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Home My WebLink AboutPermit Electrical 2008-6-16 ... .". -~,". jifI~j ,> ~ "" j . ~ t ."," ". ,'eITX' OF SPRINGFIELD,.,OR,EGON ~ ' " ... . "....,. =- ~ '-w ~ ^ _ , """ '" ZON I ry? / INITIALS !J-:j\"Y'l DATE \..o-B-aY r.---. ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CO.,t.1 z..oO x-- aD '37 L Date 1 LOCATION OF INSTALLATION: "3 '-17 L( f:'.i1-ko,v 3 COMPLETE FEE SCHEDULE BELOW - biL LEGAL DESCRIPTION J 702 J '7 V]. A New ResldentIal- Smgle or MultI-~am"y per dwellIug umt. 03/DO ServIce Included 1000 sq ft or less Each addlltonal 500 sq ft or portIOn thereof Each Manufact'd Home or Modular Dwellmg Service or F ecder $11700 JOB DESCRIPTION A deL , c \ ,r c..,^-~ 1- $2100 Permits are non-transferable and expire If work IS not started wlthm 180 days of Issuance or If work IS Suspended for 180 days $55 00 2 CONTRACTOR INSTALLATION ONLY B ServIces or Feeders - InstallatIOn, AlteratIOns or RelocatIon Electrical Contractor 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsIV olts Reconnect Only $ 7000 $ 83 00 $13800 $18000 $41300 $ 55 00 Address Phone ~ /C- / SupervIsor License Number f (:; / ExpIratIon Date f) J / Constr Contr Number I / City C Temporary Services or Feeders "!W. \0 I~~Wy@qlllr!l!l.I(:utM'ff or RelocatIon A\\EN\\O~ a~~~~~~ ~"~~~et lort~ \~w lule 'entel 1WO~0A.i{l9~ Not\\lCa\lO~ ~01_00101\fll~6'l'lffiVI)';il\\l\,pY OAR 95..- bta~P\ ~'I~l\OI\9 In ivy ':flay 0 'C8l~ ~ ~lltV oils see "B" above 0090 the centel. , ..:....~' \ cal\lng I I the ~eg- ~1S !libel 0 t.aO - - 1111 centel IS 'New Alterabon or ExtenSIOn Per Panel / One CrrcUlt Each AdditIOnal CrrcUlt or With Service or Feeder Permit $ 55 00 $ 76 00 $110 00 ExpIratIOn Date Signature of Supervising ElectrIcian $ 48 00 1/8 __,--;,,//.7 ~ Owners Name (~lA../ q c t-7-4/' Address 3 f' 7' Y-' r:::". I'::.. {,~ -D". . E M .scellaneous (ServIce/feeder not mcluded) -Each InstallatIOn Clty~,r:-:{id2... Phone -4-:f.rJ-L/7fo PumporlTT1galton , $5500 T ,) 711'6- G ?fy L:.' SIgn/Outlme LIghtmg' '440~ $ 55 00 OWNER INSTALLATION LImited Energy/Rell ~~~.(" .)n1 $ 28 00 The installatIOn IS bemg made on property I own whICh "01~~~ :lS'fE\'IlJI\ \ O~ $ 50 00 IS not Intended for sale, lease or rent I'{'i\\Gn~~~~>>'~ r..WflOll\i'f-fe frs~ Surcharges fl\li~~\lj~O~JOVE . S-o CO~~~J~~ge b r-.~ 0% Administrative Fee s: 5% Technology Fee Z. " , - 'f~ TOTAL b)-- Shared Dnve(f )/BUlldmg rormslElectncal Pemut ApplicatIOn 1-08 doc $ 400 Owners SIgnature - - ~ -- ~_/.,~~/ / Inspechon Request 726-3769 CITY OF SPRINGFIELD Building/Combination Permit 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme PERMIT NO: COM2008-00872 ISSUED: 06/16/2008 APPLIED: 06/16/2008 EXPIRES' 12/16/2008 VALUE. Status Issued SITE ADDRESS 3494 FALCON DR ASSESSOR'S PARCEL NO 1702194303700 Spnngfield TYPE OF WORK MIScellaneous PROJECT DESCRIPTION Install vehIcle fuelIng UDlt TYPE OF USE New ReSidential Owuer WAGNER TODD H & CHlSTINE L Address 3494 FALCON DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION. Contractor Type Electncal MechanIcal Contractor OWNER OWNER LIcense BUILDlI".. mrORMATION, # of Umts # of Stones Pnmary Occupaucy Group R-3 HeIght of Struct~6e Secoudary Occupancy Group on \aT~Pll:pthf.l\hIiO~\\lty Pnmary ConstructIOn TypeAiTEN1\(}IB Ole~ed bV~eD~ ~ lonh Seconddry ConstructIOn Tl\I!,\\ow lnles a~~~l "ho~lll!eii1~~52_001- # of Bedrooms Notlhca\lOn Ce 0010\h~~1f lI]llS bY OAR 952-001- o\!fpliliJ&!d~'\W/fflll U/d ~v~: "~,, mR'I. obt~\~;\_~~ ,,,,,\?~~p" " calling t\l9 cttHEy~~ffi'll'ifc)RMATION , IIllmberlol t I i-5UU'~~'-1. r u ~ n center I Overlay Dlst # Street Trees Rqd Paved Dnve Rqd - % of Lot Coverage Frontyard Setback Side 1 Setback Side 2 Setback Rearyard Setback Solar Setbacks I PUBLIC IMPROVEMENTS. 