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Home My WebLink AboutPermit Electrical 2008-6-5 ZON LJ- Y INITIALS f\ ~} DATE -cl...LJ () ( ) SOURCE ~.7' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELEl.,l1dCAL PERMIT APPLICATION CdY/21J?J '? -o/71~ - ~ .. New AlteratIOn or ExtensIOn Per Panel One CrrcUIt ) Each AddItional CrrcUIt or wIth Y1 .... ~ LL. ~ ,/.e;/n ServIce or Feeder PermIt 17 $ 400 Owners Name //Are."'tf~A ~rfe-5'!J.LJ(evny Address ---1.J./J ~ [) r ~r ' E. Miscellaneous (Service/feeder not included) -Each Installation CIty S~AAM""~Phone 7U -rJ-2-1- , . CIty Job Number 1. , LOCATION OF INSTALLATION: JqiJ/ J) Sr- LEGAL DESCRIPTION LZ!J'1 .1 ftL/ 5 .0$IffJ JOB DESCRIPTION p~~ ~Agej) j0L/~ Permits are non-transferable and expire If work IS not started wlthm 180 days of Issuance or If work IS Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY ElectrIcal Contractor ATTENTION Oregon law reOUlres YOllAb AddreJ~~I~w ~lIles ad~pte-9 by the 6regOnl1ff'~ty 10 O~~9'5E2.n OC:llltil f nose rUles are 4 et forth -001-0010 through 0 952 CIty 0090 You may obtal/f~~e d ~001. calling the center. (Note t e teleph;;e 1.1, number for the Oregon U fty NotifIcatIon SupervIsor LICS6~p~Jf800- 2-2344). ExprratIOn Date NOTICE: Constrrf1q,p~lN'~l!jfr ALL EXPIRE IF THE WORK AUTHORIZE UNDER THIS PERMIT IS NU I Exprraet~\t~EN'(LD nR I~ ARANDONED FOR SIgnat&-~~f ~ge~Yn~ ~mtcIan OWNER INSTALLATION The mstallatlon IS bemg made on property I own WhICh IS not mtended for sale, lease or rent InspectIOn Request: 726-3769 ~p-A7A " / COMPLETE FEE SCHEDULE BELOW Date 3 A. New Residentlal- Single or Multi-Family per dwelling unit. i~ \.:~~ ~ ~ ~ Service Included 1000 sq ft orless Each addItional 500 sq ft or portIOn thereof Each Manufact'd Home or Modular Dwellmg ServIce or Feeder $117 00 $ 21 00 $55 00 B. Services or Feeders -'Installation, Alterations o~ Relocation: l ~ -"< ~ 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 70 00 $ 83 00 $13800 $180 00 $413 00 $ 55 00 C. Temporary ServIces or Feeders ~~i! ~ ~ InstallatIOn, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above ~ ~ ~ i ~ D. Branch CIrcul1:s ' $ 55 00 $ 76 00 $11 0 00 $ 48 00 4-1J~ . 7fr, Pump or lITIgatIOn $ 55 00 SIgnJOutlme LIghtmg $ 55 00 Lumted EnergylResldentIal $ 28 00 Lumted Energy/CommercIal $ 50 00 MIDlmum ElectriC Permit Inspection Fee IS $50 00 + Surcharges tt' .' SUBTOTAL OF ABOVE 12% State Surcharge 10% AdrnmlstratIve Fee 5% Technology Fee J.., ~Of) '~.flt>> /2.~O l::- T 1-0 TOTAL J~7. eft> Shared Dnve(T )/BUlfdmg FormslElectncal Permit ~on 1-08 doc 225 FIfth Street Springfield, Oregon 97477 541-726-3759 Phone CIty of Sprmgfield Official ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2007-01788 COM2007-01788 COM2007-0 1788 COM2007-01788 COM2007-01788 Payments Type of Payment Cash cRecemtl RECEIPT #: 1200800000000000603 Date: 06/05/2008 DescriptIOn Add, Alter, Extend CITC Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + 10% AdmmlstratIve Fee Item Total Check Number AuthOrization Paid By Received By Batch Number Number How Received PAR THA V A BEHESHT NEJAD dIm In Person Payment Total Page 1 of 1 2 38 59PM Amount Due 4800 7600 620 1488 1240 $157 48 Amount Paid $15748 $15748 6/5/2008 Status Issued 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Lme SITE ADDRESS' 1908 D ST ASSESSOR'S PARCEL NO: 1703361310500 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01788 ISSUED: 12/26/2007 APPLIED: 12/06/2007 EXPIRES: 11/05/2008 VALUE: $ 19,000.00 Sprmgfield TYPE OF WORK Use ImtIals TYPE OF USE Repair PROJECT DESCRIPTION. Substandard BUlldmg - Fire damage repair Owner P ARTHA V A BEHESHT NEJAD INTL FOUNDA T Address. 