HomeMy WebLinkAboutPermit Electrical 2003-12-9
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. ~IQ~\ii~amilY per dwelling unit. "'.'~". ~:'.".-;,.,'.','J:,:
LEGAL DESCRIPTION '. ~roiect as submitted has thl en'd'1l,rece Included:. ..' .
170 L '3 5 :3 ( . 6l:!>~~lN{oas nol require specIfic a Items Cost siiiii;'~i
fif,;~ JOB DESCRIPTION ~;pf;val Zoning l:n~ 1000 s ft ~r less $106.00 ff,'J
~',~ i2cf~ m~~," ~~ \1. ~ ~-~0;njC~~ ~~;:~~ 500 ~~:,,;~;~
"/ ".~ Permits are kon-transferable and'expifi: Signature - . thereof $ 19.00 ,r." ~i<1
; i.:~ if work is n9.t:~tarted within 180 days Each Manufd Home or tj'k~ - I!.;,:,,::'.;
~~';~{i of issuance brifwork is suspended for Modular Dwelling ,:'~~:',-,. ,"'. "'i
": 1~.'1i 180 days. t~~, . Service er Feeder f ,.; ,:J\~~~ $ 50.00 "~.:,,~\
,,'};rJ! 2. CONJ!~OR~STALLATIONONLY B. SeryiccsorFeeders /~'~~J~.tt\ ~<'l~~
t~4;~ h'A {", . Installation, Aller'!4dns'or ,";;'}:: ., . :\ [',:' ,,:)
~}J;j~ Electrical' c'o, it,~,t,ffctoL,,'th, ,'ff' I:l s {'tl.:ZlJt{l ~C- Relocation: j; ~,::,.. ;'M'".,' ;,',\~ r.;';,~
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~,i\ Address~:~' WJ,/a 1~ ^rl1 CCI /. ' -;'.. "-"" 220001 amps or 4IeOsOS:":'" "~"~"':'_:$$.'76'.35..':.'oOoO ~',' ;,'
,." ,. . I f'.\ . , .' ,.,: .. "'; amps to ".amps:.. , .., '. ,~
l?)d Cily-S.P/L'() ~ ('Pr~one ]l<,'7-4.lj~3 0.,;,401 amps t"l600 aIftps 'i t:';:~ ~i~i.~~;: ';'J
V~,AJ " ' ."\ I " \ ;.(', , rl S' , ,'; -, '601 ampS!o ,1000amps\ ' L "
, '\~;J Supervisor License Number /4771< . 'ch-er)Oo/damps!voltS' .. :';':'.' '$375':OQ:' ,"'j
:' ,\'01. I "v,'. V..,. R . 0'1 .: '_$.'5..0_:00'_...1
"~ {'" , econnect n~ -" . _ _.. \
<.:;'; Expjration Date '10 -0 J-' ~004' ..,,'" l
<,,::-I C".:,;' ';': C(.8.,!lcI'lG74~-: , . C.'TemporatYSeo.cesorFeeders . "0 .. ,,:,j
i,~),;,i Constr COJ)ti.Nu~berPt'" _,10< ;),0-40 C . ' .,~stalliitiiln; -i(te<~ti~n,or ReloCa@t{?
