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Home My WebLink AboutPermit Electrical 2008-7-28 ZON \ fUr I INITIALS ~ fliI ~ A!. DATE i'-'L?-n-<' .... IiIIJI SOURCE m r<;pt? / Date 7 j.8/o tf ,_ __"~_"_ _L___, ,,__, 3 L COMP0!,E l!!!J;; SC~DVLE.!JELOl! '_ - ;;.("~fcnr~~~~R~EifE1fID:,Q~'G@:t\\TlliF3' ,~ "w'::";;tie^'?~;: ,=?y~~ ~tt_~~~v '::~ ~:~~'^_""'; ""~~~" 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726,3689 ELECTRICAL PERMIT APPLICATION CIty JDb Number Co ~ t:P 0 7 - 0 17 g r 1 l LOCATION OF INSTALLATION: -\61"<?J?<fi;"\z f-A LEG'7D3JZ11 , 0 ~-OO A : New R~IdeIltUl!,:-~~Il~o!,Mu!t!-Famdyper dwelling UOlt. ServIce Included JOB DESCRIPTION Tt::~f f'Ot--'A. 1000 sq ft Dr less Each addItIOnal 500 sq ft Dr pDrtlOn thereDf Each Manufact'd HDme Dr MDdular Dwellmg ServIce Dr Feeder Permits are non~transferable and expire If work IS not started wlthm 180 days Df Issuance or If work IS Suspended for 180 days f --- 2 I CONTRACTOR INSTALLATION ONLY ; _ ~* ~"_ _ ~";.;:~_~ M $11700 $ 2100 $55 00 ~--- ~ ..,.--,--- ,-~. B ,Serv.ces or F~eders - lnstallatiDn, A1teratlD~s or RelDcatIon ~~ ~ ~~~_~,L,. >>' L ~ 200 Amps Dr less 20 I Amps'ta 400 Amps ~, (J" - 40 I Amps to' 600',A mns (~ -.Ju/J!: ~rl: 601 Atups tDl.ljlO()J~~11' r$ 0'<1'11 'Ov~r 1000'Wihp[;vI()Y/?$ gUtr$S. (j (/7,::. .J .9' [It I) E1' ;IJ~ 'en .i'f.) efReFDlIT!.~c!. 0'11))5 rOil $s "Ol1lJ U fO / C'e' r tli$ ~ $r (A;, cOp/Iii O,/r$ sa ~i~ ~Number / c ,~{o'lolporw~;)'P.ta,,:;;q((jR1l?~f0I1I) . / -- '. '.80o~ft~t/-e,:.ei:; ri;?;a!t.. ' ExprratlOn Date InstallatIOn, AIt:i?~~~dkn ! / '" 200 Amps Dr less 9. 'lJOI1 '" 20] Amps to' 400 Amps ~ 401 Amps to' 600 Amps - ~ 1'1. Over 600 Amps Dr 1000 VDlts see "B" abDve Il-tgl"CtF ~.".~h O~'CUlts _ ill/lit. PC'?4ft/!ew AlteratIOn Dr ExtenSIOn Per Panel COA?, 'O'?llc. ~JLrCUlt "INy ,t,<:i1tCc. 0 ~6~al CITCUlI Dr WIth Owners Name~R\ ~I\VA.t~\\"F .~'rtr-'Ji~'ItP~'f{S-4tJ.'I'tIt1~:!r;;; __ ~_ .. $ ~O~,~_, Address ~ Of{f~' 9,\ . E~/~e'41lJ'^;D~'&ft;v~'f()rt>-r not mcluded)-Each Installalton , \ -- - '. ,"rdfll'Cl1'l/;:/) f:. :V7Vor - CI~\ }) '_ PhDne 72 t: -a,'J ~1 Pump DTlmgatlDn O,? $ 55 00 / Sign/OutlIne LightIng $ 55 00 OWNER INST ALLA TlON LImited EnergyiResldentlaI $ 28 00 The InstallatIDn IS bemg made Dn property I Dwn WhlCb Lnmted Energy/CDmmerclal $ 50 00 IS nDt Intended fDr sale, lease Dr rent MInlmnm ElectrIC PermIt InspectIOn Fee IS $50 00 + Surcharges ------~--- , , 5S- 4 'SUBTOTAL OF ABOVE {"I,O .;- ~-v z.'7'r hi8r Electncal CDntractDr Address PhDne 12% State Surcharge 10% AdmInistrative Fee 5% TechnDIDgy Fee Inspeclton Request 726-3769 TOTAL Shared Dnve(T )/Butldmg Forms/Electncal Permit Application 1-08 doc $ 70 00 $ 83 00 $13800 $18000 $41300 $ 55 00 $ 55 00 $ 76 00 $110 00 S~ $ 48 00 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2007-01788 ISSUED: 12/26/2007 APPLIED 12/06/2007 EXPIRES: 11/05/2008 VALUE $ 19,000 00 -~ Status Issued 225 Filth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlOe SITE ADDRESS 1908 D ST ASSESSOR'S PARCEL NO 1703361310500 SprlOgfield TYPE OF WORK Use 100t131s TYPE OF USE RepaIr PROJECT DESCRIPTION Substandard BmldlOg - FIre damage repaIr Owner P ARTHA V A BEHESHT NEJAD INTL FOUNDA T Address 312 19TH ST SPRINGFIELD OR 97477 Contractor Type General Electncal I CONTRACTOR I,NFORMATlON I / "'I"rlr'N Contractor ,I :" ",.,Or:,~o,n law requires You ,LIcense CAROLYN !)