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Home My WebLink AboutPermit Electrical 2008-8-4 3 SPRINGFIELD ZON ~ ~ INITIALS 1 k4 DATE 8.A.-b~ ~ SOURCE p... <t,~() J Date 7h/~ J- COMPLETE FEE scFiED~-lEiow - (:rrY OJL SPRING,FmlLD"OREGQtq r- _~. ~~ ".,' ~,:,' -=' - ~ I ~. _h 225 FlnH '~TREET . SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATIQI;V, .-- CIty Job Number ('()/M700g-U Ill{) 200 Amps or less 201 Amps to 400 Amps AT-;-::tr~~GN Orego~tiIlreaOJMdJjls follow rules adopted 6mtl\\b&lfQ)limlb'~llWf Phone ---..Notification Center. T1~rHli1ale i'~ , 6lfteAR 9:>2-001-001 0 W~l?bIlmH. . . \ ~ 0090 You may obtain copies of rules by f'l cali," the center (Note: the telephone Supervisor License Number .I ;ltlffill2r fGr the ortQorl.:l\ll1'Y i..,tMtebQQ or Feeders O::\i Center Is 1-800-332-2344). InstallatIon, AlteratIon or RelocatIon 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above D Branch CircUIts 1 LOCATION OF INSTALLATION: bSS ~AILJIf:-J- LE\~DS61:(loA1). DO nbD JOB DESCRI7TION AJ l / AL.rE'L S; L.\rc~~ Permits a/e non-transferable and expire If work IS not started wIlhm 180 days of Issuance or If work IS Suspended for 180 days 2 CONTRACTOR INSTALLATION ONLY Electncal Contractor Address City ExpiratIOn Date Constr Contr Number ExpiratIOn Date SIgnature of SupervISIng ElectrICIan Owners Name ~j: .s/ MLJ lJ..S.. Address 4Cf P (P:3 R.iJ cSt City .:5Pf=b Phone 747 -_'3_~ //J~ OWNER INSTALLATION The mstallatlOn IS bemg made on property I own which IS not mtended for sale, lease or rent s SIgnatUre _ Jl ) , ~ '-I -' xr U1I/4P(.<L InspectIon Request 726-3769 A New ResldentIal- Smgle or MultI-Family per dwellmg umt - - ServIce Included 1000 sq It or less Each additIOnal 500 sq It or portion thereof Each Manufact'd Home or Modular Dwellmg ServICe or Feeder $] 17 00 $2100 $55 00 B ServIces or Feeders - InstallatIOn, AlteratIOns or RelocatIon $ 70 00 $ 83 00 $13800 $18000 $41300 $ 55 00 $ 55 00 $ 76 00 $11000 New AlteratIOn or Extensl~n Per Panel / One CIrCUIt $ 48 00 Each Additional CrrcUlt or With L( /6 N ci'rrc~or Feeder PermIt $ 4 00 iMrr SHAJ..HXPIRE If THE WOR\{ r.c~~~~'Lrotl~f{ n'nJ"*M+T it&iH~ -Each InstallatIOn AC~ na IS ABANDONED FOR a'Ilbh $ 55 00 A~_li\ JR.. $ 55 00 LimIted Energy/Resldenllal $ 28 00 LimIted Energy/Commercial $ 50 00 Mmlmum Electroc PermIt Inspecllon Fee IS $50 00 + Surcharges 4 SijRTC!TAL ~Jo~~OlTE_ , _ b 1 12% State Surcharge 10% AdmUllstrallve Fee 5% Technology Fee '1J (Q'to J<:.D TOTAL Shared Dnve(T )/Bulldmg Forms/Electnca1 PermIt AppllcatJOn 1-08 doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2008-01145 ISSUED: 07/31/2008 APPLIED 07/31/2008 EXPIRES' 01/31/2009 VALUE' $ 1,200.00 225 FIfth Street, Sprmgfield. OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspecllon Lme SITE ADDRESS 635 FAIRVIEW DR ASSESSOR'S PARCEL NO 1703274202200 SprIngfield TYPE OF WORK Smgle FamIly Residence TYPE OF USE Repair Resldenllal PROJECT DESCRIPTION Dryrot, plumbmg and electrIcal repaIrS Owner Address MARGE SIMONS 498 N 63RD ST SPRINGFIELD OR 97478 Phone Number 541-747-3563 I CONTRACTOR INFORMATION I Contractor Type General ElectrIcal Plumbmg Contractor OWNER OWNER OWNER License ExpiratIOn Date Phone BUILDING INFORMATION I VB # of StorIes HeIght of Structure Type of Heat Water Type Range Type Energy Path Sprmkled BUlldmg Lot SIZe Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Garage/Carport Sq Ft Other Occupant Load # ofUmts PrImary Occupancy Group Secondary Occupancy Group PrImary Construcllon Type Secondary ConstructIOn Type # of Bedrooms R-3 n/a I DEVELOPMENT INFORMATION I Frontyard Setback SIde 1 Setback Side 2 Setback Rearyard Setback Solal Setbacks Overlay DlSt # Street Trees Rqd Paved DrIve Rqd 0/0 ot Lot Coverage REQUIRED PARKING Total Handicapped Compact I.PUBLIC IMPROVEMENTS I Street Improvements StOl m Sewer AvaIlable SpeCIal InstrnctlOn SIdewalk Type Downspouts/Drams Notes Paee I 013 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO' COM2008-01145 ISSUED 07/31/2008 APPLIED: 07/31/2008 EXPIRES 01/31/2009 VALUE. $ 1,200.00 225 FIfth