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Home My WebLink AboutPermit Electrical 2008-8-26 :! , ; ClTY OF SPRINGFIELD, OREGON -, I ZON INITIALS DATE SOURCE 225 FIFfIl STRFET . SPRINGFIELD, OR 97477 . PH (541)726.3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLlCATI.~b CIty Job Number '[,OVV' Z-c>o If - D ( ; Date f-z.z-of' 1 I LOCATION OF INSTALLATION. ~- --- 114l rM\--e..V L-Y\ 3 I COMPLETJi F~E SC!fEDULE BELOW __ ___ _ _J LEGAL DESCRIPTION /703>2)'3 Z. 17(DD A I New R""~~nhal- Smgle or Mulh-Famlly per d;!lIlDg UDl~-.J Service Included JOB DESCRJPTION 1000 sq ft or less ) Each addItIOnal 500 sq ft or 1= \/4e \t..J \J.-Jf~V \.wJ t v\.tC.<<.,t ~V' (~Ctv~\'IiQ.portlOn Ihereof $12100 $ 22 00 Permits are non-transferable and expire .fwork IS not started wlthlD 180 days of Issuance or If work IS Suspended for 180 days Each Manufact'd Home or Modular DwellIng Serv,ce or Feeder $57 00 2 I CONTRACTORINSTALLATlONONLY I - ~- ----~ B I Services or Feeder~ -In~tallatlon, AlteratIOns or Reloc~t1~~ 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps / 601 Amps t() 1000 Amps Phone Over 1000 AmpsNolts / Reconnect Only ~~YO\I\O - - -~-- SupervISor License Number _ ~ orAgon la~~~<<i6W~Jtl~ervlces or Feeders ____ __ __ __ _~=.J ~iiEN1 IV' ~dollted '0'1 IAll are set fo\loW ruleSCet'ter. 'T\lOse ~J'6t4'l~MratlOn or RelocatIOn NOtlilCa\IU" ^"l..oo10\tlfOUlt'1>1i1I~AIll ~ $ 57 00 OI>J\ 952.""" b\aln COllie.,. III _ '{all mav 0 \No\e: t\\'EI Amps $ 79 00 OU~i\llg\tl9::~.egonU\~~ s 0600 Amps $11400 ,....~tof 18I.1~ver 600.Amps or 1000 Volts see "B" abov"-____ -- - un --J ofSupervlsmg ElectriCian Qetl D [ Rrant-h Cln.Ults Address / $ 73 00 $ 86 00 $14300 $18600 $426 00 $ 5700 <::"7 Electrical Contractor CIty I Expiration Date New AlteratIOn or ExtenSIOn Per Panel One CircuIt Each AdditIonal ClfCUlt or with Service or Feeder Permit $ 50 00 Owners Name I\daM Stt~avce \L Address \lA\ \'.0.1\"<-( \,-'1\ E I MIScellaneous (ServIce/feeder no'..'~dude~) ~Ea~h hlS~alla!IO_~1 City ~D(\'f\.~-Rt\cJ. Phone J'If\-3,Olt\' pumpor'arrato ~'1lO1\t $5700 - \ t40't\Ct~ ~1!- {t \S NOt $ 57 00 OWNER INST ALLA T10N l\\\S PERtAt'f ~t'V41 ~ea $ 29 00 The mstallatlOn IS bemg made on property I oWf,~R\lEO '$IJIi9~Q mmerc131 $ 52 00 IS not IDlended for sale, lease or rent CO"^tAE~EP.J~~;\WG~f1c Permit InspectIOn Fee IS $52 00 + Surcharges 180n~'r~ --~--l 7 9wi'enSlgnature, tL ~) IItl'l 'l\ I SUB10EALOFABOVE 5 ~ W~- /I~ 12% State Surcharge 68<( 10% AdmmlStrallve Fee S 7" 5% Technology Fee Z St. 72~ $ 5 00 InspectIOn Request 726-3769 TOTAL Shared Dnve(T )/BUlldmg FormslElectrK.al PenTIlt ApphcatlOn 7-08 doc -~ CITY OF ~rK1j~tJI'iELD' Building/Combination Permit Status Issued 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe PERMIT NO ISSUED APPLIED. EXPIRES. VALUE. COM2008-01269 08/22/2008 08/22/2008 02/22/2009 SITE ADDRESS 1747 CARTER LN ASSESSOR'S PARCEL NO 1703253217100 Spnngfield TYPE OF WORK Electncal Work Ouly TYPE OF USE PROJECT DESCRIPTION Extend service mast Owner Address ADAM STEFANEK 1747 CARTER LN SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electncal Contractor OWNER LIcense # of Umts Pnmary Occupancy Group Secondary Occupancy Group Pnmary ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms BUILDING INFORMATION' # of Stones Ulres 'IOU to R-3 ON oJ!!tlgh't\~\ri6l\!gon Utl\ltV I\. TTENTI '11ypcJJf'lN1~ e set 10rtl1 f~VBN ;U\eSc~~WatiJ'f\,jly~Ju~e~~~ 952-001- nO\lllca1l0n 001R.fngetfy~~\l I t\16 lules bY In OAi1~~J~a'lEffilFgy~aru'e~h~ telephOne n 0090 the c'Spflnkll;lRitu.\\\tlDklot\I\Catlo nla ra\\\flQ ~L........ rwpQon ~~..., "A' n .",I,'DE$E'LJOPME'NT INFORMATION I Frontyard Setback Side 1 Setback Side 2 Setback Rearyard Setback Solar Setbacks Overlay Dlst # Street Trees Rqd Paved Dnve Rqd % of Lot Coverage I PUBLIC IMPROVEMENTS I Street Improvements Storm Sewer A v3llable Special InstructIOn Repair Resldent..1 Phone Number 541-744-3074 ExpiratIOn Date Phone Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Gal agelCarport Sq Ft Other Occupant Load REQUIRED PARKING Total Handicapped Compact Sidewalk Type DOWnSJlO~'ll~\( M01\C~: WI" S\1r>.'