HomeMy WebLinkAboutPermit Electrical 2003-9-19
'.
.~ CITY OF SPRI1~ut<lJ',LJJ
Building/Combination Permit
PERMIT NO: COM2003-00937
ISSUED: 09/19/2003
APPLIED: 09/19/2003
EXPIRES: 03/19/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 6985 GLACIER DR
ASSESSOR'S PARCEL NO,: 1802022304500
Springfield TYPE OF WORK:
TYPE OF USE:
PROJECT DESCRIPTION: Change Circuit Box0U W
-, \a\\' reqUire::, y "
__...I'Tlf \I,,'()reQOt .-. _ _........, Itlhtv
1"\1'''-'' .-4 ntedO\llIIC-.-.... -'
Owner: I \\lBElJiJ'DoNAim A &:DA~ITAfK set lo~
Address: 0\6985 GbACIER;DR' I'SPRINGFIECDj(ORC97478
NO 1I1....~~:;.... /"In1-0Qi 0 tnrou~I' v; ::_'_ ... .Ioc:;'
In V". . - - obtain CO}JltJ.;:J ..... ",' _'-....."0
0090, You ~a~en\er, (Note: the'l'CONTRACTOR INFORMATION I
calling \ e <> Oregon Utility n~., .
Contractor.l'Fype lor t'Cimtractorj32-2344). License Expiration Date Phone
Electrical 'cenlE'OWNEii-
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
BUILDING INFORMATION I , ,
'OO\\:l3d J<'<JO GlH ANI)
# of Stories: o'LotjSize:I08
Height of~rr9C:lWieOONV\3'<J 51 tlO ~~i,'r1l!i"<<tor:
Type rf)~e~I:1\V'I\:l3d 51\11 \:l30Nn ~~'~~;nglf1Ifor:
Wate~lrp-e\: 3\11 :II 3\:lldX3 11'v\1S lSIi'pt>>r~'i'I'.snt:
Range Tytf;: Sq Rl (1;ldollk\l'fCarport
Energy Path: Sq Ft Other:
Impervious Surface Area:
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descriotion ,
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee 1 of2
.
. CITY VI' ~nuNGFIELD '
Building/Combination Permit
PERMIT NO: COM2003-00937
ISSUED: 09/19/2003
APPLIED: 09/19/2003
EXPIRES: 03/19/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Ff'f'r. Paid'
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6,30
$4,41
$63,00
9/19/03
9/19/03
9/19/03
2200200000000001556
2200200000000001556
2200200000000001556
Total Amount Paid
$73.71
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 requested after 7:00 a.m. will be made the following work
day.
I Rf'OIJirf'dlnr.nf'dionr.,
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon Is trne 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:L\ ~,O Q~
ow:eM~ontractors Signature
'9 /;e, (0),
I
Date
Paee 2 of2
'.;;' "'.s ,: ,,' . " 'e~'()E-S' dNGFfEErr'0RE6<DN''r:';, " " '.,'
~~.~f:::f:':1~' ,~~ :'.~~,,~t'"::r~,~ -';r':~;6~~.\"'~-1: '. '''''~'4~~ }~.:" _ .'::" <":'tp~.~:;-4:~~'''.;;:~::i'~~\.~. ~:a-].
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRlC~'ERMIT APPLIC~lTIDN T~,C following project as submitted has the tollowing ,
, ()() 'S'/_ :r / <7/ ",,,ng, and does nof require specitic land use
City Job Number ~fT1i3 - Date ~ I; :dcfp)~ llil-
1. t~lf~~r~~~75:J~~i 3. [9Q~W~~:::~BElQW~5~b~lWj
L~';tf:~(~ON I3reCt Irel 60K ;A)5~ 1~,s~~~~~!~~l~~!l];~l~r:if#f"~~m~~~~i~~~
JOB DESCRIPTION 1000 sq, ft, or less $ 106,00
('_hcw~ Pu C; e. 6 0'1-... :~~~o:d;:~:~ 500 sq, ft,or $ 19,00
, {
Permits are non-transferable and expire if work is
not~!ar!!~. ,:"it!JiQ: !.81l.:.iay~. of, issua,!ceiord~work, is
Suspended foro1801day.s'd by the Oregon Utility
IGIIUVV I Ule.... a\Jv!-, t....
Nof1coSTAA(;;;vl<'hvSTA1l'fm~~ONHPj
2, "'-"''''''''''",''''''''''"llli.''''''''' i.t"""'H"n:t!If-1<Z;<"~",,",,"." ,
In \.71'\rt~ :1':/'......_. .------.,5
E-I""" 'I'''''' ..""" obtain copies ofthe rules
ectnca ~ontractor _ , ,. t
calling the centt:::l. \1'4ULt:, U It; l'C"I'WtJlI' . I~
Add"mber for the Oregon Utility Not;~,cation
ress _ .' ~~~ .......... ........ . A\
, \Jt.:IIlt::t I':> ,-uvv-..........c;...-...... i-'I'
City ~ P ne
Expiration Date
/
...
