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Home My WebLink AboutPermit Electrical 2009-2-19 Electrical Permit Application I . " ~. 225 Fifth Street. Springfield, OR 97477.PH(541)726-37S3tFAX(541)726-3689 1"~~~'S'~"'''=''',:;~t''.,e.'911~';''~''lVJW'';'Wtf~~:tf$~m'-'. :":1 t' ;DE~ARTMEN;ILUSE;0Nll.y0,. i. ..;t.. ~.!\r;";NiK''+l;'~''>Sl~~~I''it~#'t'a~-01u;:,~ ~'fi.!tr I Permit no.: C. q -- OCyz 43" I Date: 2 - I q ~ <::) <; I This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. . 11lW2I~_lE'OC~l::'fG(j"VERtilMENijIf~ReR0\1A~~~1 1~~~Ii~E&rS~8EbJ:Jl!E~~~. I Zoning approval verified? DYes D No I Ir~~~~~~~~~i1~~~I'Qt:~I~~<2.0~~ ~,!:Qta!1}& IIl!'~lIl!!1!(;'AifEG0RY'~O!'Jic:ONSjf,Rt!JCJjION~~Z~~1 _"."''''"''''''''''''l8",.~.",,'f.-~_,..~=, ..."., ~~a~1_ \W.~O~Hb~ I tti -- - I ' I . I I Residential, per unat, service included: 1~~~~~~~~~I!T:E~INfi~RG~;;;N;AND]iE~c~;7;N~~;~i!1 11,000 sq ft. or less (4) $134.00 $ I. - 1,(/ J 7 "1. ""/ I I Each additional 500 sq. ft. or portion $ 25.00 $ Job sIte address: ~ A ?') y.. thereof 1 City: c:,n/-W . 1 State: t) Q I ZIP: 17 i{7'7 1 1 Limited energy (2) $ 32.00' $ i~;~~OES:CRI~mi(jN[QF..g\'NJ~~;~~~~1 I ~~~71~:"s~~~~~~~ Fe~~:r (~)lOdular $ 63.00 $ I I Services or feeders: installation, alteration, relocation 1~~~~gl'i(jeI;RJ"'tii<:>WNER\$roi!~1f~~~~1 I ~:~ ~:~oo::;: ;:~ . / : ::::: 1 Name: J.li k-p r;::)oidot I 401 to 600 amps (2) I $158.00 IAddress:' C)~X /7~51. I 601 to 1,000 amps (2) 1 $205.00 1 City: sofJ/d. 1 State: OR I ZIP: Cj71.f77 lOver 1,000 amps or volts (2) .1 $469.00 1 Phone: c:flfl- /:M - N~5? 1 Fax: _ _ I 1 Reconnect only (2) I $ 63,00 I E-mail: ~iJj;@t1I>!(.om 1 This instal atlOn IS bemg made on resIdentIal or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent OAR 479.540(1) and 479.560(1). Signature: ~~~1Jc0NmR;4;CmbR~INSML!I!!~'ljION_~W~il~l: I Business Tkame: ./ 1 Address: ~ 1 City: I State: ~ 1 ZIP: I Phone: ,....(Fax: IE-mail: / 1 CCB license no.:/ """ I BCD license no.: I Signing supetVisor's license n~ I Pript...nan;e of signing supervisor: ~ ILiignature of signing supervisor: "" ~~~ ~~ ~q 440-2584-1 (9/08/COM) 7Z~ -370 q ~S6/ U ~S I 1 I 1 I I $ ~/I $ 1 $ I $ 1 $ 1 $ 1 I I I Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ I 201 to 400 amps (2) $ 87.00 $ 1 401 to 600 amps (2) $126.00 $ lOver 600 amps or 1,000 volts, see services or feeders section above I Branch circuits: new, alteration, extension per panel I a. Fee for branch circuits with purchase ofa service or feeder fee: 1 Each branch circuit I $ 6.00 I $ ! b. Fee for branch circuits without purchase ofa service or feeder fee: I First branch circuit (2) I Each additional branch circuit $ 6.00 j Miscellaneous fees: service or feeder not included 1 Each pump or irrigation circle (2) $ 63.00 1 Each sign or outline lighting (2) $ 63.00 I Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) 1 Each additional inspection: (I) .1 1 $58.00 1 $ 1 1~~~P.P.mCAN;tJUSE~~~~ . .-0 $~).I $ <f . 'lL;-' $ q.o"l $ cr~-lI1 , $ 55.00 $ $ $ $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [A]) I (C) Technology Fee (5% of [A]) 1 TOTAL fees and surcharges (A through C): Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ; J\ ( ,)0 t.AJ; ,- Ar'0/fl./ . J' \5f '2;0~ CITY OF :"lrKll'lGFIELD' Building/Combination Permit PERMIT NO: COM2009-00243 ISSUED: 02/19/2009 APPLIED: 02/1912009 EXPIRES: 08/19/2009 VALUE: Springfield TYPE OF WORK: SITE ADDRESS: 568 17TH ST ASSESSOR'S PARCEL NO.: 1703362406100 TYPE OF USE: PROJECT DESCRIPTION: Service upgrade Phone Numher: 541-726-1428 Owner: GElDER MICHAEL H & DIANE M Address: 568 N 17TH ST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor OWNER , # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 SetlJack: Rearyard Setback: Solar Setbacks: I,?ONTRACTOR INFORMATION I License Expiration Date Phone BUILDING INFORMATION' # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: nla I DEVELOPMENTlNFORMATlON I REQUIRED PARKING Total: Handicapped: . Compact: Qverlay Dist: # Street Trees Rqd: Pa.'ed Drive Rqd: % of Lot Coverage: I PU,~LI~ IM~ROVEMENTS I Sidewalk Type' . ' ATTENTION: ureaon \3" I eqUlres you to follow rules aDo)V;;silt)utslDraiits~On Utility Notification Center. Those rules are set forth . in OAR 952-001-0010 througll OAR 952-001- 0090. ,You may obtain copies of the rules by calling the center. (Note: the .t~I~p'ho,~e . ~:..:::-::-"r Tor lilt: UI l:<i:::IV1 I V~''''J ,..................