HomeMy WebLinkAboutPermit Electrical 2019-09-09SPRINGFIELD
OREGON
Web Address: www.sprlngfi eld-or.9ov
Building Permit
Residential Electrical
Permit Number: 811-19-OO2077-ELEC-Ol
IVR Number 811057858987
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
54r -7 26-37 53
Email Address: frermitcenter@springfi eld-or.9ov
Permit Issued: September 09, 2019 P.oject:
Category ot constructlonr None Specified
Submltted Job Valuer $0.00
Description of Work: Add 220 circuit for water heater
Type of Work: None Specified
Worksite Address
1125 58TH ST SPC 66
Springfield, OR 97478
Parcel
t702342200tOO
Owncri
Address:
TURPIN LARRY L
PO BOX 71641
SPRINGFIELD, OR 97475
None Specified
Inspection Status
Pend ing
Pending
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,buildingpermits.oregon.gov
Call or text the word 'schedule" to 1-888-299-2821 use IVR number: 811057858987
Schedule using the Oregon ePermitting Inspection App, search 'epermitting" in the app store
Permlts etplr€ It work 15 not stsrtGd wlthln l8O D.y6 of lsruance or lf work l. surpGnded for 18O Days or long€r d.p€ndlng on
the lctulng rg.ncy's pollcy.
All provlsion. ol laws snd ordlnancGs gov6rnlng thls type ot work wlll b6 compll€d wlth whother.p€clfiGd hereln or not.
Grantlng ot a pcrmlt does not presull|! to elvc authorlty to vlolat€ or canc€l the provlsiona of any othcr state or lo<al law
tcgulatlng connructlon or thc lrartormancG of conitructlon.
ATTEIiTION: Or.gon law raquircs you to follow r!l.. adoptGd by thc Orcgon Utility otlflcation CcntGr. Tho3€ rulla arc a.t
torth in OAR 952-OO1-OOl0 through OAR 952-O01-OO9O. You may obtiin copies ot th€ rulc. by crlllng th. CentGr .t (5O3)
232-1987.
All P€raona or Gntitl.. performlng work undcr thli pGrmit.rc requlrad to be llcens.d unlc.. €x.mpt.d by ORS 7O1.O1O
(Structur.l/XGchanlc.l), ORs 479.540 (Electrlcal), .nd ORS 693.01O-O2O (Plumblng).
Printed onr 9/9/19 page 1 or 2 C:\myRepo'1s/reports//p.odudlon/01 STANDARD
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TYPE OF WORK
JOB SITE II{FORMATION
LICENSED PROFESSIONAL INFORMATION
PENDING INSPECTIONS
Inspection
4999 Final Electrical
4500 Rough Electrical
Inspection Group
Elec Res
Elec Res
SCHEDULING INSPECTIONS
Permit Number: 811-19-OO2O77-ELEC-O1 Page 2 of 2
F€€ Descrlption
Balance of minimum permit fees - electrical
Branch circuits without service or feeder
Technology Fee
State of Oregon Surcharge - Elec ( 129o of applicable fees)
Quantity F€G Amount
$13.00
$89.00
$s.10
$t2.24
$119.34Total Fees:
c:\myReports/rcports//productlon/01 STaNDARD
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CITY OF SPRINGFIELD, OREGON
Electrical Permit A Iication
6,
225 Fifth Srr€eI. Sprirsfield, OR 97477. PH(541)?2G3753. fAx(s.t I )72C3589
This permit is issued under OAR 918-309-0000. Permits are rontrsnsferable. Permits expir€ if work is not started within 180
days of issuance or if work is suspended for lEo days.
CATEGORY OF CONSTRUCTION
ffiesidential ! Commercial
JOB SITE INFORMATION AND L
Job site address tL
city!PLt,tKzFreU>State: Q/?zvtq n//78
Reference:
DESCRIPTION OF WORK
I D5Tnt-L- Et Ecz'r4tc z-L Poo., er,- Fnz
U)/?-
PROPERTY OWNER
Name
5
cnv I)State ZIP
Phonegi/-1/4- / t/7L Fax:
E-mail: .-_--.-...-
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or re . OAR
479.540( l) and 479.560(l).
-.--/2Sigrntwe: d\77- o- - J.
CONTRAdTOR INSTALLATION,
Business name
Address
City State
Fax
E-mail
CCB license no.BCD license no.
Signing supervisor's license no.:
Print name ofsigning supervisor:
Signature of signing supervisor:
DEPARTMENT USE ONLY
St1- 2o??-Pemrit no
1/o / rzI)ate
FEE SCHEDULE
Numb€r of itrspectionr per item ( )Qty Cost
etr.
