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Home My WebLink AboutPermit Electrical 2008-5-1 ZON ltJ~ INITIAiSf~ _ DATE '"'<; ~'D~ SOURCE +^ _~~ Date 3~ 1-08 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH (54])726-3753 . FAX (54])726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number C OK1 LO 0 8' - (:) 0 ~ ( ( 1 LOCATION OF INSTALLATION: /0 TO Ic.-." C::(~ A V , 3. COMPLETE FEE SCHEDULE BEWW LEGAL DESCRIPTION /SOZ.ObZL( JOB DESCRIPTION 01700 A New Residentml- Single or Multi-Family per dwelling unit. ! 1i ~i Service Included , t'-l-EtA} U. ~\ T ~eL '200 A::1Y1t> Permits are non-transferable and expire If work IS not started wIthm 180 days of Issuance or If work IS Suspended for 180 days. 1000 sq ft orless Each addItIOnal 500 sq ft or portIon thereof Each Manufact'd Home or Modular Dwellmg ServIce or Feeder $11 7 00 $ 21 00 $55 00 2 CONTRACTOR INSTALLATION ONLY B ,~ervlces or Feeders - Installation, Alterations or RelocatIOn: CIty Phone 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 I $ 70 00 $ 83 00 $13800 $18000 $413 00 $ 55 00 70 ElectrIcal Contractor Address ,..~ SupervIsor LIcense Number ~ C vi. ExpIratIon Date 0 .., I "J..., ~ ~~ ~) c. ", 1"eQJnpnt~ervices or Feeders II) I ;Ir~-.'t 4~ '\ '$(-.., " ( ,"tfr) ')'7/ 00 "A,',f\ ~o/: q 90 1~8JbV:tf,1iV~lifl''8fjJI}ttf~()CatlOn Cq//I 0(.; il;M.,}:,Qq, 11)0 r,e 0 '//'es I}VI}-;I; 1fGOfJ;;;~0'lJt. f'gtf;t:,e tllle 'tego YotJ I. ~~dm'll1lo 4t)~ ~P!)I} ~ flte 'I1l/ht.. 0 0...-; -l~el; c.1'm~PJJi. 0-1"y Set ,'jy -w.'f}18/;~}3gV;;V(jftt~ Of 111 9$<_ fo~} Over 6~~l#kj)~~&.t~ff1.tbove D Branch CI;C1lie~ IJOI//i,..~/?"- Oy -""'I'll .'''''110, '''' '7. OIL New Alteration or ExtenSion Per..-anel $ 55 00 $ 76 00 $11 0 00 Constr Contr Number ExpIratIon Date SIgnature of SupervIsmg ElectrICIan Owners Name SieVE... ~OL.-L..I) Address 1050 l~",- '1T~y !ftj.~t . E Miscellaneous (Service/feeder not included) -Each InstallatIOn CIty~ ~<1 flelcl.. Phone Cf 5tt ~I/:.... Pump or IrngatIon $ 55 00 AUrHO t?/l,flr S SIgn/Outlme LIghtmg $ 55 00 OWNER INSTALLATION COIl1It1. 'RllfD lJ. ~4btr~EnergY/ReSIdentIal $ 28 00 The mstallcftIOn IS bemg m e on property~!J/~&'tCflJ o%D~lr/j;lfll'f1ercIal $ 50 00 IS not mterlded for sale, Ie e or rent lJ,4"y~a lr~tnttiFi~tIOn ,Fee IS $50.00 + Surcharges 4 ~UBl1 ~ ' '7D 12% State Surcharge at" v 10% AdmrmstratIve Fee 7 5% Technology Fee ;r'o One CIrCUIt Each AddItIonal CIrCUIt or WIth ServIce or Feeder PermIt $ 48 00 $ 400 InspectIOn Request. 726-3769 TOTAL R~!O Shared Dnve(T )/BUlldmg FormslElectncaI PermIt Appltcatlon 1-08 doc CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00611 ISSUED: 05/01/2008 APPLIED: 05/01/2008 EXPIRES: 11/01/2008 VALUE: Status Issued 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Lme SITE ADDRESS 1050 KINTZLEY AVE ASSESSOR'S PARCEL NO 1802062403700 Sprmgfield TYPE OF WORK Electncal Work Only PROJECT DESCRIPTION 200amp panel change out TYPE OF USE Repair Residential Owner HOLLIS STEVEN LEROY Address 1050 KINTZLEY AVE SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION' Contractor Type Electncal Contractor OWNER License BUILDING INFORMATION I # ofUmts. Pnmary Occupancy Group' Secondary Occupancy Group Pnmary ConstructIOn Type Secondary Construction Type' # of Bedrooms # of Stones R-3 Height of Structure ! T~"\J""" C , ,- I I, ; \J 'I:..);fAl~ Ht\w reqUIres you to VB \/ \ L..[,s aW-alerdf/vptfue Oregon Utlllt (hO'ilAtl', :::t1on CeR~ngJ1D'Yjle rules are set for~ In r1 902-001...nn1.Q.th h 0 0090 ~ Ene1'b1Ll1li(f)lIl~ AR 952-001- au maYsp.