HomeMy WebLinkAboutPermit Electrical 2019-09-12OREGON
Web Address: www.springfield-or.9ov
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-7 26- 37 53
Email Addressi permitcenter@springfield-or.9ov
SPRINGfIELD
Permit Issued: September 12, 2019
TYPE OF WORI(
Category of Construction: None Specified
Submitted fob Value: $0.00
Description of Work: Ductless Heat Pump
Type of Work! None Specified
fOB SITE IN FORMATIOT{
Worksite Address
1131 1ST ST
Springfield, OR 97477
Parcel
1703263301600
Owner:
Address:
KEELERCLAIREAS&
MATTHEW P
1131 1ST ST
SPRINGFIELD, OR 97477
LICENSED PROFESSIONAL INFORMATION
Business Name
OWNER - Primary
PhoneLicense
cc8
PENDING INSPECTIONS
Inspection
4999 Final Electrical
4250 Branch Circuits
Inspection Group
Elec Res
Elec Res
Inspection Status
Pending
Pending
SCHEDULI'{G INSPECTIONS
Various inspections are minimally required on each project and often dependent on the scope of work. Contact
the issuing jurisdiction indicated on the permit to determine required inspections for this project.
Schedule or track inspections at www. build ing permits. oregon.gov
Call or text the word "schedule" to 1-888-299-2821 use IVR number: 8LLO76Oa2724
Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store
All provisions of laws and ordinances gove.ning this type of work will be complied with whether sp€cilied hereln or not,
Granting of a permit does not presum€ to give authorlty to vlolate or canc€l the provisions ofany other state or local law
regulating constructlon or the p€rformance of construction.
ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility ltotiflcatlon Center. Those rules are set
forth in OAR 952-OO1-OO1O ttrough OAR 952-OO1-OO9O. Yoll may obtain copies of tl|e rules by calling th€ Center at (5O3)
232-L987 _
All p€rsons or entities pertorming work under this permit are requir€d to be licens€d unless exempt€d by ORS 701.O10
(Structural/uechanical), oRs 479.s40 (Electrical), and ORs 593.01o-o2o (Plumbing),
C \myRepo.ts/repo.ts//productron/01 STANDARo
tb Building Permit
Residential Electrical
Permit Numberr 81 1-19-OO2109-ELEC-01
IVR Number: 811076082724
License Numbea
000000
Permlts explre lf work is not started within 180 Days of issuance or if work is susp€nded for l80 Days or longer depending on
the issuing agency's pollcy.
Permit Number: 811-19-OO2109-ELEC-01 Page 2 of 2
Fee Description
Balance of minimum permit fees - electrical
Branch circuits without service or feeder
Technology Fee
State of Oregon Surcharge - Elec (l2o/o of applicable fees)
Quantity Fee Amount
$13.00
$89.00
$s.10
$t2.24
$119.34Total Feesi
C;\myReports/report /prcductDr/o1 STANOARD
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PERMIT FEES
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CITY OF SPRINGFIELD, OREGON
Electrical Permit A lication
225 Fifth Strerl.Springlield, OR 97{77rPH(541)726-3753.FAX(5,11)72G3669
DEPARTMENT USE ONLY
Permir no.: lq- @ kl
Date qlal>otlfr
(
This permit is iss[ed under OAR 918-3094000. Permits are nonlransferable. Permits expire if work is not sterted $'ithi[ 180
days ofissuance or if work is suspended for lE0 days.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
CostQtYea.