312 19TH ST SPRINGFIELD OR 97477 ReSidential I CONTRACTOR INFORMATION. Contractor Type General Electncal Contractor CAROLYN F PATTERSON C & SELECTRIC License 82276 3849 Expiration Date 04/27/2009 09/01/2008 Phone 541-744-2867 541-741-2236 BUILDING INFORMATION I # of Umts. Pnmary Occupancy Group Secondary Occupancy Group' Pnmary ConstructIOn Type Secondary Construction Type' # of Bedrooms. Al # of Stones Height of Structure Type of Heat Water Type' Range Type Energy Path Sprmkled BUlldmg VB n/a Lot Size Sq Ft Ist Floor Sq Ft 2nd Floor Sq Ft Basement. Sq Ft Garage/Carport Sq Ft Other' Occupant Load. I DEVELOPMENT INFORMATION. Frontyard Setback' Side 1 Setback Side 2 Setback Rearyard Setback Solar Setbacks Overlay Dlst # Street Trees Rqd Paved Dnve Rqd % of Lot Coverage' I PUBLIC IMPROVEMENTS I Street Improvements. Storm Sewer AvaIlable' SpeCIal InstructIOn Notes NOTICE: THIS PERMIT SHAl AUTHORIZED UNDE~ ~~~~RE IF THE WORK i~~~~NgX~ ~E~:~tBANttN~~~b~ NOT Pal!e 1 of 3 REQUIRED PARKING Total Handicapped Compact. Sidewalk Type Downspouts/Drams: ATTENTION Oldgor 19W requires \IOU to follow rules adopted by the Oregon Utility Notification Center Trose rules are set forth In OAR 952-001-0010 through OAR 952-001- 0090 You may obtain caples of the rules by calling the center (Note the telephone number for the Oregon Utility Notification Center IS 1-800-332-2344). Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01788 ISSUED: 12/26/2007 APPLIED: 12/06/2007 EXPIRES: 11/05/2008 VALUE: $ 19,000.00 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Lme I Valuation Description I Bid Amount Use Bid Amount $ Per Sq Ft or multiplIer $100 Square Footage or Bid Amount 19,000.00 Value Date Calculated DescnptlOn Tvpe of Construction Total Value of Project $19,000 00 $19,000 00 12/18/2007 ~ Fee DescnptlOn + 10% AdmmlstratIve Fee + 5% Technology Fee + 8% State Surcharge Buddmg Permit + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Temp Power 200 amps or less + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Clrc Add, Alter, Extend Orc Ea Add Amount Paid Date Paid Receipt Number $19 59 $979 $15.67 $195 86 $550 $660 $2.75 $55 00 $12 40 $14 88 $6.20 $48 00 $76 00 12/26/07 12/26/07 12/26/07 12/26/07 1/2/08 1/2/08 1/2/08 1/2/08 6/5/08 6/5/08 6/5/08 6/5/08 6/5/08 2200700000000001905 2200700000000001905 2200700000000001905 2200700000000001905 3200800000000000003 3200800000000000003 3200800000000000003 3200800000000000003 1200800000000000603 1200800000000000603 1200800000000000603 1200800000000000603 1200800000000000603 Total Amount Paid $468 24 I Plan Reviews I To Request an inspection call the 24 hour recordmg 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. Temporary Electnc. Approval reqUired pnor to UtilIty Company energIzmg pole Rough Electnc Pnor to Cover Fmal Electnc When aU electncal work IS complete. Pa!!e 2 of 3 CITY OF SPRINGFIELD. Status Iss u ed Building/Combination Permit PERMIT NO: COM2007-01788 ISSUED: 12/26/2007 APPLIED: 