HomeMy WebLinkAboutPermit Electrical 2006-10-02SPFIINGFIELO I::::: ;1I]: :.:1.,r.
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JOB DESCRIPTION
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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 :
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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
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0qfl$,ltclohPhonc
ulllltv .00
Service $ 3.00 L
E.
I
$106.00
$ 19.00
$s0.00
City
t Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners
200 Amps or less
201 Amps to 400 Amps
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
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Owners Name
Address
City Tlf tt-toC"$ 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
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Inspection Request: 726-3769 TOTAL
Shared Driv{T:)/Building Forms/Eletrical Permit Application 8-06.doc
{ {ITY OF OREGON
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LEGAL DESCRIPTION:
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N{iscellaneous (Serltce/feeder not
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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
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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.