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Home My WebLink AboutPermit Electrical 2008-6-27 Date ZON LJ- If INIT~LS N YY\ DATE! -, -09. SOURCIfD ~ (!?) ftJ!:n!nt . ~ :'CIT~eF:~-eR;~GFI!ELI),J:)REGQN . . , "'2':,.' .~ ;:11:. 'tJ";, ~~", , + ~ < 225 FtITH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number (' AJm {)()Cf1. - om .::s co I LOCAlION OF INSTALLATION: -- ~ -- ~ ~- 3lfo &;(/J-{l-, Sf- LEGAL DESCRIPTI?N { S I('\"\ 1'\.0, -f,--e~ / JOB DESCRIPTION j: rr-IS'Ii\'tC- oUft.../ cJt. 0 Uu t--C- ort- PermIts are non-transferable and explfe If work IS not started wltblD 180 days of Issuance or If work IS Suspended for 180 days 2 CONTRACTOR INSTALLATION ONLY -/ ElectTlcal Contractor Address CIty ExpIratIOn Date ~ Owners Name [(OeM aJ. ~(te ~~Le. 111 u.e( fe-r Address '7'fo WOf"- S', CIty .0~n V\~-,dd Phone 72-~ ::>;~ 20 ./ OWNl1ftllSS'TJruL/om(!Nn law requires you to The mtlr.\lIaliOnli~beiR'pg\rJ18Y tpe Oregon Utll~,'!u, ~Id,". o'l-n r~iil~lftThd!;g'PloIlg'$YaIG'1Wt't(!,= IS not Intenueo for Sale, ei e or renfgh OAR 952-001- In OAR 952-001- IU U Inruu o v" ay taln caples of the rules by wn n e c er (Note the telephone n,~v Notification en er Is1-S00-332-2344) InspectIOn Request 726-3769 SPRINGFIELD ~~ 3 COMPLE1 E FEE SCHEDULE BELOW L ~ _ _ A New ResIdential - Smgle or MultI-Family per d\\elllng umt 1.__ __ _ -"" ~_ _~M ~ _--L.~ ServIce Included 1000 sq ft or less Each addItIonal 500 sq ft or portIOn thereof Each Manufact'd Home or Modular Dwelhng ServIce or Feeder $1]700 $ 2100 $55 00 - T' r-- - ~- - -- "... - ---."~- B ServIces or Feeders - Ins!.illatlOn, AlteratIOns or RelocatJon 200 Amps or less I $ 70 00 70,(30 201 Amps to 400 Amps $ 83 00 401 Amps to 600 Amps $13800 60 I Amps to 1000 Amps $18000 Over 1000 AmpsNolts $41300 Reconnect Only $ 55 00 C Temporary ServIces or Feeders InstallatJon, AlteratIOn or RelocatIOn 200 Amps or less $ 55 00 20 I Amps to 400 Amps $ 76 00 40 I Amps to 600 Amps $11000 Over 600 Amps or 1000 Volts see "B" above D I B"';~~h CIfl:mts New AlteratIOn or ExtenSIOn Per Panel One CIrcUIt $ 48 00 Each AddItIonal CIrCUIt or wIth '7 2- <{,(,)O ServIce or Feeder PermIt $ 400 ,~~ -- E MIScellaneous (Servlce/feeder Dot mcluded) -Each InstallatJon Pump or ImgatlOn $ 55 00 SIgn/Outline Llghtmg $ 55 00 LImIted Energy/Resldentlal $ 28 00 LimIted Energy/CommercJ31 $ 50 00 MIDIIDum Electric PermIt Inspection Fee IS $50 00 + Surcharges 4 :- S~UBT01:~~~ff.BOVE ' . crt OU 12% State 'lr@iWg~nrT SHALL EXPIRE IF TH:i~~7"" 10% Adml is\rafivePe~ ~ ' 'iS1) 5% Techn~l~liF1gIZED UNDER THIS PERMIT Iv rl i <if) ,Clhf"vIENCED OR IS ABANDONED TOTAL ,INY 180 DAY PERIOD /~4 4b Shared Dnve(T )lBuildmg Forms/Electncal Penmt ApplicatIOn 1-08 doc -it. I I CITY OF SPRINGFIELD I Status Issued Building/Combination Permit PERMIT NO: COM2008-00936 ISSUED 06/27/2008 APPLIED' 06/27/2008 EXPIRES. 12/27/2008 VALUE 225 F,fth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 F,lx 541-726-3769 InspectIOn LlOe SITE ADDRESS 340 66TH ST ASSESSOR'S PARCEL NO 1702344200201 SprIngfield TYPE OF WORK Electncdl Work Only TYPE OF USE AlteratIOn ResldentJal PROJECT DESCRIPTION Feeder and CirCUIts for shop Owner MUELLER THOMAS D & MICHELLE Address 340 N 66TH ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type ElectrIcal Contractor OWNER LIcense ExpiratIon Date Phone BUILDING INFORMATION I # of UllltS PrImary Occupanc~ Group Secondary Occupdncy Group PrImdry Constructloll Type Secondary ConstructJon Type # of Bedrooms # of StorIes HeIght of Structure Type of Heat Water Type Range Type Energy Path SprInkled BUIld 109 Lot SIze Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load nla I DEVELOPMENT INFORMATION I REQUIRED PARKING FrontYdrd Setback SIde I Setback S.de 2 Setback Rearyard Setbdck Solar Setbacks Overlay Dlst # Street Trees Rqd P dved DrIve Rqd % of Lot Coverage Totdl Handicapped Compact I PUBLIC IMPROVEMENTS I Street Improvements Storm Sewer AvaIlable SpeClaIIIllli'.l!ct,LQ!l A I r l:N lIuN Oregon law reqUires you to Notes follow rules adopted by the Oregon Utility Notification Center Those rules are set forth S,dewalk Type DownspoutslDralOs ~:-: ~^.