HomeMy WebLinkAboutPermit Electrical 2018-10-10SPRiNGFIELD City of Springfield
Developfient and Public Works
225 Fifth Street
Spnngfield, OR 97477
541-726-3753O REGON Building Permit
Residential Electrical
Permit Number: 81 1-18-002404-ELEC
IVR Number: 81 10031 95533
Web Adoress www.sOinofr€ld-or'.oo!Email Aooress: permitcenter@spnngnelo-or.go!
Permit lssuedi OctoDe' 10 2018
...]Y.PE OF WORK . , '
Category of Constructioni Single Family Dwelling
Submitted Job Value: S0.00
Description of Work: Replace eleclncaL box
Type of Work: Replacement
JOB.STTE INFORMATIOI{
Worksite address
'1163 QUINALT ST
Springfield OR 97477
Parcel
1703264106900
Owner:
Address
MCGILVERY JAMES D
i 163 QUINALT ST
SPRINGFIELD OR 97477
LICENSEO PROFESSIOTTAL INFORi'ATION
Business name
OWNER - Primary
License License number
000000
Phone
lnapection
4999 Final Elect(cal
4999 Final Electrical
4500 Rough Electncal
4225 Service or Feeder
lnspection group
Elec Res
Elec Res
Elec Res
Elec Res
lnspecuon status
Pending
Pending
Pendrng
Pending
SCHEDULING INSPECTIO}IS
Various rnspections are minimally required on each prqect and often dependent on the scope of work. Contact the issuing
JUrisdiction indicated on the permit to determine required inspections for this project
Scnedule or track inspectons at www.buildingpermits oregon.gov
Schedule by phone cal ''-888-299-2821 use IVR number 811003195533
Schedule usrng the Oregon ePermitting lnspection App. search 'epermitting" in the app store
Permits must be postod an clear view on the worksite. Permits expire if work is not staned within 180 Oays of issuance or it work is
6uspended for 180 Deys or longer depending on the issuing agency's policy.
All provisions of lews and ordinances gove.ning this type of work will be comphed with whether speclfied herein or nol Grenting of
a permh aloes not prcsume to give authority to violate or cancelthe provisions ot any other state or local law regulating construction
or lhe performance of construction,
ATTENTION - CALL BEFORE YOU DIG: Oregon law reguires you to foliow rules adopted by the Oregon Utility Notific.tion Center.
Those rules are set ,orth in OAR 952-001{010 through OAR 952{01-0090. You may obtain copies of the rules by calling the Center a!
(877) 668.1001 or dial 811.
All perBons or entities perlorming work under this permit are reguired to be licensed unless exempted by ORS 701.010
(Structu.au echanical). ORS 47S.5,a0 (Electrical). and ORS 593.010{20 {Plumbing).
Pnnred on 10/10/18 PaoE i ol2 std_BuildrngPerma._p'
{s
PENDllrlG INSPECTIONS
Permrt Number 811- 18-002404-ELEC Page 2 ol 2
Fee Description
Services 200 amps or less
Technology Fee
State of Oregon Surcharge - Elec ( 12olc of applicable fees)
Quantity
Total Fees:
Fee Amount
$ 109.00
$ 13.08
s1,27 .53
Pnnteo on 10/10'18 oage 2 a: 2 sto_BuilcjrngPermr._p'
PERMIT FEES
5PfllricflEt0
&
OREGO N
'r rvw springfield'or gov
Transaction Receipt
811-18-002404-ELEC
Roceipt Number: 468294
Receipt Date: 10/ 10/18
Cily of Spnngfi€ld
Dewlopment a.d Pob c Works
225 Fifth St.eet
spnngneE, oR 97477
54t-126-3753
permke.ter@sp.inqrield-or.cov
lvortsiie address: 1163 OTJTNALT ST. Spring ield, OR 97477
Parcel: 1703264106900
Fees Paid
10/10/18
Uniit
100 Ea Servrces 200 amps or less
Srale of Orego. Surcharge - Elec (12'A ol
22+O00m-426102-1033 $109 @ s109 00
10/10/r8 100 Ea
1 0O Aulomatac Tecinology Fee
821 -0000+21 500+0000
1o(}moo{1r2560t0000
s13 0a
$5.45
$13 08
$5 45
Payment Method: Credn card authonzation
072214
Payer:james mcgilvery $127 53
Pnnr6d: 1o/10/r8 r1 23am
t127.s3
FrN Ir..3.donR@Dtj.
