HomeMy WebLinkAboutPermit 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