-.. ., Valuation Descriotion I Center is 1-800-332-2344). Stre~(!::llJljr;9i~ments: . Stor~'s~We,:~~liiTa!ll~ALL ExpiRE IF THE WO Spec..1 Instr.uc!lon:UNDER THIS PE RK , .. ._~ "'--'-' RMIT IS NOT Not~?rJl~!ltNCED OR IS ABANDONED FOR ,.,.JY i 30 DAY PERIOD. Description Type of Construction $ Per Sq Ft or multip,lier Square Footage . or Bid Amount Date Calculated Value Paee I 01'2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less Total Amount Paid Total Value of Project , ~~esP~itll 'Amount Paid Date Paid 2/19/09 2/19/09 2/19/09 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00243 ISSUED: 02/19/2009 APPLIED: 02/19/2009 EXPIRES: 08/1912009 VALUE: Receipt Numher 2200900000000000187 2200900000000000187 2200900000000000187 To Request an inspection call the 24 hour recording 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 following work day. $9.72 $4.05 $81.00 $94.77 I Plan Reviews , I ~,e~uired I~slp,ection,s I Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all information hereon is true and correct, and I further certify that any and all work performed shall he done in accordance with the Ordinances of the City of Springfi~ld and the Laws of the State of Oregon pertaining to the work descrihed herein, and that NO OCCUPANCY will he made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will he used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front ofthe property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Paee 2 of2 Date ~ - Construction Contractors Board Permit #: U'l1 - 062 LL'S 700 Summer St NE Suite 300 Address...~( / 7 -If.., .:::, / _PO Box 14140 C. ! ! . Salem OR 97309-5052. 'rs.1i811 b}. m, Date:;) //9/0 Cj .... ./ Phone: 503-378-4621 I I I Web Address: www.cch.state.or.us Statement: If'!formation NotlIe l.Joperty Owners About Constr.uction Responsibilities . Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can.be issued. This statement is requiredfor residential building, electrical, mechanical and. plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. I ~ . , ' Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3,13: ~l 1. o 2. I own, residein,.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 ~m 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 . J ~ 3B. I will be my own general contractor. (r:-U C-t/2.ua1..' 1ft hire subcontractors, twill hire only subcontractors. licensed with the Construction Contractors' . Board: 'Ift change my mind and hire a general contractor, I will contract with a coniractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to. Property Owners about Construction Responsibilities on the reverse side of thjs form. ~d~ ~.) /9a/;tOe)Q (Signature of permit applicant) 7' ~t~ . . . (White copy to issuing agency permit file, pink copy to applicant.) , . Property_owner.doc 06-01-04 r ._ ."'. r;-,..("', _ . . , .... '.f' _..... ~ J - Acting'-asY9utOwn ,Genera! Contractor? -.-- .'1, \-: 1 ........ ....... . , "t" . . ", INFORMATIO,",hNOTICE Tq PROPERTY OWNERS' ABOUT, CONSTRUCTION;RESPONSIBILlTIES , ., :' . .... '.} ~"1 > .....