-'- ~?~~~~Wlll IS ~Oi 1\-11'0 ?t~lt$ \.I~\)tR 1\-1r>.~OO~tD fOR M\1\-10R .~~1"\ nl\,IS r>.B 0IHi4\:::",r..,. t:RI\.lU. I V ~Iuahon lfiesctWtRM r Notes DeSCriptIOn $ Per Sq Ft or mulhpher Squa, e Footage 01 Bid Amount Type of ConstructIOn Page I of2 Value Date Calculated CITY OF SPRINGFIELD Building/Combination Permit Status Iss u ed PERMIT NO. COM2008-01269 ISSlJED 08/2212008 APPLIED' 08/2212008 EXPIRES 02/2212009 V ALlJE' 225 Filth Street, Spnnglield, OR 541-726-3753 Phone 541- 726-3676 Fax 541-726-3769 InspectIOn LlDe Total Value of ProJect Fees PaId I Fee DescrIptIOn + 100/0 AdmlDlstratIve Fee + 12% State Surcharge + 5% Technology Fee Service Reconnect Amount Paid Date Paid Receipt Number $570 $684 $285 $57 00 8/22108 8122/08 8/22108 8/22108 2200800000000001276 2200800000000001276 2200800000000001276 2200800000000001276 Total Amount Paid $72 39 I Plan Reviews I To Request an InspectIon call the 24 hour recordmg at 726-3769 All InspectIOns requested before 7 00 a m, wIll be made the same workIng day, Inspections requested after 7:00 a.m. wIll be made the lollowmg work day I ReoUlred I nsnectIonsJ Electric Service Approval reqUIred pnor to utIhty company energIZIng service By signature, I state and agree, that I have carefnlly exammed the completed apphcatlOn and do hereby cerhfy that all IDl0rmatlOn hereon IS true and con ect, and 1 fUl thel cerllfy that any and all work performed shall be done ID accordance With the OrdlDances of the City of Sprlnglield and the Laws of the State 01 Oregon pertalDlDg to the work described herelD, and that NO OCCUPANCY will be made of any structure Without perm"S1on of the Commumty Services DIVIsIOn, BUlldmg Safety I further certify that only contractors and employees who are ID comphance With ORS 701 005 will be u;ed on thiS proJect 1 further agree to ensure that all reqlllred IDspectlOns are requested at the proper tIme, that each address IS readable from the street, that the permit card IS located at the front 01 the property, and the approved set of plans wIll remam on the site at all times dunng construction aaV~~ '----' - Owner or Contrdctors Signature g-?--z...-o~ Date Pa2e 2 ot 2 ~ Construction Contractors Board 700 Snmmer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone 503-378-4621 Web Address. www ccb state or.us Pernnt # c.l')WI~oc::,8-0 I Z- b cr 17Lf7 C;. tLTEVL ~"( Date 6/ZZ/0'r I / Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUires reszdentlal constructIOn permzt applzcants who are not lzcensed with the ConstructIOn Contractors Board to sign the followzng statement before a bUilding permit can be Issued This statement IS reqUired for resldentzal bUilding, electrzcal, mechanzcal and plumbing permits Licensed architect and engineer applzcants, exempt from lzcenszng under ORS 701010(7), need not submit thiS statement This statement Will befiled with the permzt FIll In the appropnate blanks and InItIal boxes 1 and 2, and either box 3A or 3B !J' 1 ~2 I own, reSide m, or wIll reSide m the completed structure I understand that I must become lIcensed as a constructIOn contractor Ifthe structure IS sold or offered for sale before or on completIOn D 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 ei 3B I Will be my own general contractor If! lure subcontractors, I wIll lure only subcontractors lIcensed with the ConstructIon Contractors Board If I change my mmd and hIre a general contractor, I wIll contract With a contractor who IS lIcensed With the CCB and wIllllnmedJately notify the office ISSUIng tlus bmldmg 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 reyerse Side of thIS form. ()~ W 1dfJ-J--/ ~-:t,a-D){ ..... v.... } (Signal lITe of permit applIcant) (Date) I Whzte copy to ISSUing agency permit file, pink copy to applzcant) Property_owner doc 06-01-04 ~ ::,., '.