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Home My WebLink AboutPermit Electrical 2008-6-4 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION Ci~JobNumber COvv\ZOoS -D07 '10 1. LOCATION OF: INSTALLATION: 386S- C (l(tL:.. Af LEGAL DESCRIPTION {70S '5l.{l.{3 JOB DESCRIPTION' I Z JO 0 New J l5 ~mp ,-<5.erl/i'~ f)ox 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' '''A~' ~ii >>>" >,~ <' Electrical Contractor Address CIty Phone ExpIration Date Constr. Contr. Number ExpiratIon Date Signature of SupervIsing Electrician 6>--'-(-02 Date 3. I COMPL1:n..l!. FEE$CHEDULE BELOW <",,,",,,.l<F:,;..bv'~~"'~' ~ ,," ZON \ct Y INITIALS NM DATE to - U -ex ~ SOURCE ~~...:> "'> , > ~.^, ~ {,1il'{i"""~ >'>~>>~">~'V , A. New Residential- Single or Multi-FamiJY:'per dweJling unit. /{,{ {{ , ,'< '(A '" ,,> <{/<m Service Included 1000 sq ft or less Each addItIOnal 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $11700 $ 21.00 $55.00 '<iN, <, ""~'1ji~ii;)~i:}\\ " -.. :::' ,-,>~,,,,,,*,,*~!,'g,~,> ( B. Services or'Feeders -Instttllation, Alterations or Relocation: " ' Over 600 Amps or I 000 Volts see "B" above .., -., , ~O" '"'0<<0;*#0\'I~(i vn' ~~, > > , 'j , '" D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each AddItional Circuit or with Service or Feeder Penmt x 70 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect O.nly , I '-'.:"In 18W requIres you to 4-~ ,.~ _,~l' d ty tile Or!Qon Ubi. 'v., Supervisor License Number ,\ v ~ ~, L r 1 nose Nles l11llP rvICes or Feeders " r\i '- l' :') <)01,(;010 through OAR 952-001- n ViC20. 'rOll mRY obtain copIes bt~lIl1ti~ ~eration or Relocation Iv Galling Hie cemer.- (Note. th:ft1:'~h~BPI number for the Oregon Utlllt~( 1:)ffr.5aY8ges~ Am Cooter if 1--300-332-2'$ . ps 0 ps 40 I ps to 600 Amps $ 70 00 $ 83 00 $138.00 $180.00 $413.00 $ 55.00 "b~ q $ 55.00 $ 76.00 $110.00 ,,, ">,, $ 48 00 $ 400 Owners Name .~ QChc \ LL..\.ll"\ A Address 3'6Dl) eQ')t J4 ~ ~TJ~r:. City [u.se.'(\(, Phone~SHALl~~~~;ORK $55.00 AUTHORIZED UNDER~~) Jffiilrt'g ~OT $ 55.00 OWNER INSTALLATION COMMENCED OR IS Atffl cr~fr'. ~Jenfial $ 28.00 The in.stallation IS bemg made on prope~rlJV"m'GhffAv PERIOrr.llDIted Energy/CommercIal $ 50.00 IS not mtended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $50.00 + Surcharges Owner.; Signature: tfd cid I! J.. Inspection Request: 726-3769 E. Miscellaneous (Sel',\;ice/feeder not included) -Each Installation 4. SUBTOTAL OF ABOVE 12% State Surcharge 10% AdminIstratIve Fee 5% Technology Fee ."'11 70 8'10 "7 3fo 88~ TOTAL Shared Dnve(T )/Bmldmg Forms/Electncal PermIt ApplicatIOn I -08 doc CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2008-00790 ISSUED: 06/04/2008 APPLIED: 06/04/2008 EXPIRES: 12/04/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3805 E 14TH AVE ASSESSOR'S PARCEL NO.: 1703344312300 Eugene TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Replace service panel TYPE OF USE: Repair Residential Owner: RACHEL LUND Address: 3805 E 14TH AVE EUGENE OR 97403 I CONTRACTOR INFORMA nON. Contractor Type Electrical Contractor OWNER License BUILDING INFORMA nON I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: I~:to Primary Construction TmENTION~regon 'a~ i:iQn>\',\titity Secondary ConstructioDfCJ'\YlM= ru'es adoPte~:Y e ~a~forth # of Bedrooms: Notification center'10t~~ou n~&:O01. in OAR 952-001-00 o' rm~rB\B~: n/a JESr.: Vt'\1I ~v obtain c P _ l\.";' \a,gphnnll' _ caning the cent -. RMA nON number for the 8On-<:l<:l _ . Center i8 1- IrVV Frontyard Setback: Overlay Dist: Side 1 Setback: # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: Phone Number: 541-726-3147 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 I NOTICE: Sidewalk ~fe: TH\S PERM\T SHAlt mUlE 'f~r~;mrains: AUTHORlZED UNDER TH\S PERM' R COMMENCED OR'S ABANDONED FO ANY 180 DAY PERlOD. Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation DescriptiorJ Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Paee I of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00790 ISSUED: 06/04/2008 APPLIED: 06/04/2008 EXPIRES: 12/04/2008 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 6/4/08 6/4/08 6/4/08 6/4/08 1200800000000000593 1200800000000000593 1200800000000000593 1200800000000000593 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 following work day. L Reouired Insoection!j 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. cflJuJ.. ~ ~ - L/ - DZ Owner or Contractors Signature Date Page 2 of 2 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 #. L-Ot1/1 c-a-O S?