~iilll~mllfghe rules bf/a cal"n~ the ~_enter 1t\ln~t) tho +,. J~ f ":8:;: numb~VEVl'EOPI\imN'MNOOlQtltm~ , i 111 ,_ J DJ(, VV"-"'>oJ"t"t). Frontyard Setback Side 1 Setback Side 2 Setback. Rearyard Setback. Solar Setbacks Overlay Dlst # Street Trees Rqd' Paved Dnve Rqd % of Lot Coverage Phone Number 541-954-6542 Expiration Date Phone Lot Size Sq Ft 1st Floor' Sq Ft 2nd Floor' Sq Ft Basement Sq Ft Garage/Carport Sq Ft Other' Occupant Load REQUIRED PARKING Total Handicapped Compact I PUBLIC IMPROVEMENTS. Sidewalk Type' NOTICE: THIS PERMIT SHALL EXP~'t1lt!SWOR~ AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR At\IY 1 Rn nAY PERIOD. I Valuation Description I Street Improvements Storm Sewer A vadable Special Instruction. Notes DescnptIon $ Per Sq Ft or multlpher Square Footage or Bid Amount Type of Construction Page 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00611 ISSUED: 05/01/2008 APPLIED: 05/01/2008 EXPIRES: 11/01/2008 VALUE: 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Lme Total Value of Project Fees Paid I Fee DescnptlOn + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $700 $840 $350 $70 00 5/1/08 5/1/08 5/1/08 5/1/08 Receipt Number 2200800000000000564 2200800000000000564 2200800000000000564 2200800000000000564 Total Amount Paid $88 90 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 followmg work day. I Reouired Insoections I Electnc Service Approval reqUired pnor to utility company energlzmg service By signature, I state and agree, that I have carefully exammed the completed application and do hereby certify that all mformatIon hereon IS true and correct, and I further certIfy that any and all work performed shall be done m accordance WIth the Ordmances of the CIty 0 prmgfield and the Laws of the State of Oregon pertammg to the work descnbed herem, and that NO OCCUPANCY wII e made of any structure WIthout permiSSIon of the CommuDlty Services DIVISIOn, BUlldmg Safety I further certify that only c ntractors and employees who are m compliance wIth ORS 701 005 wIll be used on thiS project I further agrke to ensure t at all reqUired mspectlOns are requested at the proper time, that each address IS readable from the stre that t~e permIt car IS located at the front of the property, and the approved set of plans wIll remam on the site at all tI es nn construct n '\/ fW6 (ow~r orkontracto~s S nature 5./.0e; Date Pace 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 Penmt # COM z..crC ,f -- C> C b ( / ;0') 0 \c l~ \C-/f:-L/ ~ r( Date! -s: j, /6 K / / Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requlres resldentzal constructwn permlt applzcants who are not lzcensed wlth the Constructwn Contractors Board to slgn the followmg statement before a buzldmg permlt can be lssued ThlS statement lS requlred for resldentzal buzldmg, electncal, mechamcal and plumbmg permlts Llcensed archltect and engmeer applzcants, exempt from lzcensmg under ORS 701 010(7), need not submlt thls statement ThlS statement wlll be filed wlth the permlt FIll m the appropnate blanks and ImtIal boxes I and 2, and either box 3A or 3B ~ ~ I own, reside m, or wIll reside m 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 cumpletIOn o 3A My general contractor IS (Name) (CCB #) I wIll mstruct my general contractor that all subcontractors who work on the structure must be lIcensed With the ConstructIOn Contractors