-- .... - Actht~(as~Y oli.r(Own General Contractor? ~ ~)) - I 1~Ii:ORMATfoN\ NOTICE TO 'PROPERTY OWNERS" .. , AB9UJ;-C<?NSTRUCTION RESPONSIBILITIES ,\ ~ \ \ ~ , I, q NOTE This InformatIOn Notice to Property Owners about Construction ResponslbJlltles was developed by the Construction Contractors Board In accordance wrth 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 'substanl1allmprovement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responslbIhlJes and concerns Employer ~espoD.sibmties . You Will, 10 most mstances, be ruled to be an '.'employer" and the contractors you contract .wIth WIll be "employees" If you use contractors not hcensed wIth the ConstruclJon Contractors Board to do labor 10 construclJng or to assIst 10 the construchon or Improvement of a reSIdentIal structure As the employer, you must comply with the following: , Oregon's Wlthholdmg Tax Law: As-an employer, you must Withhold mcome taxes from employee wage, at the hme employees are paId You WIll be ,hable for the tax payments even If you don't actually WIthhold the tax from your employees For more mfQrmallOn, call the DepartnientofRevenue at 503-378-4988 " , ,; Unemployment Insurance Tax As an employer, you are requlfed to pay a tax for unemployment msurance purposes I \ on the wages of all employees For more mformatJon, call the Oregon Employment Department at 503-947-1488 . - ......,1 \ ~, The Oregon Busmess IdentJficalJon Number (BIN) IS a combmes! number for both Oregon Wlthboldmg and' Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or WW\\ dor state or us/formsnav hlmll for the ayplVp1.late forms Workers' Compensation In~urance: As an employer, you are subject 10 the Oregon Workers' CompensatJon Law, and must obtam workers' compensatIOn msurance for your cmployees If you fall to obtam workers' compensatJon msurance, you could be ~ubJeet to penaltIes and be haole for all claIm costs If one-of your e-mployees IS mJured on the Job For more mformatJon, call the Workers' Compensation DIVISIon at the Department of Consumer and Busmess ServICcs at 503-947-7815 J US. Internal Revenue ServIce' As an ernplojer, you must Withhold federa1mcome tax from employees' wages^" You wdl be hable for the tax payment even If you dIdn't actually Withhold the tax For a Federdl EIN number, call the IRS at 1-800-82'9-4933 or VISlt'thelr web sIte at w\"'v liS 1!O\o ", , - , Other Responsibilities all]d Areas ,of COll1cems " - Code Compliance: As the permit holder for thl~ project, you are responSible for resolvmg any faIlure'to'meet code requlfements that may be brought to your attentIOn through inspectIOns J.... ~ 'I i.~ , ~... ~ LiabilIty and Property Damage Insurance: Contact your msurance agent to s~e If you have adequate msurance coverage for aCCidents and OllliSSIOIlS such as falImg tools, pamt over spray, waler damage from pIpe punctures, fire or workthatmuslbere~o(~_ ,'r' _Q ,\ J. : \' \ _ _ -' / ""': (....J --- ..! ~ Time: Make sure you have suffiCIent bme to supeIVlse your employees Expertl.e' Make sure you have the skIlIs'to act as your own ge11eral contractor, to coordmate the work of rough-m and fimsh trades, and to nollry bUlldmg offiCIals as the appropnate limes so they can perform the reqUIred mspectlons If you have additIOnal que~tlOns call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Propcrly _owner doc 06-01-04 225 Flftq Street SprIngfield, Oregon 97477 541 ~726-3759 Phone Job/Journal Number COM2008-0 1269 COM2008-0 1269 COM2008-01269 COM2008-0 1269 Payments Type of Payment CredltCard cRecelDtl RECEIPT #, DescnptlOn ServIce Reconnect + 5% Technology Fee + 12% State Surcharge + 10% AdmlDlstlatlve Fee Paid By ADAM STEFANEK f;Q7~ E.' CIty of Sprmgfield OffiCIal ReceIpt Development ServIces Department PublIc Works Department 2200800000000001276 Date: 08/22/2008 Item Total Check Number AuthorizatIOn ReceIVed By Batch Number Number How Received dJb 203894 In Person Payment Total Page I of 1 8 17 35AM Amount Due 5700 285 684 570 $72 39 Amount Paid $72 39 $72 39 8/22/2008