The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2009-4-30 Electrical Permit Application 225 Fifth Street. Springfield, OR 97477tPH(541)726-3753tFAX(541)726-3689 1~[DE~'AR]MENjJUSB0Nl1Yi1~l ~~~jI'i!i-;"}1'C:2;.':";-;:iif~:>2?'&'!lE'=~i:s:~~ilt~~ I ;ermit no. tl'1 ~ sY'/ l I ~ate:, ~/31J 101 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. ;, I Residential, per unit, 'servi:ce included: 11,000 sq. ft. or less (4) I Each additional 500 sq. ft. or portion thereof . I Limited energy (2): $ 32.00 $ I I Each manufactured home or.. modular I dwelling service or feeder (2) $ 63.00 $ . I Services or feeders: install,alion, alteration, relocation I I 200 amps or less (2) ! $ 81.00 $ fin I I 201 to 400 amps (2) $ 95.00 $1 I Name: 1::-[.( L ( f3cT1- ( /V1L4 VLI kcr I 401 to 600 amps (2) $158.00 $ I I Address: "104'7 C ~ I 60i to 1,000 amps (2) $205.00 $ I Ic' c"c> I I ("/01.17["" IOverl,OOOampsorvolts(2.) $469.00 $ I' ny: 'Y\ \=", _ ,\ State: UiL-. ZIP: -, I., o' I Phone: 7'11;'17:2. 2- I Fax: I I Reconnect only (2) $ 63.00 $) I E-mail: I I Temporary services or fee~ers: installation, alteration. relocation 1 This installation is being made on residential or farm property I 200 amps or less (2) $ 63.00 $ owned by me or a member of my immediate family. This 1 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR I 479.540(1) and 479.560(1). . I 401 to 600 amps (2) $126.00 $ Signature: lOver 600 amps or CODa volts, see services or feeders section above J II!lJljjt;JM~,C;;:~N111RA'G;llEjRI!!INS;n.ll:L!l!'~mIPNIlR~~ICK4ill,!1 1 Branch circuits: new. alteration. extension per panel 1 I Business name: Bvv)J ~- ~ ~~ 1 I a. Fee for branch circuits'w.i,th purchase of a service or feeder fee: "I 1 Address: I I Each branch circuit I / I $ 6.00 I $ & CO 1 I CitY: I State: . I ZIP: I I b. Fee for branch circuits wIthout purchase of a service or feeder fee: 'I I Phone: I Fax: I . First branch circuit(2) .. $ 55,00 $ I I E-mail: 1 Each additional branch circuit $ 6.00 $ 1 CCB license no.: 1 BCD license no.: I Miscellaneous fees: service or feeder not included' . I Signing supervisor's license no.: I Each pump or irrigation circle (2) $ 63.00 I Print name of signing snpervisor: 1 Each sign or outline lighting (2) $ 63.00 ./ Signature of signing supenrisor: I Signal circuit or a limitcd-~nergy panel, $ 63.00 $ , alteration, or extension (2) , I Each additional inspectior1: (1) 1~~~If~C;;~I,.~13~JZERNIIIIE:Nrl~l::~ROY;6;l!![~~iifl I Zoning approval verified? DYes D'No I l~dc;;~iJlEG!DR.Y&7PFAfc0NsmRl!J.GJiIEjN~_~1 I D Residential I D Government I D Commercial I 1_)l"JOBIsimEJ1JNIi0.R.M~1iIONfA.N(jIl!Q.c;;~1iIQN~ffiJ.~1 'I Job site address: SO'l9 E s.f. I City:...flJFi c/ I State: ().. I ZIP: 'l?'I?1J I Subdivi;ion: I 'Lot no.: I~~"". ~Jgf1~-DESCRIRmI0Nti!01;ll;.wbRJ(,1l"~'~7!''!''''\!ii'! ~,l1!'L~'"""'I>'W4t~_"""""",,_,,w ' ,',,' ..1'r,~_"""",,~_Wl!. _' ,~ ," ",~_~=";,..".'"j-,<,,SJi\W%i'!y,'J ~~ 0~$ ~~ 440-2584-J (9/08/COM) $134.00 $ $ 25.00 $ $ $ I $58.00 I $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [A]) I (C) Technology Fee (5% off A]) 1 TOTAL fees and surclia~ges (A through C): $ >C ~ C~ ___ C <_ $ /D '0:1 $LjJS . $ /U/:71 , Buildi"cg/Combination Permit PERMIT NO: cOM2009-00587 ISSUED: .. 04/30/2009 APPLIED: 04/30/2009 EXPIRES: .10/30/2009 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' SITE ADDRESS: 5049 E ST ASSESSOR'S PARCEL NO.: 1702332303100 Springfield TYPE OF WORK: Eledrieal Work Only PROJECT DESCRIPTION: Replace meter/panel/add hottnb circ TYPE OF USE:: Repair Residential .- , ~ 1'1. ur~gon law renllirACO I/QU to'1 .1. CONTRA€TOR;INFORMA;r10N,. Utili! in OAR 9;2~ -", 'W,. 'uuse rUles are set far1h 0090 y," 001-0010 thrau!li;icehSe)52_mJ:~JJiration Date caiiinna~h~~~~,~:al~, ~opies af the rules vbv hdn:DiNGiINFORM;-";T,iON ~~~h;aatne , 1 Ian -",,'C, ,~ I-OUU-CS;;2-2344). ' # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: NDTlr.r:. Sprinkled Building: n/a TI-I/;DEYEJ[0PM~T INFiO~ TJ,OlS.,'IDR AU; nUKI.