The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2008-7-8 SPRINGFIELD . ~ '" ZON \ M - ~ INITIALS'['u'Y\_ DA Trrt J:~ --(11-, u25FIFTHSTREET. SPRINGFIELD,OR97477. PH (541)726-3753 . FAX (541)726-3689 _ SOURCI\'(\~~ ELECTRICAL PERMIT APPLICATION I / City Job Number rO""t~oo8- 0 101 , Date 7/8/DK ~ I LOCAT'IOIV()FINSTALiATiON: 3 -COMPI.ETEFEESCimD~tEWW- , - Z:BO--Z!.'{Z-~ S?F~--~ ~_~, _ LEGAL DESCRIPTION pO 3 "5 bl l{ 0 ssnO .~e~ R~S1~entIal- Siugl~.~r M~!I-~,,-~Iy ~_~!: d~_elling UDlt Z 'i3 0 Z-:3,Q,D S'f /, "" j; ~,ofl ServIce Included JOB DESCRIPTION U Q7,(77 1000 sq ft or less $11700 each additIOnal 500 sq ft or Clt5:1i1!"1/o ff /Czo7i'!V/C;C: portIOn thereof $ 2100 One Crrcmt ~~ Each~ddl ~t r C-;" /> _ NO~\C~~ "Ii "'~ '" iW.t:M'I'"\S $ 400 Owners Name ,---)z.,U-ar7AtZ- r" y ~~ nrJ r~p.\.. ~\~i\.~\\ 'I\i\S? :~~~t) fl.}~ ~ -----~ __' ---- Address Z~O Z:J (Zp "",\iI-\OP.~~~~Op.I'rf~lilI\Servlce!f~eder notincluded)-Ea,ch rus~al"'tlon CIty ~r, ^ , L'., f L- Phone f'f I Be, \C~~\) Ofl,'l ~~OPr'lIT1gatlOn $ 55 00 J ' /ISh I SIgn/Outlme Llghtmg $ 55 00 Lumted Energy/Resldentlal $ 28 00 LImited Energy/CommercIaI $ 50 00 MmllDum Electric PermIt InspectIon Fee IS $50 00 + Surcharges 4 --siiiilVTALlJFABOVE - - 7D ,~ -~ ~- ~--~-"'-- ~ ~-"'-'~- "- ~~ 12% State Surcharge 8 ~o 10% Admmlstratlve Fee 7' 5% Technology Fee ~ 8B~ , --oJ-: ,G];'VV IE~Si?~_@iE-11EE.n.',@ ',@Q: _ +-,'t-~_ '""'~ "~~~."~,,,!;~,, !ff",":;:;UF:~.~ \~1~ ,~''''''-'''l.'>.._-.....,,,,.,,-","%&fw4''.'',,,, .,~f!!id'J+irj'" ~ ,>.~ '!0'C- _, r1;;;W.~ ~ "'" .,-'1\:_ _ "..~C"'.=,""M;! .~'.'%."=" . ,:~ Permits are non-transferable and expire If work IS not started wlthm 180 days of Issuance or If work IS Suspended for 180 days Each Manufact'd Home or Modlllar Dwellmg Service or Feeder -- , 2 : COm:~CT?R INSTALLATION ONLY 200 Amps or Jess rrTF~1iI0. N Oregon I 201 Amy: to 400 Amps {, "":~. :dopted b~~~g~~1 ~ps NOllt'cf'tlon Center Tho~~ij9lPsb~~~!XrnPS Phone In UAR 9t>2-001-0010thr~ lJlAfll-9~f1ts UU::!U, YOU may obtain CO~mlJUf<m~tes by C~lng the center (Note the telephone ~r for the Ore 'UtiJlm.~ - -- , SlIpervIsor LICense Number \ e ('l1l1ler IS 1'~~3:3~~);U' m Ice-,,~r Feeders Exprrahon Date \ ~ InstallatIOn, AlteratIon or RelocatIOn \t 200 Amps or less Constr Contr Number f) 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "BOO above D : Branch CI;C~I~ - " Electncal Contractor Address City ExprratlOn Date SIgnature of Supervlsmg Electnclan New AlteratIon or ExtenSIOn Per Panel OWNER INST ALLA nON The mstallatlOn IS bemg made on property I own which IS not mt ded for sale, lease or rent t:._ . A1L<j.- _ , I () / InspectIOn Request 726-3769 TOTAL Shared Dnve(T )/BUlldmg FormslElectncal Permit ApplicatIOn 1-08 doc $5500 , $ 70 00 $ 83 00 $13800 $18000 $41300 $ 55 00 70 $ 55 00 $ 76 00 $110 00 $ 48 00 CITY OF SPRI~l>-t<1j<,LU . Building/Combination Permit PERMIT NO' COM2008-010I9 ISSUED: 07/0812008 APPLIED' 07/08/2008 EXPIRES: 01/08/2009 VALUE: -G\:; iiI ..... Status Iss u ed 225 FIfth Street, SprIugfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 280 23RD ST ASSESSOR'S PARCEL NO 1703361405500 SprIngfield TYPE OF WORK, ElectrICal Work Only PROJECT DESCRIPTION ServIce change TYPE OF USE RepaIr Resldenllal Overlay Dlst # Street Trees Rqd Paved DrIve Rqd % of Lot Coverage , r.~~ I PUBL~:v.~~PE~,,^\'t \~ "", '~\I;) r lh ~O \l\.\"Otft't\\'."...-.c;t)~ ~\l1\-10RIl R IS ~~~~,,~..... COMMENCEO 0 ERIOO. DownspoutslDrams AN'l' 180 CA'l' P Owner SAVNSARAE EMPREY Address 280 23RD ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Tvpe ElectrIcal Contractor OWNER LIcense # 01 Vmts PrImary Occupancy Group Secondary Occupancy Group PrImary ConstructIOn Type Secondary Construcllon Type # of Bedrooms BUILDING INFORMATION I # of StlrIe equlleS yOU to R-3 " Or ...e~m..n UtIlItY Al1l::NT10l' 'ilY v........-' tlorth 10lV8 lu'esc~~~;~~ ~ate~~ ~~2'()01. NotlhCa~~~'()01_00i ~t~~t 01 the lules bY In OAR'tou may CbMhtM telephone 0090lilng the ce~lu iW~\~I~t1\1cat\On nla ca .