(':^":T~RSONJy the Oregon Utl"~2276 C &'S ELEqRIC'-in~:< !~ose rules are sliI' f,!;th49 "" ' IlJ, flAY P'BIIlILDtNUI~'fHWfAqqON I L f 't'ln 0 Y I rr '!II 'll'! , '9 E1/"", (N t.~ 1 r."'''''c/ /01 the Or 0 e the telephone eC#JoIISt\\TV'N Xrnter Is 1.S;HelgJJJ~~lt~~'I-~on Type of HeaC VB Water Type Range Type Energy Palb SprlOkled BUlldlOg #ofUOIts Pnmary Occupancy Group Secondary Occupancy Group Pnmary Consh uctlOn Type Secondary ConstructIOn Type # of Bedrooms nla I DEVELOPMENT INFO~MATlON I Frontyard Setback S,de I Setback S,de 2 Setback Rearyal d Setback Solar Setbacks ReSidentIal ExpiratIOn Date 04/2712009 09/01/2008 Phone 541-744-2867 541-741-2236 Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Garage/Carport Sq Ft Other Occupant Load REQUIRED PARKING OVe.r)!lX..QISt Total # S~t}!Ci:Rqd, HandIcapped Pav1i/ll~r~Pmm' SHALL EXPIRE IF THE WO~pact % <lflJ1)~m\'lreJ'UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONEO FOR I pUBLlciM.~Jt~V~D. Street Improvements Storm Sewer A vadable SpeCIal Instruction SIdewalk Type DownspoutslDralOs Notes Paee I of 3 -~~ Status Issued 225 FIfth Street, Spnngfield, OR 541-726-3753 Phone 541- 726-3676 Fax 541-726-3769 InspectIOn LIlle DescnptlOn Tvpe of Construchon BId Amount Use B,d Amount Fee DescrIptIOn + 10% AdmllllStrahve Fee + 5% Technology Fee + 8% State Surcharge BUlldlllg PermIt + 10% Admllllstrahve Fee + 12% State Surcharge + 5% Techuology Fee Temp Power 200 amps or less + 10% Admllllsh ahve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Clrc Add, AlteJ, Extend Clrc Ea Add + 10% Admllllstrahve Fee + 12% State Surcharge + 5% Technology Fee Temp Power 200 amps or less Total Amount P3Jd CITY OF SrKll~GFIELD ' Building/Combination Permit PERMIT NO' COM2007-01788 ISSUED. 12/26/2007 APPLIED 12/06/2007 EXPIRES. 11105/2008 VALUE: $ 19,00000 I Valuation DescriotlOn I $ Per Sq Ft or mulhpher $100 Square Footage or BId Amount 19,000 00 Value Date Calculated Total Value of ProJect $19,000 00 $19,00000 12118/2007 J:;'PP'i', tiuIIJ Amount PaId Date PaId ReceIpt Number $19 59 $979 $1567 $19586 $550 $660 $275 $55 00 $1240 $1488 $620 $48 00 $76 00 $550 $660 $275 $55 00 12/26/07 12/26/07 12/26/07 12/26/07 1/2108 1/2/08 1/2108 1/2108 6/5/08 6/5/08 6/5/08 6/5/08 6/5/08 7/28/08 7/28/08 7/28/08 7/28/08 2200700000000001905 2200700000000001905 2200700000000001905 2200700000000001905 3200800000000000003 3200800000000000003 3200800000000000003 3200800000000000003 1200800000000000603 1200800000000000603 1200800000000000603 1200800000000000603 1200800000000000603 2200800000000001158 2200800000000001158 2200800000000001158 2200800000000001158 $538 09 I Plan ReViews , To Request an mspectlOn call the 24 hour recording at 726-3769. AllmspectlOns requested before 7 00 a m will be made the same workmg day, mspectlOns requested after 7:00 a,m. wIll be made the following work day. IRf'n~ Temporary Electnc Approval reqUIred prIOr to UtilIty Company energlzIllg pole Rough Electnc Pnor to Cover FIllal Electnc When all electncal work IS complete Paee 2 01 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01788 ISSUED' 12/26/2007 APPLIED. 