12/06/2007 EXPIRES: 11/0512008 VALUE: $ 19,000.00 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Lme 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 of Sprmgfield and the Laws of the State of Oregon pertammg to the work descnbed herem, and that NO OCCUPANCY wIll be made of any structure without permissIOn of the Commumty Services DIVISIOn, Buddmg Safety I further certify that only contractors and employees who are m complIance with ORS 701 005 wIll be used on this proJect. I further agree to ensure that all reqUired mspectlOns 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 remam on the site at all times durmg construction Owner or Contractors Signature Date Paee 3 of 3 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 PermIt # ('/~.?JY07-0176S 19o~ 7J c:T, #~~ Date &/r/fJ j, I / Address Issued by /' ''- Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requIres resldentzal constructIOn perm It' applzcants who are not lzcensed wIth the ConstructIOn Contractors Board to sIgn the followmg statement before a buddmg permIt can be Issued ThIs statement IS requIred for resldentzal buddmg, electrlcal, mechamcal and plumbmg permIts LIcensed archItect and engmeer applzcants, exempt from lzcensmg under ORS 701 010(7), need not submIt thIs statement ThIs statement wIll be filed wzth the permzt FIll In the appropnate blanks and InItIal boxes 1 and 2, and eIther box 3A or 3B - ~l /' '- ~r2 ( ---- 1 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 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 ~ 3B I WIll be my own general contractor ( If I hIre subcontractors, I WIll hIre only subcontractors lIcensed WIth the ConstructIOn Contractors Board If I change my mInd and hIre a general contractor, I WIll contract WIth a contractor who IS lIcensed WIth the CCB and wIllllnmedlately 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 to Property Owners about Construction Responsibilities on the reverse side of this form. x?~4xl~~ I (SIgnature of permIt applrJant) (Date) V (Whzte copy to lssumg agency permIt file, pmk copy to applzcant) Property_owner doc 06-01-04 ~ NotIce to Properly about ConstructIOn Responslbllttles was developed by the Board In accordance with ORS 701 055(5), passed by the 1989 NOTE TJus Constructlon as your own contractor to construct a new can many problems by aware of a substantIal respoDslbllIhes to JlJl concerns If you are m most you use contractm s not constructIOn or ruled to with of a resldentmJ structure contractors you contract with to labor m mu..t "employee~" or to aSsIst m the the mcome taxes from employee wages at hme even you actually the tax your Revenue at 503-3784988 to pay a tax on msurance purposes at 503-947-1488 Number To file a for Wlthholdmg and 1 or )V\N"\V dOT btatc 01 m/fonnsnav htmll for the appropnate In"uranc{;: As an msunmce to penalties Worker:; . are to Workers> Compensation you to obtam compensatIOn If one of your IS on the 0 at the Department Consumer Busme,ss Workers' must obtam msurance, you Job more ServIces at As an employer, you must even If yOU web sIte at ~V\'0~~lgjN'{ mcome tax tax For a employees' wageE. EIN call the You tax IRS at 1-800-829-4933 or Vl'nt you are for any faIlure to meet code to see If msurance fire or I tlme '1 O\Yn genel al tImes so 1) or \VIlte at PO doc 06-01-04 \ J