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Home My WebLink AboutPermit Electrical 2008-4-30 ZON l \Jt INITIAL~ DATE ~~ SOURCE ~ ~~-::: 41 /} )/ ()~ , , I 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number (() lY7 (J-{)O Z - tXJro 00 Date 1. LOCATION OF INSTALLATION: JDfiS r:.~L#.aiL 13~, LEGAL DESCRIPTION. , 'H , 3. COMPLETE FEE SCHEDuLE BEWW A. New Residential- Single or Multi-Family per dwelling unit. 'q JOB DESCRIPTION R~ Service Included 1000 sq. ft. orless Each addItional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $117 00 $ 21.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $55 00 2. CONTRACTOR INSTALLATION ONLY ! / B. Services or Feeders - Installation, Alterations or Relocation: Electncal Contractor .' / 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 $ 70.00 $ 83 00 $138.00 $180.00 $413 00 $ 55.00 Address City Phone / / / Supervisor LIcense Number C. Temporary Services or Feeders , / Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps y- $ 55 00 $ 76.00 $110.00 v- Expiration Date Constr. Contr. Nl)ffiber Expiration Qate / SIgnaturlof SupervIsmg ElectricIan f / / Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One CIrcUlt Each AddItIonal Circuit or WIth Owners Name _ if~A' 4 .6 dP ServIce or Feeder Permit $ 4.00 Adm." 86"/ 2 >? ~ f)J~~AI ~~ ~ E. M"....lIaneou. (Servi.elfeed.~ ooUDeluded}-Each Ioslal"'tioo City Phone -.:u,;;:- .799~) Pump or lITigation $ 55.00 SIgn/OutlIne Lightmg $ 55 00 OWNER 0 o~i'!l~tJRegon law req'Jlres ynu to Lunited EnergylResidential $ 28 00 . .. rU.es ad~~ted ~t~ {'IIEn"ll '. L' d / The mstal~~~!tma f.n..Dr e r-own\wnle~ 1,/ unIte Energy CommercIal $ 50.00 . . 1-l.s1llJlf'nr ]",..1 [J . Iilp e r les ;'fO 'ut, -, 1'1 IS not mteO'l''l:W'tf'\' ~~"lJe~!!.l()B~ ffffi rough c;.~ ;' ,;~\ c~~ j' Minimum Ele~1i'f<<a5!t Inspection Fee is $50.00 + Surcharges Own.", s,.~,,;;'~ obtain copies c: :"" , 'J! 4. SUB~ llii8U/l)S'ltAll EXPIRE IF THE ~ l'l: ~!~een~;~~~~~: ,t," ; ~~ (", 12% StatAYJJ2{JfJ~ED UNDER THIS PERMIT IS NQi ~, 0 - Ce~ is lk~:;0~':') ,,' 10%A~lrlls1Mtiv~(ft~ OR IS ABANDONED FOR \.5.~u 5% Techf1bi~gf~eDAY PERIOD. ?,7~C;:- . CJ <:7 /' TOTAL (I} 1 ~ ~ Shared Dnve(T )/BUlldmg FonnslElectrlcal Pennlt ApphcatlOn 1-08 doc $ 48.00 Inspection Request: 726-3769 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2008-00606 ISSUED: 04/30/2008 APPLIED: 04/30/2008 EXPIRES: 10/30/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1083 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264412600 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Temp electric for remodel. Owner: SHIRLEY BELL Address: 80428 DELIGHT VALLEY SCHOOL RD COTTAGE GROVE OR 97424 Phone Number: 541-942-7990 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 Frontyard 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 Impro,,~ent~ Sidewalk Type: F\ I II:N liON: Oregon law requires you to Storm Sewelmlc:<<llltJles adopted by the Oregon Utility Downspouts/Drains: Special Ins~~ion Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001- Notes: 0090, You may obtain caples of the rules by NOTICE: calling the center. (Note' the telephone THIS PERMIT SHALL EXPIRE IF THE WORK IlUIIIUI1I IUI [111;'. UIt::JYUII UlllI~Y J"mm,:,?,:',:,~ J~UTHORIZED UNDER -THIS PERMIT IS NOT Center IS 1-800-332-23~r4V-aluation Description ~OMMENCED OR IS ABANDONED FOR $ Per Sq Ft Square ~f}bXa1~O DAY PERIOD. Description Type of Construction . Value Date Calculated or multiplier or Bid Amount Pae:e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00606 ISSUED: 04/30/2008 APPLIED: 04/30/2008 EXPIRES: 10/30/2008 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 Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $5.50 $6.60 $2.75 $55.00 4/30/08 4/30/08 4/30/08 4/30/08 2200800000000000552 2200800000000000552 2200800000000000552 2200800000000000552 Total Amount Paid $69.85 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, I Reauired Insnections , Temporary Electric: Approval required prior to Utility Company energizing pole. 