-o a 790 Address 3S0S- E /0l- A-V ~ ~ Date: tI'I)g Issued by. Statement: Info. mation Notice to Property Owners About Construction Responsibilities Note. Oregon Law, ORS 701.055(4) requlres residentlal construction permlt applicants who are not lzcensed with the Construction Contractors Board to sign the followmg statement before a buildmg permit can be lssued. This statement is required for resldential bUllding, electrzcal, mechanical and plumbing permIts. Licensed architect and engmeer 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: 7'1. J2(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. 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 ft3B. I will be my own general contractor. In hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and lure a general contractor, I will contract with a contractor who is licensed with the CCB and willllnmediately 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 ~~er;{j;onstruction Responsibilities on the reverGde_o;:i (Signature of permit applicant) (Date) (White copy to lssuing agency permit file, pmk copy to applzcant) Property_owner. doc 06-01-04 r'-~ _- \ Ac)~ng) a~> v_~ul:' - eral Contractor? ~ ~<, ~ - J \INFOi\MAtlbN-~,jOTICE"O PROPERTY OWNERS ~':: .\~ \~'. ABOI.tTI!fONSTRtJCT1( RESPONSIBILITIES '. . , 1 NO TE' This Information Notice to Prope~y Owners a;';'~t~-;~;;~n Re~ponsibiltiies ~as developed b;Ih~] Construction Contractors Board in accordance with C RS 701.055(5), passed by the 1989 Oregon Legls/ature. L :~__"__________________ __ . ___ _ - _ - - . - ----- --- ~ ~,r. ~ If you are acting as your 'own contractor to construct ~ 11CW borne or make a substant1al1rnprovernent to an eXIstmg structure, you can prevent many problems_by bemg aware-cfthe followmg responslbll'ihes and concerns. Employer You will, m IJ1stances, bepJled to be an "employ~r" you ~s~ contTacto~~. not hcenscg \vith the ConstructIO~ constructIon 01'; lrnp(OVement of a residentIal structure. .:l , . -. . --. . the contractors you contract WIth will be "employees" If " - Board to do labor m c~mstructmg or to aSSIst 1ll the empICJyer:_ypu mu.st cODJply the following: \. \... Tax Law: As an employer, you You WIll be hable for the tax more mfOrmatIOn, call the Depaitment of mcome taxes from employee wages at the tIme even you don't actually wIt.hhold the tax from your at 503":378'-4988. .,' , As an employer,'you are For more informatIOn, , to a tax fOf unemployment insurance purposes..... Employment Department at 503-947-1488. ~ Unemployment on wages of an The Oregon Unemployment appropnate 7 , , '", Identification Number (BIN) IS ,'1 combmed number f()f bo):h Withholdmg and Tax. To file for a BIN, or www.dor.statc.oLus/formspav.htmll for the Workers' and must obtam msurance, you job, For more ServIces at lnsunmce: As an you are subJect'to the Oregon Workers' Compensation Law, compensatiOn msurance for you fall to obtam workers' compensatiOn be subject to penalties and c1am1 costs if one of your employees Is'mJured on the call the Workers' Compensatl:)n DrvlslOri at the Department of ConsJmer imd Busmess 15 U.S. Revenue Service: As an employer, you rrust WIthhold> federal income tax from You be hahle tax payment even If you dldn . t the tax. For a EIN IRS at 1-800-829-4933 6r visrt web Site at , '-.:.. wages.~ the '. , " As the permIt holder for thIS may ,.brought to .J:our att~nt!on Damage Insurance: omlss10n~ such as you are responSIble for resolVJ.ng any failure to meet code msurance agent to' see you have adequate Insurance' over spray, water damage pIpe punctures, fire or , \ "'i~ - , \ , , . "L ~ , ;~ , \ . \ sure you suffiCIent tIme to your sure you have the slans to act to bmldmg offiCIals as contractor, to' coordinate the work rough-m tImes so they can perform reqmred mspectlOns caB the 97309-5052. (503-378-4621) or write the agency at doc 06-01-04 225 Fifth Street Springfiel~, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00790 COM2008-00790 COM2008-00790 COM2008-00790 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 1200800000000000593 Date: 06/04/2008 DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By RACHEL LUND Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received dJb 729815 In Person Payment Total: Page 1 of 1 1l:26:10AM Amount Due 7000 350 840 700 $88.90 Amount Paid $88 90 $88.90 6/4/2008