12/06/2007 EXPIRES: 11/05/2008 VALUE' $ 19,00000 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIon Lme By SIgnature, I stdte and agree, thdt I have carefully exammed the completed dpphcatlOn and do hereby certIfy that all IIltormatlOn hereon IS true and correct, and I further certIly that any and all work performed shall be done 10 dccorddnce WIth the Ordmances of the CIty of Sprmgfield and the Laws of the State of Oregon pertammg to the work descnbed herem, and that NO OCCUPANCY will be made of any structure Without permIssIOn of the CommuDlty Services DIVISIOn, BUlldmg Safety I further certIfy that only contractors and employees who are 10 comphance With ORS 701005 wIll be used on tillS project I further agree to ensure that all reqUIred mspectIons are requested at the proper tIme, that each address IS readdble from the street, that the permit card IS located at the front of the property, and the approved set of plans will remam on the SIte at all tunes durmg constructIOn Owner or Contractors Signature Dt~ Q~~oof? ~ Pa2e 3 of 3 - Construction Contractors Board 700 Sununer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone 503-378-4621 Web Address. www.ccb state or us Penmt # CO/N1z:.a-~ 7- f70e , b~ O/70f{ ]) sf Date r/U/O? I 1/ Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requires residential constructwn permit applzcants who are not licensed with the Constructwn Contractors Board to Sign the followzng statement before a buddzng permit can be Issued This statement IS required for residential buddmg, electrical, mechamcal and plumbmg permits Licensed architect and engzneer applicants, exempt from lzcenszng under ORS 701 010(7), need not submit this statement This statement Will be filed with the permit FIll m the al'l"UI'Hate blanks and ImtIal boxes I and 2, and either box 3A or 3B ~I ~ I own, reSide m, or Will reSide m 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 o 3A My general contractor IS (Name) (CCB #) I Will mstruct my general contractor that all subcontractors who work on the structure must be licensed with the ConstructIon Contractors Board ~ OR I Will be my own general contractor If! hire subcontractors, I Will lure only subcontractors licensed With the ConstructIOn Contractors Board If I change my mmd and lure a general contractor, I Will contract With a contractor who IS licensed With the CCB and wIllllnmedJately notIfY the office Issumg this bUlldmg permit of the name of the contractor I hereby certify that the above mformatIon IS correct and that I have read and do understand the InformatIOn NotIce to Property Owners about ConstructIon ResponSIbilitIes on the reverse Side oftlus form. ~~Lkt? - (l . fA j:) :>i' ,-<-,0 r.ff'? 8, (Signature of permit applIcan ~ ~ate) I (WhIte copy to Issumg agency permit file, pznk copy to applzcant) Property_owner doc 06-01-04 \ --", (, Acting as-Yv~t Own General Contractor? - , "INFoRM'1noN ~OTlCE TO PROPERTY OWNERS' - ABOUFCONSTRUCTION RESPONSIBILITIES , ~; '\ " \ NOTE This Information Notice to Properly Owners about Construction Responslbllilles was developed by the Construction Contractors Board In accordance wilh ORS 701055(5), passed by the 1989 Oregon Legislature If you are acting as your own contractor to construct a new home or make a substantial Improvement to an eXisting structure, you can prevent many problems by being aware of the following responslblhtJes and concerns Employer Responsibilities . L You will, In most Instances, be ruled to be an "employer" and the contractors you contract WIth wlil be "employees"lf you use contractors