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Home My WebLink AboutPermit Electrical 2008-8-26 . \ I , , CITY OF SPRJNGFIELD, OREGON I ~~ ZON tH INITIALS- 'r k-l. DATE ~ '0'.p'~ SOURCE \~\~A~ 225 FIFTH STREET. SPRINGHELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CO.......... z.oc=>8' .- () I :z '70 200 Amps or less 301e~ ~.m3\).mps ,\C1\CE~ ~l t/.P\\\ffil~ \G~Xmps 1\'1\5 p~RNI\ \ t-1D~R 1\'1\S~ t~;ftGlrooo Amps PhO~~1\WR\l~~ \l3r.\S (>.\\fl,tW '~r 1000 AmpslVolts f. tQNlWI~t-1C'i:.~ PER\QO. Reconnect Only ~".t-.\'t~&OON I. ----------- Supervisor LIcense Numb;yt" "'. C I Temporary ServIces or Feeders ___ Expiration Date b Installation, Alteration or Relocation ... L LO~TION l!F INSTALlATION' _J 7 ri /Ortl -5f LEGAL DESCRIPTION 17033SI1 o<;soo JOB DESCRIPTION t1~<.J d$) fbv./J Str0"; (' ;. Permits are non-transferable and expire If work IS not started wlthm J 80 days of Issuance or If work IS Suspended for 180 days 2 I CONTRACTORINSTALLATIONONLY I Electncal Contractor Address Clly Constr Contr Number EXplfatlon Date SIgnature of SupervISIng ElectrICIan Owners Name ~! ~ C~{1 Address 7/'/ in r1i ,,,{- City .5frO Phone /Lfl- 765'1 OWNER INSTALLATION The lOstallatlon IS belOg made on property I own which IS not lfitended for sale, lease or rent 0.,= '''.f?' ~ InspectIOn Request 726-3769 Date 3 ~ COMPLE!E FEE SCHED~Ji BELOW: __~ I A I Ne~ Resl~e~I~I- Smgle or Multl-~am"r-p-e;-d~~lhng UDlt Service Included 1000 sq ft orless Each additional 500 sq ft or portIOn thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $12100 $ 22 00 $57 00 B I Servlce~ or Feeders -Installation, Alte~~~ons ~- a-eloca~~ f' 73 $ 73 00 $ 86 00 $14300 $18600 $426 00 $ 57 00 J 200 Amps or less ~ $ 57 00 201 Amps to 4li'~ A'mps $79 00 401 Amps to 600 Amps ~ $11400 Over 600 Amps..!:'~ ~~~ ~~~~R~ - --- -- -- -- -- l D ~anc~ r..~ \"e Ole" se\ \0 ~~~~}.e~~ru;:;;~~:~ -- ------- \o\\~c1tIe 'lS~~~~O~O\"IO\l~eso\~a~l\Olle$ 50 00 "'o'l\\i .-f.l(C...M\~ Itljn9 ,... ...~\l.Ua ... ~'iJ~~~0~ . ~ llO\\\' $ 5 00 '" raO ~ r,i{\\'" 011 \}\\\ "~I' ()O \\1I9we-w\eOlegN\.s3'Z.-'~-- -- --- -- - -- -~ Ii: ;~I"'~:t~d\'J~ ~\-&~7feeder not mcluded) -\<.ach InstallatIOn 1\UllIU -cell\e.- --- - - -- - -- Pump or Irngallon $ 57 00 SIgn/Outline Llghlmg $ 57 00 Llmlled EnergylResldentlal $ 29 00 Limited Energy/Commerclal $ 52 00 MIDlmum ElectriC Permit Inspection Fee IS $52 00 + Surcharges 4 I SUBl'OIAI~OFABOVE -I 73 12% State Surcharge &- 7b 10% AdminIstratIve Fee 7fd 5% Technology Fee -;J to r 7 Z- 71 TOTAL Shared Dflve(T )/BUlldmg Fonns/Electflcal Pennlt ApplicatIOn 7 08 doc Status Issued CITY OF SPRIN~I'IJ',LD Building/Combination Permit PERMIT NO: COM2008-01270 ISSUED' 08122/2008 APPLIED. 08122/2008 EXPIRES: 02/22/2009 VALUE: 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fa> 541-726-3769 InspectIOn Lme SITE ADDRESS' 717 10TH ST ASSESSOR'S PARCEL NO 1703351106500 SprIngfield TYPE OF WORK ElectrIcal Work Only TYPE OF USE New ResidentIal PROJECT DESCRIPTION New 200 Amp service Owner STANLEY VIRGIL C & MARILYN D Address 717 10TH ST SPRINGFIELD OR 97477 Contractor Type Electncal NOTICE' ContrnSlJfER' License OWl)!flItunnr~!! S~A~l EXPIRE IF THE WnRI< COMMENCED ~~~~ii"H~n}lli' ANY 180 DAY PER/rln I,LU H.m "IMlf Stones R-3 Height of Structure Type of Heat Water Type' Range Type. Energy Path Spnukled Buddmg I CONTRACTOR INFORMATION I ExpiratIOn Date Phone # of Umts Pnmary Occupancy Group Secondary Occupancy Group PrImary Construchon Type Secondary ConstructIon Type # of Bedrooms VB Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load nla I DEVELOPMENT INFORMATION . REQUIRED PARKING Street Improvements Storm Sewer Available Speclalln;tl uctlOn -- -"1':='~~ Overlay DlSt ~ ,- # Street Trees Rqd Paved DrIve Rqd ATTENTI~r:l:1 bY~lfd'r1'&\IIf&quIres yoU to fnnnw (ules adopted by the Oregon UtilII}' No,p . m ~~ ". M' Rr""',~ R952-~ot ~090, You may obtain copies 0 he r~TR%\<<lk Type calling the center. (Note the teleplio number for the Oregon Utility NotlfiClltlGilspoutslDralDs Center IS 1-800-332-2344). Total Handicapped. Compact Front yard Setback SIde I Setback Side 2 Setback Rearyard Setback Solar Setbacks Notes I V aluatIon Desc~lOtlOn , DescnptIon Type of ConstructIOn $ Per Sq Ft or multIpher Square Footage or Bid Amount Value Date Calculated Pa2e I of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO. COM2008-01270 ISSUED' 08/22/2008 APPLIED' 08/22/2008 EXPIRES: 02/22/2009 VALUE' 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe Total Value of ProJect Fees P3,ld I Fee DescnptlOn + 10% Admmlstratlve Fee + 12% State Surcharge + 5% Telhnology Fee Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $730 $876 $365 $73 00 8/22/08 8/22/08 8/22/08 8/22108 2200800000000001278 2200800000000001278 2200800000000001278 2200800000000001278 Total Amount Paid $9271 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 followmg work day, I ReoUlred T nsnections I Electric Service Approval reqUIred prior to utIhty company energIZIng servIce By signature, I state and agree, that I have carelully examlDed the completed apphcatlOn and do hereby cerlIfy that all mform.ttlOn hereon IS true and correct, aud I furthel certify that any and all work perlormed shall be done ID accordance WIth the Ordmances of the CIty of Spnngfield and the Laws of the State of Oregon pertammg to the work descnbed herelD, and that NO OCCUPANCY wIll be made 01 any structure Without permISsIOn of the Commumty Services DIVISIOn, BuIldlDg Salety I further certIly that only contracto", and employees who are ID comphance WIth ORS 701 005 wIll be used on thIS proJect I furthel agree to ensure that all reqUIred mspectIons 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 remalD on the SIte at all times durmg InstructIOn t D./11 /~ (18 Pa2e 2 of 2 , - 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 Penrut # ('OIlJA7.CfOr-O/Z70 7/7 101-t... c.. C Date sr- , q/Zz/=6" / I Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUires resldentzal constructIOn permit applzcants who are not lzcensed wzth the ConstructIOn Contractors Board to Sign the followzng statement before a bUlldzng permit can be Issued Thzs statement IS required for resldentzal bUlldzng, electrzcal, mechanzcal and plumbzng permits Licensed architect and engzneer applicants, exempt from lzcenszng under ORS 701010(7), need not submit thiS statement This statement will be filed with the permit Fill m the appropnate blanks and ImtIal boxes I and 2, and etther box 3A or 3B ~ ~ I own, reSide In, or will reSide In 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 Instruct my general contractor that all subcontractors who work on the structure must be licensed With the ConstructIOn Contractors Board OR Y 3B I will be my own general contractor If! lure subcontractors, I Will hIre 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 wIIlllnmed13tely notIfy the office ISSUIng thiS bUildIng permit of the name of the contractor I hereby certify that the ahove mformatIon IS correct and that I have read and do understand the InformatIOn NotIce to Property Owners ahout ConstructIOn Responsihilitles on the reyerse Side ofthis form, (~<;tJ t! _ - r- p~ 2-1 DB ,kBl'gnature of permit "ap~lIcant) '-' - (itate) (Whzte copy to Issuzng agency permit file, pznk copy to applzcant) Property_owner doc 06-01-04 . , '. - - ~ Atiiiig)as~Y out 'Own General Contractor? - .., ,J' \- \ ,- ~ . \, \ INFORMATION NOTICE TO PROPERTY OWNERS '\: _~ ", ,~ .ABQ.UT CONSTRUCTION RESPONSIBILITIES \ NOTE This Information NotIce to Properly 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 construct a n~ W home or make a suhstantIallmprovement to an eXisting structure, you can prevent many problems by bemg dware of the following responslblhtJes and concerns Employer Responsibilities , You will, In most Instances, be ruled to be an "employer" and the contractors you contract Wltj1 WIll be "employees" If you use contractors not licensed WIth the Construction Contractors Board to do labor m constructmg or to assist III the construcilOn ~r';mpr~vement of a reSidential stru~ture As the employer, you must comply with the following: Oregon's Wlthboldmg Tax Law: As an emplo'yer, you tTIust Withhold mcome taxes from employee wages at the time 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 mformatlon, call the Department of Revenu'e at 503-378-4988 -, -. Unemployment Insurance Tax: As an employer, you'are rcqUlred to pay a tax fO! unemployment msurance purp~ on the wages of all employees For more informatIon, call the Oregon Employment Department at 503-947-1488 "- -, -. , ,,~ - ' , .. ~ .. -.... The Oregon Busmess Idenl1ficatlon Number (BIN) IS a combmed number for both Oregon Wlthholdmg and ---- Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state or us1tormsnay htrnll for the appropnate forms ( !' , , . Workers' Compensation Insurance' As an employer. you are subject to the Oregon Workers' Compensanon law, and must obtam workers' compensatIOn Insurance for your employees If you fall to obtam workers' compensation In<;urance, you 'could be subject to penalties and be liable for all claim costs If one of your employees IS'mJured on the Job For more mformatlOn, call the Workers' CompensatIOn DIVISion at the Department of Consumer dnd Busmess ServICes at 503-947-7815 \ U S. Internal Revenue Service As an employer, you must Wlthhold federal/mcome tax from employees' 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 1-800-879-4933 or,vlslt-thclr web site at WW\" liS l!OV " Other E.esponsibinities and Areas ,of Concerns - . Cnde ComplIance As the pemllt holder for thiS project, you are re,ponslble for resolvmg any failure to meet code reqUIrements that may be brought to your atlenhon through m,pecl1ons " . LiabIlity and Property Damage Insurance' Contact your msurance agent to'see If you have adequate Insurance coverage for aCCIdents and omlbSlons such as fallmg tools, pamt over spray, water damage from pIpe punctures, fire or work thdt must be redone - , '\ __- - j 'D- )' TIme: Make sure you have sufficlent time to supervise your employees r ~ \ ~ . ExpertIse. Make sure you have the slaHs to act as your own general -contractor, to coordmate the work of rough-rn and fimsh trades, and to notify bUlldmg offiCials as the appropnate times so they can perform the reqUired mspcchons , , If you have additIOnal queb110ns call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Propcrty_owner doc 06-01-04 2250 FIfth Street SprIngfield, Oregon 97477 541-726-3759 Phone CIty of Springfield Official ReceIpt Deyelopment ServIces Department Public Works Department Job/Journal Number COM2008-0 1270 COM2008-0 1270 COM2008-0l270 COM2008-0 1270 Payments Type of Payment Check cRccclOtl RECEIPT #. 2200800000000001278 Date' 08/22/2008 Descnptlon Penn Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdmIDlstIatlve Fee P.,d By VIRGIL STANLEY Item Total Check Number AuthOrization Received By Batch Number Number How Received 4692 In Person Payment Total CJC Page I of I 9 28 53AM Amount Due 7300 365 876 730 $9271 .I' Amount Paid $92 71 $92 71 8/22/2008