Board. / OR )21' 3B I will be my own general contractor If I hire subcontractors, I wIlllnre only subcontractors lIcensed With the ConstructIon Contractors Board IfI change my mmd and hire a general contractor, I will contract With a contractor who IS lIcensed With the CCB and wIllnnmedlately notIfy the office Issumg thiS bUIldmg permit of the name of the contr ctor I hereby ce fy that the ove informatIon is correct and that I have read and do understand the Information N. 0 Pr perty Owne s about Construction ResponsibIlities on the reverse side of this form. I u I, 1SIgdt X 51,OS - -.--- e of permIt applIcant) (Date) lte copy to lssumg agency permlt file, pmk copy to applzcant) Property_owner doc 06-01-04 \ , 'as Contractor? ) I'NFORMATION TO PROPERTY ABOUT CONSTRUCTION RESPONSIBILITIES \ . \ > \ , . ." ~._....~.".".w._.m_'."M...______.__~.:'_':_fJlll!l1".._. ..". o ~~:'~roct~nl~~~~!~~~~~~::~;nce wdh ~~;~~~7;~~~;a::~o;:~~d~~~~~r::/~:~/~:,:j If you are as your 0'NIl contractor to construct a new home or a substantmllmprovement to an eXIstmg structure, you can prevent many problems by bemg aware the fol1owmg responslbIhhes and concerns Employer You '1.111, m most mstances, be ruled to be an you use contractors not with the ConstructIOn constructIOn or of a resIdentIal structur~ As , the contractors you contract Board to labor m you mu~t WIll be "employees" If or to assIst m the following: Tax Law: As an employer, you must You wIll be habie for tax more caB mcome taxes from employee wages at the tIme even you don't actually WIthhold the tax from your at 503-378-4988 . on an employer, you are For more mformat1On, , a tax for unemployment msurance purposes' Employment Department at 503-947-148Ji ------.....'" ,number for botj;1 Wlth!Ioldmg and - or \\ \v'\v dOl state 01 us/fonnspav html1 for the Identlficat10n Number Insurance Tax To file for a to the Workers' CompensatIon Law, you [flll to workers' compensatIOn costs l(one your ' 13 1l1Jured on the at Department of Consumer Busmess As an you are q' compensatIOn 1l1surance for , to penalues and call Workers' wag~ EIN number, call the Service: As an employer, you must federal mcome tax You tax payment even ly WIthhold the tax For a IRS at 1-800-829-4933 or VI3It theIr web Site at W.\~.l\~_J.1 s"goy ;0- Code As the pennIt holder may brought t<? your attentIOn , . you ale for any h.ulure to meet code " \ msurance agent to see If over spray water damage msurance pum..tures, fire or t - and on11381Ons such as . , , . 1~ to., ... ( ...."\ ... , ~ \,' 1 '" ' ......., "-.. -----' ... ~ tIme to your . - ,>- " .....! "'(11'- I ,P \It\l.- ""'"..... ..--' sure ) ou have the sk111s to act as your 0\Vl1 to bmldmg offiCIals as \, contractor, to coordmate the of rough-m tImes so can reqUIred mspectIODs (503-378-4621) or wnte the agency at doc 06-01-04 225 Fifth Street Sprmgfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00611 COM2008-00611 COM2008-00611 COM2008-00611 Payments Type of Payment Check cRecemtl CIty of Sprmgfield Official Receipt Development Services Department PublIc Works Department RECEIPT #: 2200800000000000564 Date: 05/0112008 DescriptIon Perm ServIFdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdminIstrative Fee Paid By STEVEN HOLLIS Item Total Check Number AuthorizatIOn ReceIved By Batch Number Number How ReceIved dJb 1464 In Person Payment Total Page 1 of 1 2 53 30PM Amount Due 7000 350 840 700 $88 90 Amount Paid $88 90 $88 90 5/1/2008