The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2006-10-9 ., . ~ '"' . L-i)(? ';. .... INITIALS ~ i?.....~. ~ ;'f DATE IDJqJIJt,. llii'- 'I.:"':'.. ~ SOURCE rh;' .o~ ". , Date //)_6 - /)c, 3. I COMPLETE FEE SCHEDULE BELOW ,. " .. , \ CITY OF SPRINc....ELD, OREGON 225 FIFTH 5TREET . SPRINGFIELD, OR 97477 . PH:(541)726--3753 . FAX: (541)726--3689 ELECTRICAL PERMIT APPLICATION City Job Number CiJlrn,o(Jt)t, ~ (J/:J %/ I i. '1 LOCATION OF INSTALlATION: '1?'11~ H~Y1z.I;" H..JLi LEGAL DESCRIPTION: iI 01- ~ '?O IU- I:u- Nc:>,o 'DOlcU ~/' 'f?,-;,( , JOB DESCRIPTION: 01107) A.I New Residential- Single or Multi-Family per dwelling unit. . i Service Included Installation, Alteration or Relocation 200 Amps or less $ 50.00 A7fS 201 Amps to 400 Amps $ 69.00 fOllow NItOA/)DM'cl" to 600 Amps $100.00 NOt. , rU/ft;J a.<. !Ian ''m "":'iltt -I:!V'/fb,~ Am lli:"llon Volts see "B" above. In 0;11 on ClJl1r-,-,"v-QFth--'I! .Q;'- 009 R 952-08" I. i\~ai\~qfc~iGrelJa/t~lIlli 0, Yo "00'0. - -Ute . vlll/tll ca"'ng ~~ay ~raAIm-ra~~I}I'l5~8fft. Panel nIJrnJo.^." C91~n~ ~rt>les~. t... 952'001 -. Orthe ~ch ~lional' ittu'l'UlrilYgn . . . '/l ^ I J... ?enter; ~Moe'b~.,;;J~ P'~o 'OJ $ 3.00 Owners Name l/ArM"~ .J f/~, e/~ s -8OD_?3f~'yFJoliJjoatine Address r'} 7 q 7 ~:J t1~ '" 2.,',0 1-/ In Y E. ll\llscellanl~iiili1Service/Ye'~der not included) -Each Installation I v City ~.f d. Phone '7 VI,- :!, 1& '} Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. I CONTRACTOR INSTALlATION ONLY I Electrical Contractor Address City Expiration Date . Sign re of Supervising Electrician OWNER INST ALLA nON . The installation is being made on property I own which is not intended for sale, lease or rent. oTl::rureJ4~,h - - ~ Inspection Request: 726-3769 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd iV!Jrrf1e Modular DwellinMfF(&lif $50.00 Feeder A ~ PeRMI IJ.]:Ho':..'}.!!'!l1.SJ.t-AfI_ B. I Services or f){;M!1~"!Iri~l~l,i/JJ{AJfil.1Y!!tI!..IJ."-- Relocation: : ANy 'W:fV"ED 0 117HI8 F THE W.11A1Ilfl) }J2 Amps or less 180 DAY P R 18 AR..1,v tl#lJ!JJlr-l-:Jfvr'(j.'- v 201 Amps to 400 Amps ERIOn l.!OtBlSl) Ffi'i vOr 401 Amps to 600 Amps $125.00 601 Ampsto 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 c. .1 Temporary Senices or Feeders I $ 43.00 Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 . Limited EnergylResidentiaI $ 25.00 . Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 +Surcharges 4.1 SUBTOTALOFABOVE I (03.00 8% State Surcharge b: 0 4- 10% Administrative Fee (" .30 5% Technology Fee ~3 _ /("" TOTAL /7. '-I-q Shared Drive(T:)IBuilding Forms/Electrical P~it Applic~tion 8..Q6.doc -....~...~ ~ ~,Jt 1 .' -.,." ..-" - . SITE ADDRESS: 7797 1/2 MCKENZIE HWY ASSESSOR'S PARCEL NO.: 1702363001100 Springfield .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-0I281 ISSUED: 10/09/2006 APPLIED: 10/09/2006 EXPIRES: 05/09/2007 .YALUE: NUTlCE: TI-IIC: P"D'"T "II!' L _. TYil'~mJ>>'i\?rn<~~HCf~\~~r5<.'6nrlrt WORK COMM IS t->'tRMIT IS NOT TY.P.E'XU1' ~tiQ{D cm~~iABANDONE[Jl.f@ltntial ANY B~lrAY PERIOD. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726.3676 Fax 541-726-3769Inspeclion Line PROJECT DESCRIPTION: Replace 200 amp panel. Owner: DOLBY NORMAN & ELSIE W Address: 7797 1-2 MCKENZIE HWY SPRINGFIELD OR 97478 Phone Number: 541-746-3165 Contractor Type Electrical Contractor OWNER I l.v" I "ACTOR INFORMATION I License Expiration Date Phone BUILDING INFORMATION I Front yard Setback: Side I Setback: Side 2 Setback: Rcaryard Setback: Solar Setbacks: # of Stories: Lot Size: Height of Structure Sq Ftlst Floor: Type of Heat: TION 0 S~p 2nJ1 ~IQ'lJou 10 Water Type: ATTEN : regon I~~ Ft~J~m"l,J(:'rl't Range Type: follow rullP adopted b~<itm e~~M~{jjfb~YI Energy PatlNotificatlon Center. Tho~4' W~rh~!3 se lOnr Sprinkled BililmR~ 952-00"13010 thOWG~aQA..~~2-001 9:39. ~.""::..: :-:r -.....