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 Pal!:e 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 Pernut #: Com CXJO~ -006 00 /()83 C8r]~ 7>r-' ~OtJ1J Date 4/3J loR ''-'~V I ( Address: Issued by' 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 followmg statement before a building permit can be Issued. This statement IS required for residential buddmg, electrzcal, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensmg under ORS 701.010(7), need not submit this statement. This statement will be filed with the permIt. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: if 1. I own, reside in, or will reside in the completed structure. o 2. 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 [E(' 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed wIth.the Construction Contractors Board. If I change my mmd and hire a general contractor, I will contract WIth a contractor who IS licensed with the CCB and willllnmediately notify the office issuing thIS building permit ofthe name ofthe 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. cJJaPh1 .l5JdP (Sign@Ure of permit applicant) ;f-~!J-{)g (Date) (WhIte copy to Issuing agency permIt file, pmk coPY to applzcant.) Property_owner doc 06-01-04 f Actin~'a~ Yo~r General Contractor? INFORMATION PROPERTY OWNERS AB'OUT CO~STRUCTION 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 actmg as your own contractor to construct a new home or make a substantial Improvement to an eXIstmg structure, you can prevent many problems by being aware of the followmg responSIbilitIes and concerns. Employer You WIll, m most mstances, be TIlled to be an the contractors you contract WIth wIll be "employees" if you use contractors not hcensed with the ConstructIOn Contractors to do labor m constructing'or to aSSIst m the constructIOn or of a residentIal structurs:. As employer, you ~ust comply with the following: Oregon's Law: As an employer, you must WIthhold mcome taxes employee wages at the tlme employees are pald. You W111 be hable for tax payments even If you don't actually withhold the tax from your employees. more mformation, call the Department of ' at 503~378-4988. on As an employer, you are wages of all employees. more mformation, caB to pay a tax for unemployment msurance purposes! Employment Department at 503-947-1488, '. The Oregon Busmess Identification Number (BIN) IS a number for both OregQn WIthholdmg and Unemployment Tax. To file for a 503-945-8091 or \n\'w,dor.state,or usiformsoav.htmll for the appropnate Workers' Insurance: As an employer, you are subject to the Oregon Workers' CompensatIon Law, and must compensatIOn msurance for your If you fail to obtain compensatIon msurance, you could be subject to penalt1es and be liable for costs If one of your employees 1S injured on the Job, For more mformation, call the Workers' DIViSIOn at the Department of'Consumer and Busmess SerVIces at 503-947-7815 U.S. Service: As an employer, you must You WIll be the tax payment even If you IRS at 1-800-8294933 or ViSIt theIr web Site at \,\"v;''W.U1,..gPX. federal mcome tax from employees' wages WIthhold the tax. For a Federal EIN number, can the Code reqmrements that As the permit holder for thiS you are responsible for resolvmg any failure to meet code be to your attentIOn through coverage for aCCIdents work that must be lnsunmce: Contact insurance agent to see If you 'have omISSions such as fallmg tools, pamt over spray, water damage pIpe msurance fire or , ~ ~ 0 ~\ I ,,\ <;:'~ Make sure you have suffiCIent tIme to supervIse your employees. Make sure you have the sk1l1s to act as your O\\TI to notify buIlding officials as contractor, to work of rough-Ill tImes so they can perform the reqUired m'3pectIons questions call the ConstructIOn 97309-5052. (503-3784621) or vvrite the agency at PO doc 06-01-04 225 Eifth Street Springfield, Oregon 97477 5'41-726-3759 Phone Job/Journal Number COM2008-00606 COM2008-00606 COM2008-00606 COM2008-00606 Payments: Type of Payment Check cRecemtl RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department 2200800000000000552 Date: 04/30/2008 DescriptIOn Temp Power 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdmInistrative Fee Paid By SHIRLEY BELL Item Total: Check Number AuthorizatIOn ReceIVed By Batch Number Number How Received ddk 1196 In Person Payment Total: Page 1 of 1 lO:23:38AM Amount Due 5500 275 660 550 $69.85 Amount Paid $69 85 $69.85 4/30/2008