$
$Job site address: ,/,/eft
Number of itrspections per item ( )
R6idential, per unit, service included:CATEGORY OF CONSTRUCTION
I Commercialn Residential E Govemment
JOB SITE INFORMATION AND LOCATION
s186.00
s36.00
Total
cost
Each additional 500 sq. Ii. orpo(ion
Zonirg approval verified? ! Y". ! No
City: fu,lXafigl State: /f,!ztP: 47./771 Limited energy (2)
Reference:
CONTRACTOR INSTALLATION
/r
Address
City:
a
being made on
member of nry immediate
or farm properry
family. This
property rs not
479.540(l\ and
intended for sale, exchange, lease, or rent. OAR
$89.00 S
st 12.00 s
st 3l -00 S
s22r.00 S
s285.00 s
$654.00 s
s89.00 $
s122.00 S
st ??.00 $
Taxlot
PROPERTY OWNER
Name
tft
ZI
FaxPhor.ei1l
{, /a trl
Signature
Brroch circuits: ,ew olteration, extension per panel
over 600 amps or 1.000 volts, see services or feede$ section above
Services or fe€ders: irstallation, aheralion, rclocation
200 amps or less (2)
201 to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 anrps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
Temporrr.v serviaes ot l*ders: irstallation, a|eration, relocatioh
200 amps or less (2)s89.00 S
201 to 400 anrps (2)
401 to 600 amps (2)
This installation is
owned by me or a
Each manufactured home or modular
dwelling service or feeder (2)
a- Fee for branch circuits with purchase of a service or feeder feeBusiness nanrc
$Addrcss
b. Fee for branch circuits withoul purchase ofa service ot feedcr fce:ZIPCity
s89.00 SFirst branch circuit (2)FaxIJPhone
s8.00 SEach additional braoch circuitE-mail
S
S
S
Miscellaneous fees: se ice orfeeder not included
$89.00Each pump or irrigation circle (2)
s89.00Each sign or outline lighting (2)
s89.00Signatue of signing supervisor:
Print name ofsigning supervisor:
CCB license no.:
Signing supervisor's license no
Signal circuit or a limilcd.cncrgy pancl.
aheralioD. or extension (2)
SEech edditional inspection: (l )
OEPARTMENT USE
S
S(B) Enter l27o surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
$ i\q.9q
Lest edited ?/l/2019 BJones
1,000 sq. ft. or less (4)
s{4.00
DESCRIPTION OF WORK
State:
E-mail:
$t.00Each branch circuit
State:
BCD license no.:
sr02.00
(A) Enter subtotal ofabove fees
(Nlinimum Permit Fee S102,00)
s
TOTAL fees and surcharges (A through D):
F
Propefi Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed wilh the
Conitruction Contractors Board to sign the following statement before a building permit can b€
issued. (ORS 7O1.325 (2ll
This statement is required for lesidential building, electrical, mechanical, and Plumbing Pormits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statemenl will be filed with th€ permit.
:'] r own, reside in, or will reside in the completed structure and my general contractor ts
Name CCB#Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board'
or
ru lwill be performing work on property I own, a residence that I reside in' or a residence that lwill--- reside in. lf I hire Jub"ontr""tor5, lwill hire only subcontractors licensed with the Construction
Contractors Board. lf I change my mind and hire a general contractor, I will select a contractor
who is licensed with the ccB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and unde6tand the ln,ormation Notice to
anU t trereby certify that the information on this home
ck lre k
Homeowner€ About Construction Responsibilities,
owner statement is tlue and acculate.
a /2,/?
Date
.LK.-
Print Name of Permit Applicanl
gnalure ol Permit APPlicant
Address
\ZDatelssued
=5
q
Permil #\4 -@tcqrnrzrr+ H
\rg
Please check the aPProPriate box:
r
This CopY for Permit Offices
lnformation Notice to Owners About
Construction ResPonsi bi lities
(oRS 701.325 (3))
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 9730$5052
Telephone: 503-378-4621 - Fa(: 50+3712007
Website Address: wwworeoon.oov/ccb
Homeowners acting as their own general contEcto6 to constluct a new home
or make a substantial imiprovement to an existing structure, can prevent many problems
by biing aware of the following responsibilities:
a Homeowners who use labor provided by workers not licensed by the Construclion Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
oregon,s withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are Paid. You will be liable for the lax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
Unemployment lnsurance Tax: Employers 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 503-947-1 488.
Oregon's Business ldentification Number (BlN): is a combined number for both Oregon
Wthholding and Unempioymenl lnsurance Tax- To file for a BlN, go online to the Oregon Business
Registry. For questions, cail 503945-8091 .
Workers Compensation lnsurance: Employers are subject to the Oregon Workers Compensation
Law, and musl obtain Workers Compensation lnsurance tor their employees. lf you fail lo obtain
Workers Compensation Insurance, you could be subjecl to penalties and be liable for all claim costs
if one of your workers js injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
Tax Withholding: Employers must withhold Social Security Tax and Federal lncome Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
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For a Federal EIN number, g o online to www.irs.oov
Other Responsibilities of Homeowners:
Code Compliance: As the permit hoider for a construction projecl, the homeowner is responsible
for notifying building officials at the appropnate limes, so thal the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
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 accidenls and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone- Liability lnsurance must be sufficient to cover injuries to persons on the job site who are not
otherwrse covered as employees by Workers Compensation Insurance.
Expertise: Homeowners should make sure they have the skills to ac1 as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
a
^..,^6. ai^^f6.1 O_rni 6 This Copy for Permit