~ ::: ::~ ::~: ::-, ":W...J:", J,~ ~ ::: ::31 0090 You may obtam caples of the~1 sbv D I NOTICE- 1JiratlOn escrlotlOn . calling the center (Note the tele .. THIS PERMIT SHALL EXPIRE IF THE WORK number for the Oregon Utility NotlflcalJon DeSCrIptlO1I Cemwet6rti\l~,w,haa44) ~Per Sq Ft Square Fo.dtli!'ejORIZED L~Y;\f-..R THIS P\;~M[a~Jll,QJi or multJpller or BId AIl{9/lR\MENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD Paee I of2 -Wi ~ . Status Issued CITY OF SPRlNGFmLl} Building/Combination Permit PERMIT NO: COM2008-00936 ISSUED: 06/27/2008 APPLIED. 06/27/2008 EXPIRES' 12/27/2008 VALUE: 225 F,fth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fa. 541-726-3769 InspectIOn Lme Total Value of ProJect Fees Paid I Fee DescriPtIOn + 10% AdmmlstralIve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend ClrC Ea Add Perm ServlFdl 200 amps or less Amount PaId Date PaId ReceIpt Number $980 $1176 $490 $28 00 $70 00 6/27/08 6/27/08 6/27/08 6/27/08 6/27/08 2200800000000000979 2200800000000000979 2200800000000000979 2200800000000000979 2200800000000000979 Total Amount PaId $124 46 I Plan Reviews I To Request an mspectlOn 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 followmg work day I RellUlred InsnectJOns I ElectrIC ServIce Approval required prIor to ulIlIty company energIZIng servIce Rough ElectrIC Pnor to Cover Fmal ElectrIC When all electrIcal work IS complete By sIgnature, I state and agree, that I have carefully exammed the completed appllcalIon and do hereby certify that all mformdtlOn hereon IS true and correct, aud I further certIfy that dny and all work performed shall be done m accordance WIth the Ordmauces of the City of SprIngfield and the Laws of the State of Oregon pertammg to the work descrIbed herem, and that NO OCCUPANCY WIll be made of any structure WIthout permISSIOn of the Commumty ServIces DIVISIon, BUlldmg Safety I furthel cerlIfy that only contractors and employees who are 10 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 lIme, thdt each address IS reddable 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 2 of2 . 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 - Pemllt# COmr:JnoR ~ (J()C!f3~ Address 34() (nu-t:h st Issued by ~ 1t1,/ I Date ~/ 0;:( I Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law. ORS 701 055(4) requires resIdential construction permit appltcants who are not ltcensed With the ConstructIOn Contractors Board to Sign the followmg statement before a bUlldmg permit can be Issued This statement IS required for resldenttal buddmg, electrical. mechamcal and plumbmg permits Licensed architect and engmeer applicants, exempt from ltcensmg under ORS 701 010(7), need not submit this statement This statement Will be filed With the permit FIll m the appropnate blanks and Imtial boxes 1 and 2, and either box 3A or 3B k11 eJ 2 I own, reside m, or Will reside m 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 mstruct 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 IfI hire subcontractors, I will lure only subcontractors licensed With the Construction Contractors Board IfI change my mmd and lure a general contractor, I Will contract With a contractor who tS lIcensed With the CCB and wlllnmnedlately notJfy the office Issumg this buIldmg permit of the I name of the contractor I hereby certify that the above mformation IS correct and that I have read and do understand the InformatIOn Notice to Property Owners about Construction Responslblhties on the reverse Side of thiS form. ~1{ ~ I' (S'I at e of permit applIcant) ~/u!o?; I (Date) (WhIte copy to