Totel
cost
Residentisl, per unit, service includcd
1,000 sq. ft. or less (4)s186.00 $
Each additional 500 sq. ft. or portion
thereof $36.00 $
Limited energy (2)s44.00 $
Each manufactured home or modular
dwelling service or feeder (2)s89.00 $
Services or fe€ders: instal lorion. alterotion- relocarion
200 amps or less (2)$l12.00 $
201 to 400 amps (2)$l3l.00 s
401 to 600 amps (2)s22r.00 s
$601 to 1,000 amps (2)s285.00
$654.00 $Over 1,000 amps or volts (2)
$89.00 $Reconneo only (2)
Temporary services ot feederci installation, aleration, relocation
s89.00 $
201 to 400 amps (2)$122.00 $
401 to 600 amps (2)$177.00 5
Over 600 arnps or 1,000 volts, see services or feeders section above
Branch circuitsi rrel1 olterotion, e{ension per panel
a. Fee for branch circuits with purchase ofa service or feeder fee:
s8.00 $Each bianch circuit
b. Fee for brarch circuits without purchase of a service or feeder fee:
Filst branch circuit (2)s89.00 5
Each additional braach circuit s8.00 5
Mls{ellrneous fces: service orfeeder not included
s89.00 $Each pump or irrigation circle (2)
sr 02.00 $Each sigr or outline lighting (2)
Signal circuit or a limited-enetgy panel,
alteration, or extension (2)$r02.00 $
i,Eich sdditioral inspection: ( I )
DEPARTMENT USE
t/aL(A) Enter subtotal of above fees
(MiDimum Permlr Fec $102.00)
(B) Enter l27o surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through D):
t
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? n Yes flNo
E Govemment
Taxlot.:
Address:
ZIP:
Phone:
200 amps or less (2)
$r02.00
$
$
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Lrst edited 7/l/2019 BJones
Propefi Owner Statement
Regarding Gonstruction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contraclors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 l2ll
I have read and undeEtand the lnformation Notice to Homeownerc About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
L ou It--
Print Name Permit Applicanl
s of Permit Applicant
7-"-4
Date
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 be filed with the permit.
I own, reside in, or will reside in the completed structure and my general contractor is
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
X 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, lwill hire only subcontractors licensed with the Construction
Contrac{ors 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 lhe name of the contractor to the ofiice
issuing this Building Permit.
aq- ?-oo /l- €
Address 1(2f {7*L #ao
Q^feeo IY
Date
q1??F
This Copy for Permit Offices
Please check the apProPriate box:
Permit #:
lssued by:4?-
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a
HomeowneE acting as their own generill contracto6 to construct a
or make a substantial improvement to an existing structure, can ptevent
by being aware of the following responsibilities:
Homeowners who use labor provided by workers not Iicensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employeeJ. As an employer, you must comply with the following:
oregon,s withholding Tax Law: Employers must withhold income taxes from employee wages
at th-e time employeesire paid. You will be liable for the tax payments even if you dor't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-3784988.
Unemployment lnsurance Tax: Employers are required to pay a tax for Unemployment insurance
purpo""r 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
Withiolding and Unemployment lnsurance Tax. To file for a BlN, go online to the Oregon Business
Registry. For questions, call 503-945-8091 .
Workers Compensation lnsurance: Employers are subjecl lo the Oregon Workers Compensation
Law, and must obtain workers compensation lnsurance for their employees. lf you fail to obtain
wo*"r, compensation lnsurance, you could be subject to penalties and be liable for all claim costs
it on" of yorr *orkers is injured on the job. For more information, call the workers compensation
Oiri"ion it tn" Departmeni of Consumer and Business Services at 800-452-0288'
Tax Withholding: Employers must withhold social security Tax and Federal lncome Tax from
;;by;; *"g"i yor',iy be liable for the tax payment, even if you didn't actually withhold the tax'
For a Federal EIN number, go online to www irs oov'
lnformation Notice to Owners About
Construction ResPonsi bi I ities
(oRS 701.325 (3))
new home
many problems
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 973095052
Telephone: 503-378-4621 - Fax: 5033732007
Website Address: www. oregon. gov/ccb
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Other Responsibilities of Homeowners:
CodeCompliance:ASthepermitholderforaconstructionproject,thehomeownerisresponsible
t*
""t,tying
Orilding officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections'
PropefiDamageandLiabilitylnsurance:HomeownersactingaStheirowncontractorsshould
coniact [heir insu]rance agent to ensure adequate insurance coverage for accidents and omissions'
sucn as tatting tools, paini overspray, water damage from pipe punctures' lire' or work that must be
redone.Liabilitylnsurancemustbesufficienttocoverinjuriestopersonsonthelobsitewhoarenot
oihenrvise covered as employees by Workers Compensation lnsurance'
Expertise:HomeownersshouldmakesuretheyhavetheSkillstoactastheirowngeneral
"o,iri""tor.
and the expertise required to coordinate the work of both rough-in and fnish trades.
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r/6h^a,h, ^wnar r.l^nre.i C-2O16 This Copy for Permit