not licensed Wlt\1 the ConstructIOn Contractors Board to do labor In constructing or to assIst m the constructIOn or Improvement of a'resld.entJal structure As the employer, you must comply with the followmg: ~ .. ~ , Oregon's Withholdmg Tax Law: As an employer, you mu.t WIthhold mcome taxes from employee wages at the time employees are paid You WIll be liable for the tax payments even If you don't actually WIthhold the tax from your employees For more mfonnatlon,-calf the Department of Revenue at 503-378-4988 ' , - Unemployment Insurance Tax As an employer, you are reqUIred to pay a tax for unemployment msurance purp;~~ on the wages of all employees For more mformatlon, call the Oregon Employment D~I"u .",ent at 503-947-1488 1 ' ~ The Oregon BUSiness Iden~fic;tlon -N~ber (BrN) IS a combined numbe; for b9!h Oregon WIthholding and'-- Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or wwwdor state 01 usffonnsnav htmll for the appropnate forms Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Cvu'l',"usatlOn Law, and must obtam workers' compensatIOn msurance for your employees If you fali to obtam workers' compensatIon msurance, you could be subject to penalhe's and be liable for all claim costs If one of your eJ!1ployees IS IllJured on the Job For more information, call the Workers' Compensa'tJon DIVISIon at the Department of'Consumer and Busmess ServIces at 503-947-7815 ' "- U,S Internal Revenue Service: As an employer, you must WIthhold federal mcome-1ax from employees' wages~ You Will be hable for the tax payment even If you dIdn't actually WIthhold the tax For a Federal EINnumber, call the IRS at 1-800-829-4931 or vmt thelT web sIte at Www liS 1l0Y " "Other Responsibilities and Areas of Concerns ~''"'''' Code ComplIance' As the permit holder for thIS project, you are responSible for resolvmg any faIlure to meet code reqUIrements that may be brought to your attentIon through mspectlOns j , LIabilIty and Property Damage Insurance: Contact your msurance agent to'see If you have adequate msurance coverage for aCCIdents and Offi1SSlOns such as fallmg tools, pamt over spray, ,waler damage from pipe punctures, fire or work that must be redone \ r, " \ - (~_ \ '\, r: l ,,_ \.' 6 ,-" ') '~\c;, k \ V -J~. " ~,,\~f\-t'}\l.Jj\ :;}--'~,SN\~) s' r Time' Make sure you hav~ufficlent ttme to supervIse your employee. ' < ExpertIse: Make sure you have the skIlls to act' as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to nottfy bUlldmg offiCIals as the appropnate times so they can perform the reqUIred mspectIons If you have addItIOnal questtons call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 - " Property _ Dwner dDc 06-01-04 225 FIfth Street Sprmgfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01788 COM2007-0 1788 COM2007-0 1788 COM2007-01788 Payments Type of Payment Check cRecemtl RECEIPT #: "._."A1NQPI~ ; _J& "" iii: CIty of Sprmgfield OfficIal ReceIpt Development Services Department PublIc Works Department 2200800000000001158 Date: 07/28/2008 Description Temp Power 200 amps or less + 5% Technology Pee + 12% State Surcharge + 10% Admm,stral1ve Pee Paid By PARTHA V A BEHESHT NEJAD Item Total Check Number AuthorILatlOn ReceIved By Batch Number Number How Received dJb 849 In Person Payment Total Page 1 of 1 I 53 30PM Amount Due 5500 275 660 550 $69 85 Amount Paid $69 85 $69 85 7/28/2008