__ .h';lile _ _" ".,AA\_ nuo"'rDtiMGL6~ i'kTlNFORMATlON I Frontyard Setback SIde I Setback SIde 2 Setbdck Rearyard Setback Solar Setbacks Street Improvements Storm Sewer AvaIlable SpeclallustructlOn Notes I Valuation DescriotlOn I DescnptlOn $ Per Sq Ft or mulllpher Square Footage or BId Amount Type of ConstructIOn Page I of2 Phone Number 541-868-4411 ExpIratIOn Date Phone Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load REQUIRED PARKING Total Haudlcapped Compact Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-01019 ISSUED. 07/08/2008 APPLIED' 07/08/2008 EXPIRES: 01108/2009 VALUE' 225 FIfth Street, SprIngfield, OR 541-726-3753 Phoue 541-726-3676 Fdx 541-726-3769 InspectIOn Lme Total Value of P, oJect fm Palll . Fee DescrIptIOn + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Techuology Fee Perm ServlFdr 200 amps or less Amount PaId Date Paid ReceIpt Number $700 $840 $350 $70 00 7/8/08 7/8/08 7/8/08 7/8/08 2200800000000001044 2200800000000001044 2200800000000001044 2200800000000001044 Total Amount Paid $88 90 I Plan RevIews I To Request an mspectlOn call the 24 hour recordmg at 726-3769 All mspections requested before 7:00 a m. wIll be made the same workmg day, mspections requested after 7:00 a.m wIll be made the followmg work day I. .R~(J~ired InsD~cho~.s, I ElectrIC Service Approval reqUIred prIor to utIhty company euerglzmg servIce By sIgnature, I state and agree, Ihat I have carefully exammed the completed applIcatIOn and do hereby certIfy that all mformatlOn hereon IS true and correct, and I further certIly that any and all work pertoJ med shall be done m accordance wIth the Ordmances of the City of SprIngfield and the Laws of the State of Oregou pertammg to the work descrIbed herem, and that NO OCCUPANCY wIll be made of any structure without permlSslOu of the Commumty ServIces DIVIsIOn, BuIldmg Safety I further cerllfy that only contractors and employees who dre m complIance wIth ORS 701 005 wIll be used on thIS project I further dgree to ensure that all requIred mspectlOns are requested at the proper hme, that each dddress IS readable from the street, that the permit card IS located at the frout of the propel ty, aud the approved set of plans wIll remam on the SIte at all times dUfmg constructIOn ~ .------- 7/g(ot5 Owner or Contractors SIgnature Date Page 2 of2 - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone 503-378-4621 Web Address www ceb state or.us Penmt # ("Ol/Vl ?:ooli"- O/Of,? ;;J.2'lJ .;:{3 rd ,rI- . Sont1"JAeA.J, oR Q\'f17 I ' ~ t\ Dat: 7/~/ CTY I I Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requires residential constructIOn permit apphcants who _are not hcensed with the ConstructIOn Contractors Board to Sign the followmg statement before a buddmg permit can be Issued This statement IS required for reSidential bUIldmg, electrzcal, mechamcal and plumbmg permits LIcensed architect and engzneer apphcants, exempt from hcensmg under ORS 701010(7). need not submit this statement This statement will be filed with the permit Fill m the appropnate blanks and rmtlal boxes 1 and 2, and eIther box 3A or 3B 01 @2 I own, reSIde m, or WIll reSIde m the completed structure I understand that I must become hcensed as a constructIOn contractor If the structure IS sold or offered for sale before or on completIOn o 3A My general contractor IS (Name) (CCB #) I Will mstruct my general contractor that all subcontractors who work on the structure must be hcensed WIth the Construction Contractors Board OR 5t 3B I Will be my own general contractor If! hIre subcontractors, I wtlllure only subcontractors hcensed WIth the ConstructIOn Contractors Board If I change my mmd and lure a general contractor, I Will contract With a contractor who IS hcensed With the CCB and wl11nnmedlately notify the office Issumg tlus bUlldmg permIt of the name of the contractor I hereby certify that the above mformatlOn 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. J ~A/k:U'. f ~ '-1/U log / (SIgnature of permIt apphcanl) r (Date) (WhIte copy to Issumg agency permit file, pmk copy to apphcant) Property_owner doc 06-01-04 " . Acting as 'Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES , , \ , \ \ '-.