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Home My WebLink AboutPermit Electrical 2004-1-21 \ , ~ ". . f \ ... ' " . ,.' . .' ," CITY OF. SLJNGFIELD, OREGON 0' ''',:, '" .. . roject es submined has the following as not reqUIre specific land use 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 l1'o.,17 Lonm"t , H~ ~~~'~L~O"~C~'A'~T-Cl'o:ALN-~O"~F'EIRMN.~S-TJ'AL~ cmLAAPl'~10~7TC~TI~F ~() ~~~__ ._~~t:ori~ed_Slgnature..~ - ~\-~;; I. H I 3.. COMPLETE FEE SCHEDULE BELOW L_._ _. _"_'__"_'_"_'__ _ .J ,_..~_.----_._._---"'--'- -- - -' -.--....- ;JO'J \ I,JLAJi) WA!j 7EGAl DESCRIPTION it oj Ud-. j:; 88VVb SP,~;{, FIALT) 0 L , j JOB DESCRIPTION 12t?LAUv Lj'xLf, '?O~-t."res.,.outo O!},la'l" .~~ UtlllW Permits a~~tf~OI/i'J?!;!toSXl!iU'(iJr~s t tori Each Manufact'd Home or not startt\h\'ltHin\~l\!l~fJ~suan~'1~df;Wll'rEk !jseZ..oo Modular Dwelling Service or suspend~\r.)Vll~~~bo\er. lnOS oUgn OAR 95 9' \ Feeder $50.00 r-'l\l~iC3tIO._._r\.P~' ~O.thL ''7 "'.D~tne'{I.\\e ~._... -- --...-- I 2. i COfa~G!J'O~'1N,.,:, 'Nt ~hOOe B. Services or Feeders ~ Installation, Alterations or Relocation: ' ,--0_ '-'1'-U-m3'1-0 -I'lote:-tne. -~' tioO'- ----.---- ..-1 r'\090. 0 eoter. ( 'rw N Ica Ele icarC'eH/!~the C ,....,,"00 \J\\I . ,r') 200 Amps or less $ 63,00 ""per Ion"". - ~ .P'C'C'-?oC'Z" ,,r 20 I Amps to 400 Amps $ 75,00 u~, ~('\.l',e ("~'" 401 Ampsto 600 Amps $125,00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375,00 Reconnect Only $,~O,OO I.. .\ tll: ,~V" . '-'-.r.c -- t:~\'\\\t. It '-''1'5 ~ll.\ -, C. I Tempof{r.\'.,Servic",,-or,\Fcroers, nell-WlI \ J' L -\;~i~:?I:~i'A~~~~l)t\{:~~~;~~t\yrQ\\ .----.- Install~~ol\,\~lte1ati\r~f\ ~Iocallb'n 200 A"\I;~~W~Ct.I>.'{ ?t\\I()\)')( $ 50,00 ,)D 00 201 Amp~\~'l'4'\!O\A~ps $ 69.00 40 I Amps to 600 Amps $100.00 r Address City EXPi7ate "'" Constr. Contr. Number '" / , Expiration Date Signature of Supervising Electrician r Owners Name / / m LvI LSo./ Address 80 rY orA II fl z..u.. +0./ z;l D ' _ City (Joff~64vv Phone 9'Ya./'J3,j OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: . ~ La.>J ,,/ .' /~ --:> Inspection Request: 726-3769 l/..V\';,t- StAlD 'K<.c.,<..Pt To: 7/1'>"> (.,.JII-So-./ BDdS(P HIl ztLto.J Rt>_ ('oli-l16t.. 6, ~V!" ot.. <;1'1;)4 A. f New Rcsidential- Single or l\1ulti~Family per dwelling unit. Service Included 1000 sq, ft. or less Each additional 500 sq, ft, or portion thereof $106.00 $ 19,00 Over 600 A'!'ps or 100Q..'~01~~ee "B" above, D. ! Branch C~cults ___ .__ New Alleration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with Service or Feeder Pennit $ 3.00 -I , E. I Miscellaneous (Service/feeder lIo;h.c111ded) ~Each-lllstallatiOl~ 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 f-:-- -'^- . ' 4. I SUBTOTAL OF ABOVE L~___ _.._ -----l I 50'Z-O- 7% State Surcharge 10% Administrative Fee 3~'~ s..c.u 5.-q-;5O TOTAL Shared Drivc(T:)lBuilding FormsIEh.'Clrical Pennit Application 1-o3.doc 58~ \ ;~ \ \ . CITY OF SPRIj\j\Jt<1J!,LU Building/Combination Permit PERMIT NO: COM2004-00077 ISSUED: 01/20/2004 APPLIED: 01/20/2004 EXPIRES: 07(20/2004 VALUE: Status Issued , 225 Fifth Street, Springfield, OR- 541-726-3753 Phone 541-726-3676 Fax .--541-726-3769 Inspection Line ------ _. c_d +.... .~. ATTEN IIUI\I:urttyull Ia.n '''''''1-'. -- ,I ,- ~-. :.- tAt:: ,,-dnntea oy III" V'''\jV" J.r."1 SITE ADDRESS: 2b:2~~B)\NU Wlp" Those ruleS'llfW%Wtll'orTYPE OF WORK: Electrical Work Only ASSESSOR'S PARCEL Ncx,f1c~i3SOliOlfo h hOAR 952-00 I OAR 952~9,91-0P1? t ro~g I TYPE OF USE: Repair PROJECT DESCRJPTI~90Reptllcll'jlllSiobtam caples of the rules calling the center. (Note:.t~e ~~I~,~~~~:_ mber lor me u'''yv,' ",\.1"1 ,.~.".