~ ~.' '; ... ---l -'\\"- '. <- .; . . -.., . ..' ~ 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 ~s: your ~wn ~on~~c;or t~ construct a~new home or make a subs~ntial improverrient i~ an existing structure; you can preventrriany proble'msby beirig aWare of the follo\vi~g.tesponsibilitie's and concerns. . , I" ,...... ~,m,~lo~~r ~~sponsi~i1it.ie~\ ',,' . '. . ,',..'f I Y ouwill, in.!"ost instances, ,be ruled to bean "employer" and. the contraqtors you contract witl1 will be:'~!"ployees" i~ you ,!se c.onl!aq!o~~not licensed wJ\h th~ CO(1slfuqtlon y,(:,"(rap~o~s ~oard.to ~o ,Jabor in con~~c~ing or,to assist in the . construction.or,jl1)provement ofa residenti\ll str;uct:ur~. As'the.empIoyer, you must cOl!lpIy yv;tb the f~IIowiug: I . ".... ,,~ . ...... _ +, _ . . .' .... . ..1 ,,~oj ,.- .~- \ . - . _', t~.~ ':. -<.~." . .l..' f' ''],: _' '. ." ,', r _., _ : . . .': ' '(", \. I Oregon's Withholding Tax Law: As an employer~ you must withhold income taxes from employee wages at the time; employees are paid. You will be ljable for the. tax payment~ even if you don't actually withhold the tax from your' employees. For more information;'call the'DepiuitTI'ent o(Revenut'; a't 503C3'784988. ". '.. . '. ',' ';'..,' -' . . Unemployment Insurance Tax; As art employer, you are~feq~ited. to.pay a taX for unemployment'insunince purposes Jj on th~. wages of all employees. For more information;call the O~egon Employment Department at 503-947-1488. .1 The ar'~~o~ J~usi~e~s' 'I~~nti~~~;~o~'~'~~~ber' (~IN).' is .; :o~birt~d. ~~~r_ f\?; both~ Oreg~~ -~i;~o~din~ andl.' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.oLus/formsoav.htmll for the' appropriate fonns. . _. . ,!\ t . ~! . f' 4 _ Workers' 'Compeusation Insurance: Asan employer, you are subject to the Oregon Workers' Compensation Law, and mus.~ obtain WWke[S' ~omp.en~~.ti\m insurl'llcefor your empl,?Y<;,es.: .If you f~il to obtain 'Yor.!<.ers'.,con;pensationi insurance, youcouli:! be'subjectto penalties and be liable for all c1~itncosts iforie:~fymlr employee.sis injl!fed on thel job. For more information, call the Workers' Compensation Division at the Departnient of Consumer ana Business Services at 503-947-7815. . _ . ! I , .. .'. .1. . I .'!' t- -"0' .. '-.- ' . - U.S. Internal Revenue Service: As an employer; you must.Withhold'fedeiaFincoriie tax from employees' wages.t..' You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call thel IRS'aH-800~8i9-4933.orvisittheirwebsite:at-ww\V:ii'S.l!ov., ,.. , '.' j-..... " .,', l to. .' ,I. -;.. .. . ;.... '. I r . j '..~.' ",;.' "". .: '. " ~... ; . . . :': I . _, r;" .;" 't _: Other.Responsil>mties~I1,(L.~reasof.CQll(;:erns., ' i.,. . Code Compliance: As the permit holder for this project, you are responsible for resolving ;my failure to meet code 'I require.lllent~ th.at ~~y be. brol!ght t~ you:: ?tt~~t~on ~hri:J~gh in~pec~on;. . '.' .... . .1 . Liability and Property Damagc'Insftfance: ., Contact' yoiJdhsuranc~' agent"to see if you have' adequate' ihsurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. ,\ , \ \ '.', '. '-c \ '. . _ ~ ,.~- ,,\ . 1_"""" ,",''''-' \ ,......- ,....."'. ~. Time: Make-;'ure y~u hi;e 'suffici~nt time to ~~pervi~e' your-employees.'. :.:, .':'. ": -.' . ":.".. . --'0. ; ~., " : " , ..' '. " ,,~ .,"~ . .. . . .'" .... Expertise: Make sure you have th'e skills to aCt as your own general' contractor, to coordinate the work of rough-in and finish trades, aDd to notify building officials as the appropriate times so they can perform the required inspections. If you have. additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. " ."'; '. Property _owner-doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2200900000000000187 Date: 02/19/2009 I :50:36PM Paid By MICHAEL H. GElDER . Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 7576 'In Person Payment Total: Amount Due 81.00 4.05 9.72 $94.77 Job/Journal Number COM2009-00243 COM2009-00243 COM2009-00243 Description Perm ServlFdr 200 amps or less + 5% Technology Fee + 12% State Surcharge Payments: Type of Payment Check Amount Paid $94.77 $94.77 cReceintl Page 1 of 1 2119/2009