- NOTE ThIs Information Notice to Property Owners about ConstructIOn Responslblltlles was developed by the ConstructIon Contractors Board In accordance wtlh ORS 701 055(5). passed by the 1989 Oregon Legislature If you are actmg as your oWn contractor to construct a new home or make a substantIal Improvement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responsIbIlItIes and concerns , ' You wIll"m most mstances, be ru)ed to be an "employer" and the contractors you co~tra~t WIth wIll be "employees" If you lIse contractors not ,lIcensed with the ConstructIon Contractors Board to do labor m constructmg or to asSISt m the constructIOn or Improvement of a resIdentIal stru~ture As the employer, you must comply with. the following: .' Employer Responsibilities .' Oregon's Withholding Tax Law: As an employer, you must wIthhold mcome taxes froin employe~ wages at the tIme employees are paId Y 011 wIll be Jlable for the tax payments even If you don't actually withhold the tax from your , ' employees For more mformatton. call the Department of Revenue at 503.378-4988 Unemployment Insurance Tax: Ai; an employer, you are reqUIred to pay a tax for unemployment msurance purposes,' on the wages of all employees For more mformatIon, call the Oregon Employment Department at 503-947-1488 , ' 'J ~ y i I The Oregon Busmess IdentJficatIon Number (BIN) IS a combmeq nnmb(,;r for both Qregon WIthholdmg and' Unemployment Insurance Tax To file for a BIN, call 503-945.8091 or wwwdorstateorusiformsnavhtmll for the approprIate forms . ~ Workers' Compensation Insurance: As an employer, you are slIb]ect to the Oregon Workers' CompensatJon Law, and must obtam workers' compensatIon msurance for your employees If you faIl to obtam workers' eompen~atlOn msurance, you cOllld be subject to penaltIes' and be lIable 'for' all'c1alm cos,ts If one of your employees Is'mJured on the Job For more mformatIOn, call the Workers' CompensatIon DIVISIon at the Department of eonsllmer and Busmess SefVIces at 503-947-7815 v - U.S. Internal Revenne ServIce: As an employer, you must WIthhold feaeral mcome tdX from employces' 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 IRS at 1-800-829-4933 or VISIt thclr web sIte at WW\\ 11 S'QOV ' , , , , ,OtheIr :!Responsibilities 21llldl Areas 'of COnCeIrllS Code ComplIance: As the pelmlt holder for thIS proJect, you are responslblc for re50lVl~g any faIlure to meet code reqUIrements that may be brought to your attentIon through mspectIons . , LIability and Property Damage Insurance: Contact your msurance agent to see 1f you have adequate msurance coverage for accldcnts and omISSIOns such as fallmg tools, pamt over spray, water damage from pIpe puncture" fire or "- work that mlls! be redone , \ TIme. Make sure you have suffi~lent tIme to supervIse your em-p]oyees , , ExpertIse. Make SlIre you have the skIlls to act as your o~ general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfy bUlldmg offiCIals as the appropnate tImes so they can pcrform the reqUIred mspechons If you have addItIOnal questJons call the ConstructIon Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Property_owner doc 06-01.04 225 FIfth Street Springf!oJd, Oregon 97477 541-726-3759 Phone ~ji CIty of Sprmgfield OffiCIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 I 0 19 COM2008-01019 COM2008-0 I 0 19 COM2008-01019 Payments Type of Payment Cash Change Job/Journal Number COM2008-01019 COM2008-01019 COM2008-01019 COM2008-01019 Payments Type of Payment Cash Change cRecemtl RECEIPT #. 2200800000000001044 Date. 07/08/2008 DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By SAUNSARAE EMPREY SAUNSARAE EMPREY Item Total Check Number AuthOrizatIOn Received By Batch Number Number How Received dJb dJb In Person In Person Payment Total DescriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge e 10% AdmmlstralIve Fee PaId By SAUNSARAE EMPREY SAUNSARAE EMPREY Item Total Check Number AuthOrization Received By Batch Number Number How Received dJb dJb In Person In Person Payment Total Page I of I 2 29 20PM Amount Due 7000 3 50 840 700 $88 90 Amount Paid $90 00 ($1 10) $88 90 Amount Due 7000 350 840 700 $88 90 Amount Paid $90 00 ($110) $88 90 7/8/2008