-:... _^~lo~ "f th~ rllh:u:, h\ I DEVELOPMENT INIIG.RMll'fU:l1S9Iter. (Note: the telephone numberfortne Oregon UtilltyRE~titIRlbIJlPARKING Center is 1-800-332-2%1~1: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: # of Units: Primllry Occupllncy Group: Secondary Occupllncy Group: Primary Construction Type Scconda.)' Construction Type: # of Bedrooms: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Descriotion I DescriPtion Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calcullltcd Pace 1 of2 -~4iiI . -=ITY OF ~rKIN'-'l'lI!.LD . Building/Combination Permit PERMIT NO: COM2006-01281 ISSUED: 10/09/2006 APPLIED: 10/09/2006 EXPIRES: 05/09/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fee. Paid I Fee Description + lOIYo Administrative Fee + 5'Y., Technology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $3.15 $5.04 $63.00 10/9/06 10/9/06 10/9/06 10/9/06 Receipt Number 2200600000000001410 2200600000000001410 2200600000000001410 2200600000000001410 Total Amount Paid $77.49 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. I Reouired In.neelions 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 hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who arc in compliance with ORS 701.005 will be 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 of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Paee 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 Pennit#: eomA -O/;;)g J Address: 179'1 Vz. (VI~U-G- Hzur ISSUedbY:~~ Date: IO-(P ~Ia . , Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for 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. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: !ZJ 1. ~ 2. 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 ~ 3B. I will be my own general contractor. IfI hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor 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 this form. IL~ )/ kJd //)..-9- 01 (Signature otpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 \ \ , . Adnrnfg ~~~ '({))~Ir'OWIOl GteIOlteIr'~n C'IOl~Ir'~~t({))Ir'? . II \- .' . IINFORMATION NOTICE TO PROPERTY OWNERS , ABOUT CONSTRUCTION RESPONSIBILITIES . - ~, ~ -t I' . .": ~. ,. " \. NOTE: This Information No/ice /0 Properly Owners about Construe/ion Responsibilities was developed by /he Construe/ion 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 new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. lEmlPHoyeJr lResjploilllsilbiiHWes You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As tbe employer, you must comply witb tbe fo."owing: Oregon's Withbolding Tax Law: As an employer, you must withhold income 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 information, call the C~I'''' ~Hent of'Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax 'for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification 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.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs 'if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S, Internal Revenue Service: As an employer. you must withhold federal income 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 1-800-8i9-4933 or visit their web site at www.irs.l!ov. Other R.esjponsibiHities and Areas of Concems Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. I Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. , . . . - Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the al'l"~I'.;ate 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 Spr;hlglield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2006-0 1281 COM2006-0 1281 COM2006.0 1281 COM2006.0 1281 l'aymcnts: Type of Payment Check cReccil1tl RECEIPT #: . ",AINQFlllU) ~ CiKf Springlield Official Receipt D"pment Services Department Public Works Department 2200600000000001410 Date: 1 0/09/2006 Description Perm Serv/Fdr 200 amps or less + 10% Administrative Fee + 8% State Surcharge + 5% Technology Fee Paid By NORMAN J. DOLBY Item Total: Check Number Authorization Received By Batch Number Number liow Received ddk 2070 In Person Payment Total: Page I of 1 I :20:43PM Amount Duc 63,00 6,30 5,04 3,15 $77.49 Amount Paid $77.49 $77.49 10/9/2006