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 Street Improvemeuts Storm Sewer AvaIlable Spec13llnstructlOn SIdewalk Type Downspouts/Drams Notes NOTICE~ flllEW01\l( :~H~~r~ ~~~~~ ~~NRD~i~~ciTF~RNOT COMMENCED OR IS ABA ANY 180 DAY PERIOD. Pa2e 1 of3 Status Issued 225 FIfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspectton LIRe DescriptIOn Tvpe of ConstructIOn Fee DescriptIOn -Mechamcallssuauce Fee- + 10% Admlnlstrattve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Ctrc Gas Outlets 1-4 Mlmmum/Adjustment Electrical MlRlmum/Adjustment Mechamcal Total Amount Paid CITY OF SPRINGFIELD" Building/Combination Permit PERMIT NO. COM2008-00872 ISSUED 06/]612008 APPLIED' 06/]612008 EXPIRES. 12/1612008 VALUE: I Valuation Descrmtlon I $ Per Sq Ft or multIplIer Square Footage or BId Amount Value Date Calculated Total Value of Project F"". p.YlLJ Amount Paid Date Paid ReceIpt Number $20 00 $10 00 $12 00 $500 $48 00 $500 $200 $45 00 1200800000000000655 1200800000000000655 1200800000000000655 1200800000000000655 1200800000000000655 1200800000000000655 1200800000000000655 1200800000000000655 6/16/08 6/16/08 6/16/08 6/16/08 6/16/08 6/16/08 6/16/08 6/16/08 $14700 I Plan ReViews I To Request an inspectIOn call the 24 hour recordmg at 726-3769. All mspectlOns requested before 7.00 a m. WIll be made the same workmg day, mspectlOns requested after 7'00 a m. will be made the following work day. 1-RplnnirprlJnsneChons I Rough Gas After lIne IS mstalled and required testlRg and capped If not attached to an applIance FIRat Gas When all gas work IS complete Rough ElectriC Prior to Cover FlRal ElectriC When all electrical work IS complete Paee 2 00 _SiP.AI'!I_G!!:,I~I?, , , ,- , Status Issued 225 FIfth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769InspectlOu Lme CITY OF ~r K1j~GFIELD Building/Combination Permit PERMIT NO' COM2008-00872 ISSUED: 06/16/2008 APPLIED: 06/16/2008 EXPIRES: 12/16/2008 VALUE By slgudture, I state and agree, that I have carefully exammed the completed applIcatIOn and do hereby certify that all mformatlOn 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 pertalnmg to the work descrIbed herein, aud that NO OCCUPANCY WIll be made of any structure without permiSSIOn of the CommuDlty Services DIvIsion, BUIlding Safety I further certIfy that ouly coutractors and employees who are m complIance with ORS 701 005 WIU be used on thIs proJect I further agree to eusure that aU 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 aU times durmg constructIOn - ,- .~_.~.";.~, Owner or Contractors s~ - Pa2e 3 of3 -Property_owner doc06:0 l-u4 6--/C-o& Date - --- -- - ~ I A~~llllng In~ 'Yolllfi'9Wllil GeJmelra,n Contractor? - . )0 __ '''':'i~~6RMAil~N-'rJOTlCE TO:PROPERTY 6WNERS' - ~, '\ ~~\'\~ ,_r~ A~9UnG9_NSTRUCTl~f\lIRESPONSIBILlTIE_S-:~~~~ r..' ~..~ '_ . .. , 'I, j,..J ~ NOTE This Information Notice to Property Owners about Construction Responslbllttiiis was developed by the ConstructIon Contractors Board In accordance wtlh ORS 701 055(5), passed by the 1989 Oregon Legislature ~ "j' ~ ' ',~" l ~' , - _ ~ . .'<; lJt ~ --.. If you are actmg as your own contractor to construct a new home or make a subs.tantJallmprovement to an eXlstmg .- _... , ~ , , .. ~_ r structure, you can prevent many problems by bemg aware of the followmg responslblltties and concerns JEmployer Responsibilities ,. 1~""(''U\ ..:'r~'~L'-t -. \"\ ......~\'Jn~~\.. '...,;'J'~\'l,). ......... . n\..~ ?...~ ':.\t"I'_:;.,O You .will;m,mosJ tgeJa.nce.;;, be ruled to be.al;t~'.l1mployer'\llf1d,the contractqrs yog con1'1i:ct Wll!1 WtU be,~'e!llpI9yees" If you u~e cOt;ltra~to,:s,n?t.l!censed Wlth the ~Pl"\~!&Et~~n \::;'W?p:~ctors Boaf(!.<o,do labor,m cqr,;~1j;1ctmg or,t? aSStst m the constructIon{>: ~pro{\~\T!-;\\t, '?f~,r;~~\jent:~I.ftr,\If-~~ A~ !he ~'!lP!o~er' you ~ust conw1y .~!~t~,e/o~~~ID~: \-\'.