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Home My WebLink AboutPermit Electrical 2008-4-16 . ZON ~ INITIALS 1 A-\ DATE ~-. \ -"\. 09IJ SOURCE _ M. ~n- Date 4// ~/ rx I COMPLETE FEE SCHEDULE BELOW (, 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty lob Number COt'VlZOO<l... 0053\ 1. LOCATION OF INSTALIATION: ~~2. CV1e.,.yOK-e.G l?Jy. LEGAL DESCRIPTION: \f?b2rx 0 V2.. () \n::t::) lOB DESCRIPTION _r.e~lt\.U.., ~ ~Sc 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. CONTRACTOR INSTALLATION ONLY Electrical Contractor '" / / Address / Phone / // SupervIsor LIcense Number // // ExpiratIon Date /' Constr. Contr. N4er ExprratlOn L CIty , Owners Name Mi& .S~ Address .~&'2- GI1e.r~.,._ Lar. CIty ~;~fid.tJ Phone q'6~-5763 OWNER INST ALLA nON ~.m!AAllatJon is being made on property I own which [~!nlcJt~~tl;r;ded for sale, lease or reQ1, THE WORK THIS PERMIT SHALL EXPIRE n.. OO!:[€l~",NDER )-IIS PERMIT IS NOT Q~_Jl ANY 180 DAY PERIOD. Inspection Request: 726-3769 3. A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq ft or less Each addItIOnal 500 sq. ft or portion thereof Each Manufact'd Home or Modular Dwellmg Service or Feeder $117.00 $ 21.00 $55.00 B. Services or Feeders - Installation, Alterations or Relocation: 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 C. Temporary Services ~r Feeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each AddItIOnal Circuit or WIth ServIce or Feeder Permit I $ 70.00 $ 83.00 $13800 $180.00 $413.00 $ 55.00 70.0U $ 55.00 $ 76 00 $110.00 $ 48.00 $ 4.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrIgatIon $ 55 00 Sign/Outline Lightmg $ 55.00 Lumted Ener~iMt:tim4b~l Oregon law reqt$ir.lftOjbu to Limited Ene~~rliHlMi9poPted by the O~Utillty Minimum Electr~~w1~i~~t~~~~~1~1~~6~~s 4. SUBTOT.4n9l)FYllBmqEobtain copies ofthe rulesteJ. 00 12% State S ~IlJ~~ the center. (Note' the t~l~fJilOne~ .'/'0 1 0% Admin~~tlor the, Oregon Utility Notifteatte~. 00 50/ T hn I F 'eenter IS 1-800-332-2344). ~ /0 ec 0 ogy ee -=> _ .:::. c...J TOTAL q,g .cto Shared Dnve(T )/BUlldmg Forms/Electncal Permit ApplicatIOn 1-08 doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00531 ISSUED: 04/16/2008 APPLIED: 04/16/2008 EXPIRES: 10/16/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3662 CHEROKEE DR ASSESSOR'S PARCEL NO.: 1802061201000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Replace meter base. Owner: Address: SUMMERS MICHAEL A & CARLA J 3662 CHEROKEE DR SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION 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 Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I Front yard 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' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00531 ISSUED: 04/16/2008 APPLIED: 04/16/2008 EXPIRES: 10/16/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 $8.40 $3.50 $70.00 4/16/08 4/16/08 4/16/08 4/16/08 2200800000000000469 2200800000000000469 2200800000000000469 2200800000000000469 Total Amount Paid $88.90 I Plan Reviews, 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. I Reouired Insoections I 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 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 Pa2e 2 of2 : 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. Perrmt #. COM ~... 0C63 l Address: 3Io(L;?- Gltn:..rok.:e-e.... 1?sv. Issued by' ~ Date 4~ rJ?: Statement: Information Notice to ,Property Owners About Construction Responsibilities r Note: Oregon Law, ORS 701.055(4) requzres resident1al constructzon permit applzcants who are not licensed with the Construction Contractors Board to sign the followzng statement before a buildzng perm1t can be issued. This statement 1S required for residential budding, electrzcal, mechanical and plumbing permits. Licensed arch1tect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit th1S statement. This statement will befiled with the perm1t. I FIll in the appropriate blanks and initial boxes 1 and 2, and either bo~ 3A or 3B: : 1%L 1. ~ 12( 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. : 0 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 W' 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, 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 for~. ~/d~ tf-/J-6 r , ~ - (Signature of permit applicant) (Date) (White copy to Issuing agency perm1t file, pznk copy to applzcant) \. Property_owner doc 06-01-04 Acting as Your- Contractor? 'INFORMATION TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE This InformatIon Notice to Properly 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 as your own contractor to construct a new you can many problems by being aware or make a substanttallmprovement to an eXIsting followmg responsibilitles and concerns. You W1U, m most mstanccs, ruled to be an "employer" contractors you contract w1l1 be "employees" If you use contractors not hcensed WIth the COn$tructlOn Contractors to do labor m constructmg or to assu;t m the constructlOn or of a reSIdential structure. you must comply tbe following: Tax l,aw: As an you must are You WIn be liable for the tax For more mfonna.tlOn, call the mcome taxes from employee wages at the tIme even you don't Withhold the tax from your at 503-378-4988. As an you are For more mformatlOn, call a tax for unemployment msurance purposes' Employment Department at 503-947-1488 ' on IdentlficatlOn Number Unemployment Insurance Tax. To file for a appropnate forms. number for both Oregon WIthholdmg and or \vw\v.dor.state.or usliornlSoav.htmll for the Wm.'.kers' Insurance: As an you are to the Oregon Workers' CompensatlOn Law, and must obtain compensatIon msurance for your employ.ees. you fail to obtam workers' compensatlon msurance, you could be subJect'to penalties and be lIable co~ts If one of your employees IS mJured on the Job. For more caU the Workers' . at the Department of Busmess ServIces at 503-947-7815. U.S. Internal As an employer, you must You W1lJ be hable for the tax payment even If you actually IRS at 1-800-829-4933 or web SIte at \'Il\v'\V m;,gQY. employees' wages~.' , a number, caU the As permIt holder for thIS proJect, you are responsible may be brought to your attentlon any to meet code Insurance: omissions such as to see If you have adequate msurance water damage pIpe punctures, fire or ..;-- suffiCIent tIme to supervIse . the slaJls to act as your own buIlding officlals as contractor, to coordmaie the work rough~m so can perform the or \VfIte the agency at doc 06-01-04 225 Fi(th Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00531 COM2008-00531 COM2008-00531 COM2008-00531 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 2200800000000000469 Date: 04/16/2008 DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdminIstrative Fee Paid By MICHAEL SUMMERS Item Total: Check Number AuthorizatIOn ReceIVed By Batch Number Number How Received ddk 01828Z In Person Payment Total: Page 1 of 1 2:38:03PM Amount Due 7000 350 840 7.00 $88.90 Amount Paid $88 90 $88.90 4/16/2008