HomeMy WebLinkAboutPermit 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
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ZON \ct Y
INITIALS NM
DATE to - U -ex ~
SOURCE ~~...:>
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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