10t10t14
Cashier Katr na Alrdelson
Electrical Permit Application
225 Fifth Street.Springfi€ld. OR 974774PH(5,41)726-3753.FAX(541)726-3689
This permit is issued uDder OAR 918-309-0000. Permits are trotrtransferable, Permits expire if work is trot started withiD 180
days of issuance or if work is suspeoded for 180 days.
Job site address 1
FEE SCHEDULE
NuEber of iospections per item ( )Coster-Totalcost
Residetrtial. per unit, senic€ included:
1,000 sq. ft. or less (4)s181.00 s
S 00 S
Limired energl (2)
Each manufactwed home or modular
dwelling service or feeder (2)s 86.00 sReferenceTalilot
Services or feeders: insrallat ion. altera,ion. relocation
PROPERTY OWNER s127.00 s
E-mail:j;)1._tnc;
This installation is being made on residential or farm propert-v
owned by me or a member of my immediate famill. This
propes is not intended for sale. exchange. lease, or rent. OAR
479.s40(1 ) and 419.560(l).
200 amps or less (:)
Brstrch circuitsi neia. alteration. etension per panel
Business name a. Fee for bBnch circuits with purchase ofa service or feeder fee
Each branch circuit s 7.42 s
b. Fee for branch circuits without puchase ofa service or feede, fee: i
sFelxcF't!ol--
l-L..€&,4SYiiB.,tr,\
i tNql+ t
S
5
ureallgnS
s
S
Each additional bmnch circuit
Each pump or irrigation circ)e (2)s 86.00
Signal circuil or a limted-energ-v panel. I s 99.00I alEration. or exension (2)
i Esch additiodal iDspection: (1)
E-mail
CCB license no
Signing supen,isor's Iicense no
I Print name ofsipning supervisor:
BCD license no
Siglature of signing supervisor:
(A) Enter subtotal of above fees
(Mirimun Permit Fee 599.00)
(B) Enter t 29i, surcharge (.12 x [A])
s
s
s
DEPARTMENT USE ONLY
Permitno.: 16-ooXott
o"t", )O lo IB
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? ! Yes n No
CATEGORY OF CONSTRUCTION
I Residential E Govemment
JOB SITE INFORMATION AND LOCATION
Cin 1 Stzte: Qfl ZP 77
DESCRIPTION OF WORK
R"t-c"l fut
5 *l-'Name : t'66
Address: 77 Oqu/t lf
ztP,97t/ 7 7Cir;*: f,p o $;-;Ll Stl,te: OR
Yr,"""'jq,f4- 3pl
CONTRACTOR INSTALLATION
Address
Srater)wCitr
i Fax:
I s 109.00 S
oo200 amps or less (:)
201 lo 400 amps (:)
s215.00401 to 600 amps (:)
601 Io 1.000 amps (2)s277.00
Over 1.000 arnps or volrs (2)$635.00 S
Reconnect only (2)i s 86.00
s 86.00 5
201 to 400 amps (2)s 118.00 s
s172.00401 ro 600 amps (21
Over 600 arnps or 1.000 voits. see services or feeders section above
s E6.00
s 7.42
First branch circuil (ll
5
Miscellineous fees: rervice or feeder not included
S
00 5sEach sien or outline lighting (2)
|
Ss99.00
DEPARTMENT USE
$121"6TOTAL fees and surcharges (A through D)
Last edit€d 7/1/2018 BJones
(C) Technolos Fee (5% oflAl)
(a7
E Commercial
Phone:
Fa)(:
I Each addinonal 500 sq. ft. or poftion
I thereof
ls*.oo ls I
$
Temporar-v services o a leede'|s'. installation. aheratioh, relocation
ZIP
CITY OF SPRTNGFIELD, OR-EGON
loo.
