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Home My WebLink AboutPermit Electrical 2006-06-23Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax S4l-7 26-37 69 Inspection Line Buitding/Combination Permit PERMIT NO: COM2006-00783ISSUED: 0612312006APPLIED| 06t23t2006 EXPIRESz 1212312006 VALUE: SITE ADDRESS: 522 r4TH ST ASSESSOR'SPARCELNO.: 1703362304800 PROJECT DESCRIPTION: Install 200amp service Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential License Expiration Date Phone Owner: Address: RASMUSSEN EILEEN 53189 MCKENZIE HWY BLUE RIVER OR 97413 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Contractor Type Electrical Contractor OWNER gt Building Overlay Dist: # Street Trees R(d: Paved Drive Rqd: oh ofLot Coverage: VN Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:{d \o(nla \t st Type: REQUIRED PARKING Total: \.J$ Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: $ Per Sq Ft or multiplier ,s Square Footage or Bid Amount s: Valuation Description Description Type of Construction Page I of2 Value Date Calculated ,a ,,$' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line ITY F FIELD Building/Combination Permit PERMIT NO: COM2006-00783ISSUED: 0612312006 APPLTED| 06t23t2006EXPIRES: 1212312006 VALUE: Fee Description + l0o/" Administrative Fee + 87o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $5.04 $63.00 $74.34 Total Value of Project Date Paid 6t23t06 6t23t06 6t23t06 Receipt Number 1200600000000000957 1200600000000000957 1200600000000000957 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. Electric Service: Approval required prior to utility company energizing service. lnsnections By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, 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 of 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 further 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 ring construction. -29 .60 DateOwner or Contractors re Pase 2 of 2 r ees ralo I t.J)z SPP '\FIELD zoN INITIALS DATE SOURCEZfr,225 FIFTH STREET . SPRINGFTELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 E LE CTRICAL P EKM IT APP LI CATION City Job Number (6,,v12-o<>6- O 5 ?E3 1. LOCATIAN OF INSTALIATION t L{1-;- S J- Date LLa/L- -./ scHED(-tLr spt6h' A. Nerv Residential - Single or Multi-Family per dwelling unit. gZ LEGALlz 3 oLt &oo JOB DESCzuPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 7 Electrical Contractot t r ^ -.i Address -hontCiry $50.00 200 Amps or less | $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 AmPs $125.00 601 Amps to 1000 AmPs $163.00 Over 1000 Amps/Volts $375.00 Reconnect Only $ 50.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 New Alteration or Extension Per Panel $ 43.00 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 8% State Surcharge l0% Administrative Fee TOTAL $ r06.00 $ 19.00 C ONT RACT O R IN STALI-{TI O N ONI.I' v 1p:,-Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date S ignature of Supervising Electrician Yf,P IRE_IF.tE WORK (Owners Name Eiu:a(/ ab;il;/ssey' /-< -Address JdA ciWvnn"ffi*,/6{6 OWNER INSTALLATION The installation is being made on properry I own which is not intended for sale, lease or rent. Owners Signature: R THI $ l'00P OR -Each Installation PER10[).' Pump or imgation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy,&.esidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $'15.00 * Surcharges 4. SLiBTOTALOFABOT,'E LS SOT E $>o Inspection Request: 126-37 69 Shared Drive(T:)/Building Fonns/Electrical Permit Application l -06 doc 3. COIITPLETE FEE 3 B. Services or Ieetlers - Installation, Alteratiolrs or 0 E. .tu/4_ -i.A Construction Contractors Board 700 Summer St llE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.stataor.us 6*DO-? E3 SzL t"rtu_ S.l- Permit #: Address: Issued by:Date:Z 7 o (" Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensedwith the Construction Contractors Board to sign thefollowing statement before a butldtng permtt can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer appltcants, exemptfrom licensing under ORS 701 .010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 38: \ EK t. I own, reside in, or will reside in the completed structure. B X 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. tr 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. 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. ,6;b (Signature of permit applicant) @ate) (White copy to issuing agency pennilfile, pink copy to applicant.) Properly_owner.doc 06-0 I -04 Act$mg e$ thur fiwm &emerat'Cfntractor? INTCIRMAYION hIOT*SH TS PROP€RTY CIWNHR$ ABSUT EO'\{STft IJCTISN KT$F*NS}ENL'TIES IVOIE: ?