Street, SprInglield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme I Valua~lOn Descrmh~~ , EstImate Estimate $ Per Sq Ft or mulllpher $100 Square Footage or B,d Amount 1,20000 Value Date Calculated DescnotlOn Tvpe of ConstructIOn Total Value of Project $1,20000 $1,20000 07/31/2008 F~~~, ~ Fee DescrmtlOn + 10% AdmmlStratIve Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend CIrC Add, Alter, Extend Ctrc Ea Add BUlldmg PermIt FIXture Samtary Sewer - 1st 50 Feet Amount PaId Date Paid ReceIpt Number $22 80 $27 36 $11 40 $48 00 $1600 $50 00 $64 00 $50 00 7/31/08 7/31/08 7/31/08 7/31/08 7/31/08 7/31/08 7/31/08 7/31/08 2200800000000001177 2200800000000001177 2200800000000001177 2200800000000001177 2200800000000001177 2200800000000001177 2200800000000001177 2200800000000001177 Total Amount PaId $289 56 I Plan Reviews I To Request an mspectlOn call the 24 hour recordmg at 726-3769. AllmspectlOns requested before 7 00 a m. will be made the same workmg day, mspectlOns requested aftel 7:00 a.m. WIll be made the followmg work day L.R~nllirp.rlJnsnections I Footmg After trenches are excavated FoundatIOn After forms are erected but pnor to concrete placement Frammg InspectIOn PrIor to cover and after all rough mmspectlOns have been approved Rough Plumbmg PrIor to cover and mcludmg reqUIred testmg SanItary Sewer Lme PrIOr to fillmg trench and mcludmg requlI ed testmg Fmal Plumbmg When all plumbmg work IS complete Rough ElectrIc PrIor to Cover Fmal ElectrIc When all electrIcal work IS complete Fmal BUlldmg After all reqUIred mspectlOns have been requested and approved and the bUlldmg IS complete Paee 2 013 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO. COM2008-01145 ISSUED. 07/31/2008 APPLIED: 07/31/2008 EXPIRES 01/31/2009 VALUE: $ 1,20000 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme By SIgnature, I state and agree, that I have carefully exammed the completed applicatIOn and do hereby certIfy that all mformatlOn hereon IS true and correct, and I further cerllfy that any and all work performed shall be done 10 accordance wIth the Ordmances oftbe CIty of Sprmgfield and the Laws ofthe State of Oregon pertammg to the work descrIbed herem, and that NO OCCUPANCY wIll be made of any structure without permISSIon of the Commumty ServIces DIVISIOn, BuIldmg Safety I further certify that only contractors and employees who are m comphance WIth ORS 701 005 wIll be used on thIs proJect I further agree to ensure that all reqUIred mspectlOns are requested at the proper lime, 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 rem am on the SIte at all hmes dunng construction 'ii{JjV~hf4--/ 7~ :3/-/JY Dale Paee 3 013 - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone' 503-378-4621 Web Address' www ccb state.or.us Pemut # (OvVILoo?-D Ill{ j 6.5) f-Al(UJ ley) ~6 Date 7/3,10 f" I / Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUires residential constructIOn permit applzcants who are not licensed with the ConstructIOn Contractors Board to sign the followzng statement before a buddzng permit can be Issued This statement IS reqUired for residential bUlldzng, electrzcal, mechanzcal and plumbzng permits Licensed architect and engzneer applzcants, exempt from lzcenszng under ORS 701 010(7), need not submzt this statement This statement will be filed with the permit FIll m the appropnate blanks and rmtIal boxes 1 and 2, and either box 3A or 3B I IZJ 1 I own, reside m, or wIll reside m the completed structure ~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 D 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 , 3B I Will be my own general contractor IfI lure subcontractors, I Will lure only subcontractors licensed With the ConstructIon Contractors Board IfI change my mmd and hire a general contractor, I wIll contract with a contractor who IS licensed with the CCB and wIlIllnmedlately notIfy the office Issumg tlus bUlldmg penmt 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 of thiS form. v/{(J~~~V~f{) "7- :3-/-oY V ~(Slgnit~r~ ofpenTIlt applicant) (Date) (WhIte copy to Issumg agency permit file, pznk copy to applzcant) Property_owner