Loading...
HomeMy WebLinkAboutPermit Electrical 2006-10-02SPFIINGFIELO I::::: ;1I]: :.:1.,r. ,,' :,i r:- ,. @,"'.;.'':i ZON INITIALS DATE I n03s9sq D S6oo JOB DESCRIPTION /oo ,,w/s L Z crrc-,il Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. 00TTRACTORTNSTALT'ATTON ONLY Electrical Contractor Address tt0,T,t$iL: Phone AUT'hISRIZED c0MMENU ED Supervisor License Number $ Auutao DAY PE Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Elecfician LOCATION OF INSTALI.ATION : Szt Pnoac >T- 225 FIFTH STREET . SPRINGFIELD,OR|T4TT . PH:(541)726-3753 r FAX: (541)726-369 E LE CTRICAL P E RM IT AP P LI CATI ON Ciry Job Number COr.tlZ>O6 -otzs't Date /0 -Z - csc 3. COXTPLETEFEE SCIIEDULE BELOV' A. New Residential - Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder B. Services or tr'eeders - Installation, Alterations or Relocation: / $ 63.00 43 A$,FtOT $ 7s.00 $ 125.00 $163.00 $37s.00 $ 50.00 C. Temporarl'services or Feeders Installation, Alteration or Relocation 200 Amps or less $ s0.00 law N 0qfl$,ltclohPhonc ulllltv .00 Service $ 3.00 L E. I $106.00 $ 19.00 $s0.00 City t Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners 200 Amps or less 201 Amps to 400 Amps Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial iP t- a Owners Name Address City Tlf tt-toC"$ s0.00 $ 50.00 $ 25.00 $ 4s.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SUBTOTALOFABOVE 8% State Surcharge 10% Administrative Fee 5% Technology Fee EY ss .{J- Inspection Request: 726-3769 TOTAL Shared Driv{T:)/Building Forms/Eletrical Permit Application 8-06.doc { {ITY OF OREGON souncef t?yPsfer,t.)5 LEGAL DESCRIPTION: rho rutas hI N{iscellaneous (Serltce/feeder not 0fl a , L1--------7s-------Z-o elpEH{aalall3,t-3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 I nspection Line P FIE Building/Combination Permit PERMIT NO: COM2006-01259ISSUED: 1010212006 APPLIED: 1010212006 EXPIRES: 0410212007 VALUE: SITE ADDRESS; 527 PARK ST ASSESSOR'S PARCEL NO.: 1703353405600 PROJECT DESCRIPTION: 200amp service and 2 circuits for garage Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential License Expiration Date Phone Owner: Add ress Contractor Type Electrical SMITH A WILSON 527 PARK ST SPRINGFIELD OR 97477 Contractor OWNER CONTRACTOR INFORMATION IILDING INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Typer # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes U # of Stories: Height of Structure Type of Heat: Water Type: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: ndicapped: VN 901\ 1H\S CEku ANY $ Per Sq Ft or multiplier Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot is1 Square Footage or Bid Amount Valuation Descriotion Description Tvpe of Construction Page I of2 Value Date Calculated affirI \t 1HE NOBK isuor r0Rnla 1H\S OF Building/Combination Permit Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2006-01259ISSUED: 1010212006 APPLIEDz 1010212006EXPIRES: 0410212007 VALUE: Fee Description + l0oh Administrative Fee + 57o Technology Fee + 87o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid $6.90 s3.4s $5.52 $6.00 $63.00 t0t2t06 t0t2t06 l0t2t06 l0t2t06 10t2t06 Total Value of Project Date PaidAmount Paid $84.87 Receipt Number l 20060000000000 l 475 r 20060000000000 r 47s I 20060000000000 r 475 l 20060000000000r475 I 20060000000000 l 475 Fees Paid Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all inlbrmation hereon is true and correcto and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws ol'the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I I'urther agree to ensure that all required inspections 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 remain on the site at all times during construction. Owner or Contractors Signature Paee 2 of 2 Date Lm Keourreo lnsDecilons I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Cir-' of Springfield Official Receipt D. ,lopment Services Department Public Works Department RECEIPT #: 1200600000000001475 Date: 1010212006 e:5e:40AM Job/Journal Number coM2006-01259 coM2006-01259 coM2006-01259 coM2006-0 t259 coM2006-01259 Description Perm ServiFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 570 Technology Fee + 8%o State Surcharge + llYo Administrative Fee Amount Due 63.00 6.00 3.45 5.52 6.90 Item Total $84.87 Payments: Type of Payment Paid By Received By Batch Number Number How Received Amount Paid Check A WILSON SMITH djb In Person Payment Total: $84.87 -sffi 670t cRecernl I Page I of I 101212006 Construction Contractors Board 700 Summer St ItlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ry[41lglgq permit g. COr*z.ror-- O lzt ? Address 5z- PA-rLt< Issued by:\(Date: / O o6 Et-2 Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement wtll befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: \ $- f . I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. tt -z oR { 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. lc ,(-o6 of permit applicant)@ate) (White copy to issuing agency permitfile, pink copy to applicant.) ( Property_owner. doc 06-0 I -04 Acting as Your Own General (Sntractor? )' INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RESPON$IBILITIES If you are acting as your own contractor to construst a new home or make a substantial improvement to an existing structure, you can prevent nrany problems by being aware of the following responsibilities and concerns" Employer Responsibitrities You will, in neost instances, be ruled to be an o'employer" and the contrastors you contract with will bp "employees" if you use ccntractors not licensed with the Construction Contractors Board to do labor in constructing or tc assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withhotding Tax Law: As an employer, you m*st withhold income taxes from employee wages at frre time empioyees are paid. You will be liable for the lax payments even if you don't actually withhold the tax from your employees. For more inforrnation, call the Departrnent of Revenue at 503-378-4988. Uuemployment fnsurance Tax: As an employer, you are requkeit to pay a tax{or unemployment insurance purposeb on tho wages cf ail employees. For more information, call the Oregon Employment Departm:!:f at 503-947-1488. ; The Oregon Business Identification Number (BIh{) is a combiaed number for both Oregoa.;Withhoiding and Unemployment1nsuranceTax.TofileforaBIN,ca1i503.945.8CI910rforthe Workers' Compensation Ins*rance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' cornpensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947 -7 8l5. U.S. Internal Revenue Service: As an employer, you must withhold federal incorne tax fronl 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 m"S 1t 1-800-8294933 or visit their web site at tlIuryJIEgQ-Y Other Respon$ibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any faiture to meet code requirements that may be brought to your attention through inspecticns' .,:: Liability and Property t)amage fnsurance: Contact your insurance agent to see if you have'ddetiuate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. i Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general conbactor, to coordinate the workof rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner. doc 06-0 I -04 NOfE; This lnformation Notice to Property Ourners about Canstruction Responsibilifies was developed by the Constructian Cantractars Board in accardance with ARS 7A1.055(5,), passed by the 1989 aregon Legislature.