F r-e p=rti; e',.rns r Statem s nt
Regai'd i n g eonsti'ucrion Respons ibi lities
-|r=,.ri-\nl,\rj:=.l,!r=.-=<id:--::j^lr'<:;:,r-r,:nnar,r;:rrlir::;<
Con-st;-rciron Ccnii:cicrs Soaic ic sign the iolloiving steiemeni befora a buiicing par-.-irii can D€
:rcr,:; ,aE<:na tri , t1l
Name E:piratioft Date
I will inform my general contractor that all subconi-3ctors who work on the structure [']ust be
Iicensed wiih the Construction Contractors Board.
ot
=+I will be performing work on property I own, a residence that I reside in, or a residence that lwill
reside in. lf I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. lf I change my mind and hire a general contractor, lwiil select a contmctor
who is licensed will the CCB and wiil immedlately give the name of the contractor to the ofice
issuing this Building Permit.
I have read and undersiand the lnformation Notice to Homeowners About Consiruction Responsibililies,
afld I heraby certiry that the information on this homeowner shtement is true and accurate,
Jorrr 2 n:.1.
Pnnt Name of PermitApplicani
',ru7,U''rtrt.,lolilr*
FE*t.*;iP;itApph;t Dara
Permit #:
Address
0
otbl,
w_
lssued by:)D Bat-.
This Copy for Pemit Oifi.'J
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informaiion lJotiee to Owners Abotiflnnef i"E rnf inn Reennnqih !iir
!;necwnais:c:jj-_! zsi:€it'ovin gEiei:l ccni:=c:ors ic corsi:!c: = :'lsy!'i:i:
:i --ilii ::!:::::i.=i --r:::'.'-:--'::::: :;'l :--"-rS::--.: =i:'i:--:.i;n. :i_'l :r_i.:: :l=-' l::- : ::
:1. :a::.; :w:-: ei:-i iailcwin-c '=srcnsrLiiiii==:
Oragon's ij,iiihholding Tax L:w: -mployers musi wiihholi income iexes iiom employe= wages
at the tim€ employees are paid. You will be liable for the tax payments even if you don't actually
wiihhold the tax from your employees. For more inJormatjon, call the Department of Revenue at
503-378+988.
Unemployment lnsurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of a,i employees. For more infonnation, call the Oregon Employment
Department at 503-947-1488.
Oregon's Business ldentification Number (BlN): is a combined number- for both Oregon
VVithhoiding and Unemployment lnsurance Tax. To file for a BlN, cail 503-945-8091 or go to
n 11-055 for the appropriate forms
Workers Compensation lnsurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. lf you faji to obtarn
Workers Compensatjon lnsurance, you could be subject to penaities and be liable for ail claim costs
if one of your workers is injured on the job. For more informatjon, call the Worl<ers Compensation
Division at the Department of Consumer and Busjness Services al503-947-7815.
Tax Withholding: Employers must withhold Socral Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federai EIN number, call the IRS at 1-800-829-4933 or visit their website at www irs oov.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE; Suiie 300, PO Box 14140, Salem, OR 9730*5052
Telephone: 503-378-462'1 - Faxr 509373.2007
Website Address: www oreoon oov/ccb
Other Responsibilities of Homeowners :
Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifyjng building officials at the appropriate times, so that the required inspections can be
performed. HomeowneTs are also responsible for resolving any iailure to meet code requir-ements
that may be found through inspections.
Property Damage and Liability lnsurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. L)abiiity Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensatlon lnsurance.
Expertise: HomeowneTs should maka sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and inish trades.
i/DroDe.W owner adopted 9-2-3-08 This Copy for Per,nit Applicant
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