r -!.,"l' ~t(f-cil-I"-'~ Q$.f'\.fI ..'J
(,::i~_~f!XPiratio~Date r-="'~;'.~ ,,~...r>" : . 200ampsor')ess. : $50.00'J
~.?~~i1$,-,: : b~~;-..~ - ~ ", ~.~:;~.: . 20J anf 5to'466 inn s, ,',:;;~ . ' _ .$69.00 ~
tf~S:'~:;:' ." Sigh~hitc, ~f~upervising Electrician , "'1\i~~~!dt,Lto600:>l,Hl:S~".: . '"Ie;:" - $'10.0.00~ . I
'~~;'\:,'; :~,<. ~ ," ~" THIS P@'Mbfl~l'lWEtoe.~f<WSlf.ffi.wORf( " . ,,4
.,',,:} . ,Ph,.. ~.', ~;-r..~1"c'-. AUTHORIZt~'QNDER, THISPERMI'FI&, N,O:"T . 'j
" "";~2f 7,/V""'.'c":'\':l)", \ ~ &OJ:Na\fJllG:!i~fi IS ABANDONED tOR . '".1
Pt"'1~2.~:S Na~e !?~;,t~~~~ ~ ~~ ,ANY 1 $ltQ~~!}t~tension Pi~~~~el: ':.... , . "1
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CITY OF SPRINGFl....LlJ
Status
Issued
Building/Combination Permit
PERMIT NO: COM2003-01221
ISSUED: 12/08/2003
APPLIED: 12/08/2003
EXPIRES: 06/08/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 7034 MAIN ST
ASSESSOR'S PARCEL NO.: 1702353100900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Replace meter base
Owner: BRENDA AUGUSTINE
Address: 7034 MAIN ST SPRINGFIELD OR 97478
Phone Number: 541-747-2703
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
MITCHS ELECTRIC INC
License
146745
Expiration Date
01/18/2005
Phone
541-747-4483
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constructinn Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback: Overlay Dist:
Side 1 Setback: # Street TFlIRqd:
Side 2 Setback: 'i'\C~' "'''PIRt WavelEIWiV d:
~O, . 1 S~p..LL ~I\ r.n~M1 )!> N
Rearyard Setback:1~\S PtWAI I'mER 1~IS PWd'6fI1or~overage:
Solar Setbacks: ~U1~ORII~?"ljnt:l IS Jl.BM~OONED u
CON\~\~OO~; PERIO~'PUBLIC IMPROVEMENTS I... I' ',: I'll" Ie". ,_>1,,1,2: \,".I.!lO
p.l'l'l 'e' "_" . ., 1".1' ,'- .Ity
Street Improvements: . .. " Sidewalk Type:"". ,-". '. . 'or
i r. if '. I '- -', 'l .' ~ 1
. .' l Down,spoutslDrai,!s:':\.' ....1'(
. II: '
Total:
Handicapped:
Compact:
Storm Sewer Available:
Special Instruction:
l),\,
. ".,.
1,lr... '
I. .'
Notes: .
...,O:jll.' .,
I . . ~ i . i1 ~ ,...,
. .1_
,- -;
~ ..., .. ..
.. .
, .'
. ~ . '-,-.
. ,_........
~".""'" .,...-
I Valuation Descrintlon I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
. Paee1of2
.
. CITY OF ~rKll~\,yt<mL1J
Building/Combination Permit
PERMIT NO: COM2003-01221
ISSUED: 12/08/2003
APPLIED: 12/08/2003
EXPIRES: 06/08/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fpps Paid'
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$4.41
$63.00
12/8103
12/8/03
12/8103
1200200000000002564
1200200000000002564
1200200000000002564
Total Amount Paid
$73.71
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.
~ Reouired Insnections ,
1 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 accnrdance 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 are 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 of2
e.
. .
. .
\" ./
". ,"
. .'
~onstruction contracts Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Pbone: 503-378-4621
Web Address: www.ccb.state.or.us
Permit #: ('0,"", zA _0 I z. 'Z \
Address: 7D3/--f
jI1I1 A IN
"S.T
Date: /?--/8/os
I I
Issued by:
n'E.
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 "pp.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B:
[x'l.
~ 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
~ 38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If! 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 Ownjs about Construction Responsibilities on the reverse side of this form.
~1\LL.j_ AIM,wj,~ 1d-~-Q3
~ (Signatur~fpermit applicant) (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
",.t'.uJ_owner.doc 03/11/03
. .
Acrrnnng ~:& 1{ ~\UlIl" ((])wnn GtennteIl"~n C~nnrrIl"~Crr~Il"?
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
.
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 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.
JEmplloyell' Re~poll1l~n!IJnmne~
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 the employer, you must comply with the following:
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 liable for the tax payments even if you don't actually withhold the tax from your
employees. For a State Business ill number, call the Business Information Center at 503-986-2200. , "
Unemployment Insurauce 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.
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 866-816-2065 or fax them at 801-620-7115. "
"
Otll1ell' Re~poll1l~nlOnnntne~ ~llIl1ldl A..Il'elll~ olf COll1lceIrIl1l~
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.
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 notilY 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 03/11/03
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01221
COM2003-0122I
COM2003-0122I
Payments:
Type of Payment
Check
,r
J:~;_:
~..
Receipt #: 1200200000000002564
Description
+ 7% Slate Surcharge
+ 10% Administrative Fee
Perm ServlFdr 200 amps or less
Paid By
BRENDA AUGUSTINE
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official ReceiPt
Development Services Department
Public Works Department.
Date: 12/08/2003 1l:20:53AM
Amount Paid
Item Total:
4.41
6.30
63.00
$73.71
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71
.
.