1rlUns: I OAR 952-9,91.-90, in' copies of the rules I ::l090, YoU; may obta ote: the telephO~e calling the center. (~n Utility NotificatIOn n..mbertor the Ore~__ nnn"~44', u'",' ..,,1" I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Valne Date Calculated Description Type of Construction Total Value of Project Paeelof2 . . CITY OF SPlUl"l\.J't<lJ'..LD Building/Combination Permit PERMIT NO: COM2004-00032 ISSUED: 01/09/2004 APPLIED: 01/09/2004 EXPIRES: 07/0912004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fp.p.~ P,..id J Fee Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.00 $3,50 $50,00 ' 1/9/04 1/9/04 1/9/04 1200400000000000035 1200400000000000035 1200400000000000035 Total Amount Paid $58,50 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 requesled after 7:00 a.m. will be made the following work day. I Rp.oIlirp.rl' ,.nertinn. . I"~ 1 Electric Service: Approval required prior to utility company energizing service, By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 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 Page 2 of2 I), , , .... / ", .,' " .,' , ' ~ Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.eeb.state.or.us Permit #: COM 20. - (;) 00'5 Z Address: / I'f 0 }:::i" ".J2:/ t:y ~,G Issued by: Date: /- '7 -Ul( 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 befiled with the permit. Fill in the app.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B: --err I. --m- 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 ~ 38. I will be my own general contractor. 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 the above information is correct and thaI I have read and do understand the Information Noti1lye to;,; roperty ~2 ab?ut Construction Responsibilities on the reverse side of this form. i ),) ~ 1/9/rJ~ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner, doc 03/11/03 -.', . Acting as Yout: Own General Contractor? INFORMATION NOTICE TO PROPERTY OWr-!ERS 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, Employer Responsibilities 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 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 a State Business ill number, call \he Business Information C~nter at 503-986-2200, Unemployment Insurauce 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, ' . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. .Ifyou fail to obtain workers' cv,ul'~usation insurance, you could be subject to penalties and be liable for all claim costs ifone of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U,S. Internal Revenue Service: As an employer, you must withh~ld federal income tax from ~mployees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-71 15, Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this '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 general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can penorm the required inspections, If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 03/11/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2004-00032 COM2004-00032 C0M2004-00032 Payments: Type of Payment Check .' ~-,'~~.""",'''''~,~,-','"''',''",,'''''''.,i,., ':" 'I , , , , ';".' >! ",!"' T.. ,) *H~/" ''',; ;.' Receipt #: 1200400000000000035 Description + 7% State Surcharge + 10% Administrative Fee Service Reconnect Paid By HARRY ANDERSON Received By djb l.:beck Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department Public Works Department Date: 01/09/2004 lO:18:32AM Amount Paid Item Total: 3,50 5.00 50.00 $511.5U How Received In Person Payment Total: Amount Paid $58.50 $511,5U . .