$is Infonyration N*tis* to Propedy Owners abaut Constructi*rz &esp*nsibilrffes w,{?,$ d*velap*d *y f*e Consfnrc#on Oonfr*cfors Bcard in aecardaxco urifh CI&$ 7$?.05$f5J, pass*d by ttte ?$8$ Or*go* legislafurc" {f y*u are a*ting fi$ y{!*r *w,n c*::tra*N*r l* **nsln:et a new h*nte elr m*ke a subst*ntial iarprelve:x*nt t* an rxistir:g struetxr*, you fia:r pr*v*n{ many prcblesns by being aware l:f the folloxring r*sponsibilities and s*nfemts. ffi xxap&wyer Kssp*mstblXtfics Y** wiltr, in mcst instanc*s, be ruied t$ i:e sn "empl*y*r'* and the ccnkactors y*u ***ira*t rvith w'iII i:e "emp3*y*es'* if, ysrr u$* contractors n*t li**r:sed with tke Cernstn-'iati*n Contrast*rs ffioard t* d* iab*r in c*nstn:*ting tir Nl: sssist in th* co*stru*ti*n cr impr*vsm*xt *f * r*sid*ntial $tru*nx*rs. &s the ertlp[*y*r, you m*st **xrpXy wi*h the ftr]]owixg: $r*g*txl's \ffithX:ry*d$mg X'xx {-mtt: As *x *mp}*yerr y*L, ;:rust witkk*ld ir:**:&'r* ta:xes from el:':p}*y** w{ig*$ ct rhc ti:rnc e:xptr*ye*s are paid. Y*r: w"il? b* liabX* fur th* tax pey:::e$ts cv*n if y*x d*r:'t *etual}y w'itkl:*trd the tax &*nt y*ur *mptr*yees" Fq:r m*re il:f&xxlati*x, *all th* I)ep*rtxnent *f Rev*::ue at 5{}3-3?849$S; {.Iu*mploymext X:lsux"ctx}ee ?ax: As an *n:pl*yer, you are reqr:ired to pay * tax for *n*mp}oym*nt insurance purposeg cn the wag*s *f all *mp}*y"*es. S*r sr*r* ixfeim:ati*:r, cli}l *:* *regm Hmirl*ymmrt ileB*rtm*xl at $*3-$47-14S8. The Sregon E**iness {denfifieati*n Jltrurxber {*#{} is a csrffibined number for both *r*g*n XVithhoiding and Unerop1oym*ntInsr:::*rr**Tax.T*{11ef.*raEIN.*a].}5*3-945-E*$10rM&,Ix]-lfbrt&* appropriatc fnrms. W'orkers' Compen*atiax trnsuraxcet As ax ernployer, you ar* subject t* the Or*gon Wcrkers' Cornpensation L&w" and must obtain worker$' cornpensation insurance for your employees. If yox f*il to obt*ix w*rkers' e*rnpensati*n insxance, you could be s*bject to penal:ies and be liable for all claim costs if oxe of your empioyees is injured on the job" F*r more infbrrnation, call the Workers' C*mpensation Division at the l)cpartment of Consulner and Susiness Services at 503-947-?8 15. LI.S" Ixternal Revemu* $ervlc*: As *:: *r:rplelyer, Ji*r.; fi&;s{ withhc}ld fb<ieral inec>me tax **m er*pl*yees' w*g*s. Yeru will bs liable f*r the tilx payTnefit *vsn if y*u diqful't a*txa}ly withh*3d th* tax. F*r * Sedaral frfinl numher, cxll the IR.S at 1-8S0-8294933 *r visit their vieb site at xlyly"ltg,gg-y" $thsr Kespoxlsitrilities xrtd A"rees af C*mcersr C**!* C*rxxplixxl*:x: As th* p*rrnil kq:l<3*r f*r thts pr*j*e{, y*r* ar* r*sp*nsib}e f*r r*s*luing any f*{irr* tc} r:?set **d* requirernrnts thilt mray b* irroug?:t t* yt*w attenli*n tlr*xgh in*p*etir:r:s. I-iabitr{*y xmd Fr*p*r*p l}ar*rxg* &xstxr*xre: C*nts*t 3.*xr i*surance agent tn see if y*rr h*ve ad*q*ate i*suranee sovcras* i.*r *c*id*:rts a$d *rnissi*.*s su*k as {b}ling t**}s, pai*t *ver $pr*}r, ca/alcr damage fr*:r: pipe pr:netures, fire *r w*rk tl:*t mxst be red*ns. Tim*: Mak* su:"e yon have su{fr*i*nt fijxe tci supervix* y*ur employees. Xxper*$xe; &{ilke sure yl>* have the skjlls to nct ers your or\"n gencral rontractor" to c**r$itt;l{e thr:vcrk*f r*ugh-in and tln'ish kad*s, xnd tcl :r*:tif,y Xruil*$ing o*fici*ls *s the *ppr*3:riate t{mes sa they *** perftrnn {.h* rcquir*d insp**ti**s. If yoti h;:v* addici*n*l questi*ns eatri th* C*nxtraetj*n Ccntraetors B*ard {5{i3-3?S-4$?1} *r $,,yit* th* ager:*y a{ F* Box X414'0, Sale:n, *K A?3*9-SS52. Froperty*owner.d*c *6-S t -*4 t 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Ca of Springfield Official Receipt L . elopment Services Department Public Works Department RECEIPT #: 1200600000000000957 Date: 0612312006 2:18:53PM Job/Journal Number coM2006-00783 coM2006-00783 coM2006-00783 Description Perm Serv/Fdr 200 amps or less + 8% State Surcharge + l}oh Administrative Fee Amount Due 63.00 5.04 6.30 Item Total:s74.34 Payments: Type ofPayment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Cash Change DARIN STEWART DARIN STEWART djb djb In Person In Person Payment Total: s80.00 ($5.66) s74.34 Job/Journal Number coM2006-00783 coM2006-00783 coM2006-00783 Description Perm Serv/Fdr 200 amps or less + 8% State Surcharge + 10Yo Administrative Fee Amount Due 63.00 5.04 6.30 Item Total:s74.34 Payments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Cash Change DARIN STEWART DARIN STEWART djb djb In Person In Person Payment Total: $80.00 ($5.66) $74.34 cReceint'l Page I of I 6t23/2006