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Home My WebLink AboutPermit Electrical 2008-4-10 Date ZON \1)(L INITIALS, ~ DATE a. \P\..OS SOURCE ~ Lf~IO/()6 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number COIM..ZOO(j- DOL( '7 1-( 1. LOCATION OF INSTALLATION: st DS-60~ cs-bg>f b LEGAL DESCRIPTION /7D2. 33fL( JOB DESCRIPTION' r2 8> /Jd.d-- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. CONTRACTORINSTALLATI070 Y 2. ~ectncal Contractor ", / Addr~~ / ~ / CIty ""- /hone ~I Sup"fYisqtU;:\Cl>nSe A "; :,., ~ ';;~:wm- SHALL ~!RE IF THE WORK Exp1]~~\Qqllj~;~~o l1#8-ER Tr;!~~RMIT IS NGl- ~~~tli7i:~~ED OR IS ABANDO D FOR ConsAJ~rf~u~915[nIOD. Expiration Date / ,--/~" Signature of Supervisrng Electncian Owners Name l...eS<;J-€'."'- Address 6"f:, 6K'" n Ill, Kc) 11 57 r'.e e<J- City 51? (', 'rJq R'e Icf Phone 76Z b - / f cf- 50' " , OWNER INSTALLA nON The rnstallatlOn is being made on property I own which IS not rntended for sale, lease or rent. Owners Signature _~'l-->~ , .~~ /' Inspection Request: 726-3769 3. COMPLETE FEE SCHEDULE BELOW A. New Residential - Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each addltiona1500 sq. ft. or portIon thereof Each Manufact'd Home or Modular Dwelling ServIce or Feeder $II7.00 $ 21.00 $55 00 I' B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less $ 70.00 201 Amps to 400 Amps $ 83.00 401 Amps to 600 Amps $138.00 601 Amps to 1000 Amps $180.00 Over 1000 AmpsN olts $413 00 Reconnect Only ~TT[NTION' Oreoon l.aw ~~YQ 11;:',;"01 flilt'S adopted b th 0 S yettta , y e reg on UtiJity c. Temporary , . Those rules are SEltforth 0090 y, ~ - 10 through OAR 952-001- . au mat9Qtam cop 1 th Installation, AIt~1J~~ '~~mm1~o(N les 0 e rules by 200 Amps or les9umber for the Or~~lnno~~~II~ ~~~~r:~one 201 Amps to 400 Amps Center is 1-800-332~3~-iP. I.iCilJOtl 401 Amps to 600 Amps $110'00 Over 600 Amps or 1000 Volts see "B" above. D. Brancb Circuits New Alteration or Extension Per Panel One CirCUIt r Each Additional CrrcUlt or WIth ServIce or Feeder PermIt $ 48 00 $ 4.00 l.{B '{ E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrIgatIon $ 55 00 SignJOutlrne LIghting $ 55 00 Limited Energy/ResIdential $ 28 00 Limited Energy/Commercial $ 50 00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges S-2. ~Zl( S%~ Z60 bb 6Lf 4. SUBTOTAL OF ABOVE 12% State Surcharge 10% AdminIstrative Fee 5% Technology Fee TOTAL Shared Dnve(T )/BUlldmg FormslElectncal PermIt ApphcatlOn 1-08 doc CITY OF SPRINGFIELD Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: cOM2008-00494 ISSUED: APPLIED: EXPIRES: VALUE: 04/09/2008 10/1012008 $ 31,500.00 SITE ADDRESS: 5688 D ST ASSESSOR'S PARCEL NO,: 1702331405606 Springfield TYPE OF WORK: Family Room TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Addition Owner: NIXON LESTER M & CONNIE L Address: 5688 D ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION' Contractor Type General Electrical Contractor GORDON BRET EVANS OWNER License 102721 Expiration Date 1012012008 Phone 541- 7 46-4803 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # 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 Garage/Carport Sq Ft Other: Occupant Load: R-3 n/a REQUIRED PARKING Frontyard Setback: Overlay Dist: Total: Side 1 Setback: # Street Trees Rqd: Handicapped: Side 2 Setback: Paved Drive Rqd: Compact: Rearyard Setback: % of Lot Coverage: ATTENTION' Oregon law requires you to Solar fWiff~~. ~~~1,~~~~~~~:~7~te~h~~~~~I?:~~.~~:~~~~rt THIS PERMIT SHAL I PUBLIC IMPROVEMENTSIIiR 952-001-0010 through OAR 952-001- AUTH}WI~~ L EXPIRE IF THE W ODe"l, You rpay obtain caples of the rules by Stret,tOmME e WOER THIS PER ORK , calling tfflP~~:r~WOte: the telephone StoIiw~e"8n"X~~i~a"G IS ABANOONEMOIT IS NOT number fWoWGs,QrM.wrlrillY!y Notification Special Insh~aiib\i:PERIOO. FOR Center IS1-800-332-2344). I DEVELOPMENT INFORMATION' Notes: Pae;e 1 of3 CITY OF SPRINGFIELD - Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2008-00494 ISSUED: APPLIED: EXPIRES: VALUE: 04/09/2008 10/1012008 $ 31,500.00 I Valuation Descriotion I Dwelline:s Tvpe of Construction V Wood Frame $ Per Sq Ft or multiplier $105.00 Square Footage or Bid Amount 300,00 Value Date Calculated Description Total Value of Project $31,500.00 $31,500,00 04/0912008 ~ Fee Description Plan Review Residential + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $190,07 4/9/08 1200800000000000330 $5,20 4/10/08 3200800000000000221 $6,24 4/10/08 3200800000000000221 $2.60 4/10/08 3200800000000000221 $48.00 4/10/08 3200800000000000221 $4.00 4/10/08 3200800000000000221 Total Amount Paid $256.11 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(]lliredJnsoections , Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Pae:e 2 of 3 CITY OF SPRINGFIELD - Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: cOM2008-00494 ISSUED: APPLIED: EXPIRES: VALUE: 04/09/2008 10/10/2008 $ 31,500.00 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, C )..