/
Constr"Contr, Number
"
/
}::ipiration Date
- ,/ Signature of Supervising Electrician
Owners Name,
nfl,u:-.ld A, 6e\ (
r;ittcl'r=rDr,
747-2'/)''2' )
Address ~q~S-
City :5D~ I d
I
Phone
l
-.~,
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
(j )&'~A~
Ii......
(JI~
Inspection Request: 726-3769
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
..
$50,00
_~7f.." '~'!"'-#r";';~^ ':l~'~"";'':' ~'l':.' -_..4~-""~....,1~"."",~",,,, ..~'~'--,~.~p "-i;,~',' _"'~:"" ,', '. -
B. ~o~r.\'iC'eSlor'j;Fee'ders',~ris!fllationclAltei:itions;or~R. elocatio'?:,'j,f I
hT.'">iih~'1fB~rr,.,.t,:~~ . .....,.^-\i~dO:..,.O~AWiI4mr:.b....'!:"Sl?'oo,;~n:..,
03NOON'V8'V SI f:l!}..lliJ~PIl,II"(' '
200Anl~rv~fsflV>JH3d SIHl u:'3"- -- $ 63,00
, 0-, ,,0) U:1Z'H"I"Ii"
201 AqjOOMlg).j1"9V"3HldX31~';fi~' ~:B'I).? ,
401 Amps to 600 Amps ",lIVVn25,00Yl
601 Amps to 1000 Amps :~I~lh~N
Over 1000 AmpsNollS $375,00
Reconnect Only $ 50,00
c. ~a.oj~f;)tS.m~~'o-r}~~,ee'4~~;:~~\~~_~11'~tJ)"~,'~::'!;; '~1:~
Installation, Alteration or Relocation
$ 50,00
$ 69,00
$100,00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 VollS see "B" above,
~k-:-~!C!~';2"1";'.''$-':1'~ ''"'- _p.' '*~"'V"'<<- '", "fnl'::; '"'"&j!*-r:l .>~~', "~$'-'''~
D ;.!tBr:ancti<C~ifcul'ts'l~i' l;!':;'ri;"'i"'\l!;';-~~""'" ',~,'v~~-';:\l: i.'t1....^',::;:,~~~!!"..~.,... ,"},::,,,,,
. ~<;",:.,~...,.~'",..._ '.;-9~ ~",i\"J.;~ 'l1Ul.,q>?<ll:~::\t:Yii~ ,'}.'\:iJ:k-_i !;~,r-.il&tf>:~..i'" :;'~';0"I..>.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43,00
$ 3,00
E. ~l~~~ta'~!~~~'ts;~_i~J~~~~F:~~~~i~lKl~~~~n?'
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
~~.,,,g:;."'l,,,,c".;""'''''''''''''''''~''f,\,:~,;~'':;''F'''''J. ~3 00
4, ~SUlfTOTADOF/ABOVEl,,; '~~';h'~'ii'~~j"
,. :. "1,:"',';:';--1'::',. ,.""c,.;;" '_ ~_.:. ,*",':j"'"T-~'.. .~..-...\i:,_''"' ." . '''~,:r:_. ~;'m'~'.
_ ....... "".... '.. "", _, ,_ ,.. . A _"~ _,,-~~__,_ .
<';,4/1
~-3o
13- -7/
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding Fonns/Electrical Permit Application 1-Q3,doc
225 Fifth Street -
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00937
COM2003-00937
COM2003-00937
Payments:
Type of Payment
CreditCard
~;Li
~~]
~,;"',.~"',.,
Receipt #: 2200200000000001556
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
njm
Check Number
Batch Number Authorization Number
Paid By
DONALD A BELL
000174 972467
City of Springfield Official Rece,ipt
Development Services Department
Public Works Department
Date: 09/19/2003 2:37:20PM
Amount Paid
Item Total:
63,00
4,41
6.30
$73.71
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71
.
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C. . c ·
onstructlOn ontractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Weh Address: www.ccb.state.or.us
permit#:~QO.3 -00y35-7
Address:&1K~ &ta~ tV
Issued by:n, rn ' Date: ~/Jf~)1
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 be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
ff I, I own, reside in, or will reside in the completed structure,
D 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,
D 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
~B, I will be myown 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 nnderstand the Information
NC;:~=rs ab~t:;::n Responsibilities on the reverse Sid;/~~fj:'~
(Signature of permit applicant) / (D'ate)
(White copy to issuing agency permit file, pink copy to applicant)
Property _ owner,doc 03/11/03
'.
, ..,. .
A~ting, as Your Own General Contractor?
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT Co'NSTRUCTION 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 tbe employer, you must comply witb tbe following:
Oregon's Witbbolding Tax Law: As an employer, you must,withhold income talles 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 ID number, call the Business Information Center at 503-986-2200,
Unemployment Insurance 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. If you fail to obtain workers' compensation
insurance, you could be subject to penalties and be liable for all claim costs if one 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 withhold federal income tax from employees' wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federnl EIN number, call the
IRS at 866-816-2065 or fax them at 801-620-7115,
Other Responsibilities and Areas of Concerns
, .'. t,
Code Compliance: As the permit holder for ihis 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 :rou hav~. 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 notity building officials'as the appropriate times so they can perform 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