~,\'~l"''''', !l",:~~,,"'i1;::,~- ~ n 1 - ~\, '1\\\ .f)'\t:"" Oregon's WIthholding Tax Law: As an employer, you mu~t Wlthhold mcome taxes from employee wages at the tIme employees are patd You Wlll be hable fQr the, tax payments even If you don't actually wtthhold the tax from your emp]oyee~ For more mformatton~cai(tlie DepaTiirient'ofReve~ue at 503-378-4988' 'I, Sl1 ',c J' .::- , . '-.. Unemployment Insurance TaX" As an employer, you are reqUIred to~pay a tax for Unemployment msurance purpos~ on the wages of aU employees For more mformatlon, call the Oregon Employment Department at 503-947-1488 "'- The o:~~~~t ~~:m;:~"Id~:~fi~:~:~"~~~~( ~~~ 'tS '; co~bll~:;~ ~wnbe; }or ,~~~~egll~~ ~;th~o;dm~ and ~ Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or w""w dor state or us/formsoav htmll for the apP~pljatefo~~___~ ____ _ _ ___ ___, _n__ _ '10_ "'iJ:.r~-,,!\~~ .'"t _ 1..:, 'P"~ ') I 'I' Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtam workers' compensatIOn msurance for your employees If you faIl to obtam workers' compensation msuran~e, you coufdbe~~~Ject fu p'ina1t;b~ ahd be iiable for all clllt~ costs'tfone of your employees Is1ifiiured on the . -1 ,..,......... "..... ...., f" ...- -' -..., \U no. ......-,...... Job For more mformabon, call the Workers' Compensation DlvlSJon'at the'Department of Consumer ana Busmess ServIces at 503-947-7815 .hC'> U.S. luternal Revenue ServIce. As an employer, you must wlthho]d'feaeral~hcome:tax frOin'empioyees"w~'", You WIll be hable for the tax payment even If you didn't actually wllhhold the tax For a Federal EIN number, call the IRS an-800-829-'4933 6r VISIt thctr,{Veb SIte at\vww US'l:!ov1JdIJG '~ILJ:Jurf ':VI I -:: T',;~:;u, G ~;!1l1 i,! (I ( '. 'J It- .' r r I _tFt"I...... t1 .. - -; "l ."11&J.o; :'; .liC ..... 13 1!l1 i::r....... ~ -....., \. 1 =:-"'!l:.. 1 J 1 ~.)~ ''', '" ,,-,Othe,r. ~esponsil>mt~es~alll!dl Areas 'oU~9~cer!ts, r _ " u , f{ I',.,..... rf: 1 d Code Comphance, As the penrut holder for thiS proJect, you are responsIble for teso vmg any al ure to meet co e reqUIrements that may be brought to your attention through mspectIons , ~ l- \.._ 'r::: ~~;~.. $"".:},Il ~..... ~ ~ "0--: 00)-_ _. '." - Liabthty and Property' Dam'a'gelInstiT1'h'(?e:- Contact your'thSUrance'~gent to'~e 1f iou have.adequate'msJrance' coverage for aCCIdents and omISSIOns such as falhng tools, pamt over spray, water damage from pIpe punctures, fire or workthatht~st~r~d'p~':--,,:;:~ ~~_'C::: _. __ -.' ..... -., ---~ ~-~- ~ -- ....... -- - - -- - -- - - - - -- - - - - - -- - - ~, - - Time Make sure YClIt-have suffiCIent ttme to supervise your employees - _ I",:~ ) .' . 1 '" ............ / I' r " ." I r'" 1 . 7111" \ 'f -\.... ~ "'" Expertise' Make sure you have the slalls 10 act as your own 'general contractor, to coordm'ate the work of rough-m and fimsh trades, and to notIfy bUl]dmg offiCIals as the appropnate ttmes so they can perform the requIred lllspectlOns It you have addItional questIons call the Constructton Contractors Board (503-378-4621) or wnte the agency at PO Box ]4140, Salem, OR 97309-5052 Property_owner doc 06-01-04 225 FIfth St,reet Sprmgfield, Oregon 97477 541-726-3759 Phone ~ City of Sprmgfield Offictal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-00872 COM2008-00872 COM2008-00872 COM2008-00872 COM2008-00872 COM2008-00872 COM2008-00872 COM2008-00872 Payments Type of Payment CredltCard cRecemtl RECEIPT #: 1200800000000000655 Date: 06/16/2008 Description Gas Outlets 1-4 MInimum/AdJustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend ClfC MInimum/AdJustment Electncal + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By TODD WAGNER Item Total <":heck Number AuthOrization Received By Batch Number Number How Received dJh 016288 In Person Payment Total Page I of I 11 19 16AM Amount Due 500 4500 2000 4800 200 500 1200 1000 $14700 Amount Paid $14700 $147 00 6116/2008