doc 06-01-04 Actlil~ ~~ 'Y o'~r. Own GelITleral Contractor? v..) v .l' 'INFORMATION-NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ~, '< \ t NOTE This InformatIOn Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board In accordance with ORS 701 055(5}, passed by the 1989 Oregon Legislature If you are acting as your own contractor to cons'truct ~ new home or make a substantJallmprovement to an eXisting structure, you can prevent many problems by being aware of the follOWing responslbl!ttJes and concerns Employer Responsibilities You Wlll, In most Instances, be ruled to be an "employer" and the contractors you contract With Will be "employees" If you use contractors not !tcensed With the ConstructJon Contractors Board to do labor m constructJng or to assist In the constructIOn or Improvement of a residentIal structure As the employer, you must comply With the following: \. ~ ~ ~ . Oregon's Withholding Tax Law: As an employer, you must wlthho]d Income taxes from employee wages at the time employees are paid You WlII be !table for the tax payments even If you don't actually Wllhhold the tax from your employees For more InfonnatJon, call the Department of Revenue at 503-378-4988 ' Unemployment Insurance Tax: As an employer, you are reqUITed to pay a tax for unemployment Insurance purposes on the wages of all employees For more mformatJon, call the Oregon Employment Department at 503-947-1488 \ The Oregon Busmess IdentJficatJon Number (BIN) IS a combined number for both Oregon Withholding and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state or us/formsoav hlmll for the appropnate forms ,. - Workers' Compensation Insurance: As an employer. you are subject to the Oregon Workers' CompensatIOn Law, and must obtain workers' cvu'p""usatJon Insurance for your employees If you fali to obtain workers' compensation Insurance, you could be subject to penaltJes and be hable for all claim costs If one of your employees IS Injured on the Job For more InformatJon, call the Workers' CompensatJon DIV1slon at the Department of Consumer and BUSiness SerVIces at 503-947-78]5 U.S Internal Revenue Service: As an employer, you must Withhold federal mcome tax from employees' wages \ You WlII be !table for the tax payment even If you didn't actually Withhold the tax For a Federal EIN number, call the \ IRS at ]-800-829-4933 or VISIt theIT web sIte at \"w.. I1S uov _) . i Other ReslPom~ibmtnes 2lDldl Areas of COJlleen.s Code Compliance: As 1he permIt holder for thiS proJect, you are responSIble for resolV1ng any faIlure to meet code reqUIrements that may be brought to your attentIOn through InspectJons LiabIlity and Property Damage Insurance: Contact your Insurance agent to s~e If you have adequate msurance coverage for aCCidents and omIsSIons such as fallmg tools, paint over spray, water damage from pipe punctures, fire or work that must be redone Time Make sure you have suffiCient tJme to supemse your employees Expertise: Make sure you have the skIlls io abt as your own general contractor, to coordmate the work of rough-In and fimsh trades, and to notJfy bUIlding offiCIals as the al'l',vl'uate urnes so they can perform the required mspectJons If you have addluonal questions 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 Sprmgfield, Oregon 97477 541-726-3759 Phone 1~ IlL - - City of Sprmgfield OfficIal ReceIpt Development ServIces Department Pubhc Works Department Job/Journal Number COM2008-0 1145 COM2008-0ll45 COM2008-0l145 COM2008-0l145 COM2008-0ll45 COM2008-0 1145 COM2008-01145 COM2008-0l145 Payments Type of Payment Check cRccemtl RECEIPT #: 2200800000000001177 Date' 07/31/2008 DescriptIOn BUlldmg Permit fIxture Sanitary Sewer - 1st 50 Feet Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add + 5% 1 echnology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By MARGE SIMONS Item Total l.:heck Number AuthorizatIOn Received By Batch Number Number How Received dJb 3206 In Person Payment Total Page I of I 2 02 02PM Amount Due 5000 64 00 5000 4800 1600 II 40 2736 2280 $289 56 Amount Paid $289 56 $289 56 7/3112008