__.. Owner: WILSON TIM'~ r~_~;c 1_Rnn-~~2-2344). Address: 80256 HAZELTON RD COnAGE GROVE OR 97424 Contractor Type Electrical Contractor OWNER I '-V". ~CTOR INFORMATION' License Expiration Date Phone # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATION I ~U 1I1.t: # o~Stor~~;iS PERMIT SHALL EXPIR"'~~Si~ef INORK Height o~~m0'1ffLED UNDER THIS ~qJfht1'ft,~roYrh Type Of~t'lWIMENCED OR IS ABA D~~ f,J 2nd'FI'llor. Water T e: N sq'iitlB&~R,ent: Range T :Iy 180 DAY PERIOD, Sq Ft Garage/Carport Energy Path: Sq Ft Other: Impervious Surface Area: . SETBACKS I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/? of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downsponts/Drains: , Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculatcd Total Value of Project Paee 1 of2 . . CITY OF ~r~r\;GFIELD Building/Combination Permit PERMIT NO: COM2004-00077 ISSUED: 01/20/2004 APPLIED: 01/20/2004 EXPIRES: 07/20/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fp.e~ Pair! I Fee Description + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 1/20/04 1/20/04 1/20/04 2200400000000000047 2200400000000000047 2200400000000000047 Total Amount Paid $58.50 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 Reouired fnsnectinns I 1 Rough Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service. 3 Final Electric: When all electrical work is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 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 ofany structure without permission of the Community Services Division, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 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. (~.. ~~ n\'('\ ~o..{)~{'~ \ , Owner r Contractors Signature \ ~Lo- 04 N fV\ Date' Pal1e 2 of2 t), . , , . \ / " " ". ." , .' -' . . 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 Pemrit #C('Yy\~4 -(j:)o'7 7 Addre~cW I ~ l(l1MrL l:iJ.-c!: ISSUedby~lf) Date: l-dD-~lDl' 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 befiled with the permit. Fill in the ayy,vy,;ate blanks and initial boxes I and 2, and either box 3A or 3B: ~ I. I own, reside in, O~ll resi~n 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 D 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 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 understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. .~ -&J~ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/1 1103 . ' . Acting as. Your' Own General Contractor? . I . . :' , INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION 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 Legis/ature. 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 Respop.sibi.lities 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 the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer,. you must withhold income taxes ,from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actualiy withhold the taX from your employees. For a State Business ill 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 Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns , , Code Compliance: As the p~rmit holder for this 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 you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work ofrough-in and finish trades, and to notifY building officials as the appropriate times so they can p~,;"u" 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 03/11/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . . " } . '" Job/Journal Number COM2004-00077 COM2004-00077 C0M2004-00077 Payments: Type of Payment Check Paid By TIM WILSON d' ~,'LJ,,:"'~~~~,~"~.,"',' .',1 .-;~. : Receipt #: 2200400000000000047 Description Temp Power 200 amps or less + 7% State Surcharge + 10% Administrative Fee Received By njm Check Number Batch Number Authorization Number 3552 CitY of Springfield Official Receipt Development Services Department Public Works Department Date: 01/20/2004 1:26:45PM Amount Paid 50,00 3,50 5.00 $58.50 Item Total: How Received In Person Payment Total: Amount Paid $58.50 $58.50