Issumg agency permit file. pmk copy to appltcant) Property_owner doc 06-01-04 , , ' Actib.g as 'Your-\{)W'n General Contractor? J INFdRMATION\~i>TICE TO PROPERTY OWNERS c ABOUT CO~SrRUCTION 'RESPONSIBILITIES . , " NOTE This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board m accordance with ORS 701 055(5), passed by the 1989 Oregon Legislature If you are actmg as your own contractor to construct a new home or make a substantlal tmprovement to an eXlStlng structure, you can prevent many problems by being aware of the following responSlbllItles and concerns Employer Responsibilities You WIll, m most mstance,s, be ruled to be an "employer" jl1ld the contractors you contract Wlth WIll be "employees" If you use contractors not Itcensed Wlth the ConstructIon Contractors Board to do labor m constructmg or to assIst In the constructlon or lIpp~ovement of a resldentlal siruiture ,As the employer, you must comply with the following: \' . 4 Oregon's Wlthholdlllg Tax Law: As an employer, you must WIthhold mcome taxes from employee wages at the tlme employees are paId You WIll be lIable for the tax payments even If you don't actually WIthhold the tax from your employees For more mformatlon, call the Department of Revenue at 503-378-4988 Unemployment Insurance Tax: AI; an employer, you are reqUIred to pay a tax for unemployment Insurance purposeS" on the wages of all employees For more Informatlon, call the Oregon Employment Department at 503-947-1488 , The Oregon Busmess Ident1ficatlon Number (BIN) IS a combined number for both Oregon Wnhholdmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or WViW dor state 01 us/formsnav htmll for the appropnate forms Workers' Compensation Insurance: As an employer, 'you are subject to the Oregon Workers' CompensatIon Law, and must obtam workers' compensatIOn Illsw;an~e for your employe~s If you fall to obtam workers' compensatlon msurance, you could be subject to penaltles and be liable for all claim costs If one of your employees IS mJured on the Job For more mformatlon, call the Workers' Compensation DIVISIon at the Department of Consumer and Busmess Servtces at 503-947-7815 U.S. Internal Revenne ServIce' As an employer, you must Wlthhold federal mcome 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 1-800-829-4933 aT VISIt thetr web sIte at www us !lOV Other Responsibmtnes and Areas of Concerns Code Compltance As the permIt holder for thIS proJect, you are responsIble for resolVIng any faIlure to meet code reqUIrements that may bc brought to your attl:JC1tlon through mspect10ns LIability and Property Damage Insurance: Contact your msurance agent to see If 'you have adequate msurance coverage for aCCIdents and omISSions such as falling tools, pamt over spray, water damage from pIpe punctu~es, fire or work that must be redone : "') \ .. ~ \ - --' 1.\ " J) Time. Make sure you have suffiCIent tlme to supervIse your employees , Expertise. Make sure you have the skIlls to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notlfy bmldmg offiCials as the appropnate tImes so they can perform the reqUIred mspectlOns If you have addItIOnal questlons call the Constructlon Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Property_owner doc 06-01-04 225 Fifth Street Sprmgfillld, Oregon 97477 541-726-3759 Phone 6~ WiL_ I I City of Sprmgfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00936 COM2008-00936 COM2008-00936 COM2008-00936 COM2008-00936 Pdyments 1 ype of Payment Check cRLcemtl RECEIPT #. 2200800000000000979 Date. 06/27/2008 8 52 22AM Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + ) 0% AdmInIstrative Fee Amount Due 7000 2800 490 II 76 980 $124 46 PaId By mOMAS MUELLER Item Total l;heck Number AuthOrization ReceIVed By Bdtch Number Number How Received Amount Paid ddk 3895 In Person Payment Total $124 46 $12446 Page 1 of ) 6/27/2008