~iV'JJ.J lli0L~ L, - \ 0 ~ () ~ Owner or Contractors Signature Date Pae:e 3 of 3 225 Fifth Street, Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00494 COM2008-00494 COM2008-00494 COM2008-00494 COM2008-00494 Payments: Type of Payment Check cRecemtl RECEIPT #: 3200800000000000221 Date: 04/10/2008 Description Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + 10% AdmInIstratIve Fee Paid By LESTER M NIXON Item Total: Check Number AuthOrizatIOn Received By Batch Number Number How ReceIved nJm 1013 In Person Payment Total: Page 1 of 1 1l:01:55AM Amount Due 4800 400 260 6.24 520 $66.04 Amount PaId $66.04 $66,04 4/1 0/2008 '0. . 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.u~ Penmt #: CO ~ 2.-0 of - C) 0 4,9 t.f ~b~cf b St- ~~'\ /A-/ Date: -11-/0 r- CJcY Statement: Information Notice 0 operty Owners About Construction Responsibilities Note. Oregon Law, ORS 701.055(4) requires reszdentzal construction permzt applzcants who are not lzcensed with the Constructioll Contractors Board to sign the followmg statement before a buildmg permzt can be issued. This statement is required for residential building, electrzcal, mechanical and 'plumbing permits. Lzcensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submzt this statement. This statement wzll be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and eIther box 3A or 3B: ~. ~. 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, 3A. My general contractor is.~ s\-o<....rA + c.s~,^^- ~\-Y\.E:5 (Name) IOZ7Z \ (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 wiU be my own general contractor. (eL~( Cfi L) 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 that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~ /J1A~~ (Sigtia't~ <;>fpermit applicant) {lor-.., 9 ~ ()r-, ~ ; . - (Date) (White copy to zssuing agency permit fi(e, pmk copy to applzcant.) . I Property _ owner. doc 06-01-04 Acti~g' as'V ?lir INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBIUTIES. , ' ~ \.$', "'J-~ ~...... General Contractor? - , NOTE. This Information Notice to Property Owners about Construction Responsibilitfes was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. > 'I, you are actmg as your own contractor to construct a new home or make a substantIal improvement to an eXIsting structure, you can prevent many problems by bemg aware the'fol1owmg respomablhties and concerns. Employer You wl11"m most be ruled to be an "employer" the contractors,YQ,u coptr~ct with wIl1be "employees" If you use contractors not lIcensed WIth the ConstructIOn Contractors BQurd to 90 labor m constructmg or_ to assist m the constructIOn or of a residential structure. the' you must ,coInPly with the following: , , , As an employer, you must \~Ithhold 'mcome taxes' from employee wages at'the tIme You WIll be hable for the tax payments even If you don't actually wIthhold the tax from your more mformation, call the Department ' at 503-378-4988. " on -...- Tax: As an employer, you are reqUIred to pa,y"a tax for unemployment insurance purposes '-- employees. For more mfonnatIOn, Employment Department at 503-947-1488. -, '- " The Unemployment appropriate fonns. . . \ - ~ - -~~ - ~'- - '" ~\ Identificahon Number (BIN) 18 a combmed. number- for both Oregon WIthholdmg and Tax To file for a BIN, can 1 or \v\vw.dor.state.or us/fonnspav.htmll for the ~ )I ~ ...J / ,.;.. . ~ msurance, you Job. For more at , Workers' Compensation As an employer, you are subject to the Oregon Workers' CompensatIon Law, -compensatIOn msurance for your employees. If you fall to obtam workers' compensatIOn be subject to'penalties and hable'for'rill costs If one of your employees IS 'injured on the call the Workers' CompensatIon at the Department of Consumer and Busmess ~"-. 7815. . -" \ ' '\ Service: As an ~mployet;'Y6u'-mli5t-\V1thhold -federal mcome tax from employees' -wages. ~s tax payment even 1fyou dIdn't actuaHy wIthhold the tax. For a Federal EIN tile IRS 'at 1 ::800::.829-4933 or ViSIt therr web site at vV\yw.1rS..,g9v. . -.,' -of Con~erns holder for thlS proJect, you are responslble for resolvmg any faIlure to meet code to your ~ttentIOn through , , ,). ~ ~' Insurance: C011tllct your Insurance agent to see If you have adequate msurimcc . omISSIOns such as fallmg over spray, '.'vater damage from pipe puncturCb, or \. I : )1.. [~" ... - ~ ;:." .,L Time: sure you have suffiCIent tIme to supervise yoU! , \ '\.. .. sure you' have the slans to act as '. to notlfy bmldmg officials as , own . , contractor: to coordmate the of rough-m times so they can perform the requm:d mspectlOns. questlOns call the ConstructlOn 97309-5052. (503-378-4621) or the agency at "L doc 06-01-04