(!:O UNDER THIS PERMIT .,S' ND~ C01;lMENC'(i){(efiay iUi~t.8ANDDNED FDR /~Nl 180 D#lstf<E\,t{lJ9:s Rqd: Paved Drive Rqd: % of Lot Coverage: Owner: Address: MCGUIRE ELIZABETH MA Y 5049 E ST SPRINGFIELD OR 97478 Contractor Type Eleetrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Seeondary Construction Type: # of Bedrooms: Front yard Setbaek: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I.PUBLlC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone Lot Size: . Sq Ft 1 st Floor: 'Sq Ft 2nd Floor: Sq Ft Basement: ,Sq Ft Garage/Carport 'Sq Ft Other: .oecupant Lnad: REQUIRED PARKING Tntal: Handieapped: Compact: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Descriotion , Dcscrilltion $ Per Sq Ft or mnltiplier Square Footage . or Bid Amount Type of Construction Paee I of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2009-00587 ISSUED: 04/30/2009 APPLIED: 04/30/2009 . EXPIRES: 10/30/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspeetion Line Total Value of Project Fees Paid I Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amonnt Paid Date Paid Receipt Number $10.44 $4.35 $6.00 $81.00 4/30/09 4/30/09 4/30/09 4/30/09 1200900000000000322 1200900000000000322 1200900000000000322 1200900000000000322 Total Amount Paid $101.79 I Plan Reviews I 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. I Re(]uired Insnections I . " Electric Serviee: Approval required prior to utility company energizing service. Rough Electrie: Prior to Cover Final Electrie: When all ~Iectrical work is complete. By signature, I state and agree, that 1 have carefully examined the completed applieation and do hereby certify that all information hereon is true and eorrect, and I further certify that any and all work performed shall be done in aecordance 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. 1 further certify that only contraetors and employees who are in compliance with ORS 70(005 will be used on this project. I further agree to ensure that all required inspeetions are requested at the proper time, that each address is readable from the street, that the permit eard is loeated at the front of the property, and the approved set of plans will remain on the site at all times during construction. f'kd-Of /J v7vtZ' }Ih [ z).M '/".-1 ,!/ , . Owner or Contractors Sig ature Lf hO/o9 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 Permit #: (!. <7 - $"" z'7 Address: e;zJ'f <1 F 5'1 Issued by: ~, Date: Y3% 1 Statement: Information Notice to Prop'erty 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 b~ilding 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 ORS701.0JO(7), need not submit this statement. This statement will be filed with the permit. Fill in the' apprepriate blank~ and initial boxes 1 and 2, and either bex 3A ,Or 3B: ->(vJ1t 1. '~Ka 2. I 'own, reside in, ,Or will reside in the completed structure. .'". I understand that I must beceme licensed as a'censtructien.centracter if the structure is sold or 'offered fer salebefere 'or'en c~mpletien. . D "3A. My general centracter is (Name) (CcB #) , ." "I ' . I will instruct my general centractor that all subcentracters whe work en the structure must be' licensed with the Censtructien Centracters Beard. . OR ,.;tSJM ~ 3B.. I will be my ,Own general centractor. If! hire subcentracters, I will hire 'only subcontracters'licensed with the Censtructien centracters B,Oard. If! change my mind arid hire a general centracter, I will centract with a centracter whe is . . . licensed with the CCB'and will immediately netify the 'office issuirigthis building permit ,Of the name of the centracter. I / . I hereby certify that the above information is correct and that I have read and,do understand the Information Notice toproJlerty Owners about (:onstruction Responsibilities on the reverse side of, this form. c;() r.I~n ~mI;.A/~~ / (Signature ,Of permit applicant) LI/10/0CJ (Date) (ff7hite copy to issuing agency permit file, pink copy to lJPplicant.) Property_owner.doc 06-01-04 . 1 - ... ~, . . Acting as Y mirOwnGener-all' Contractor?'.':. ..~ fl _._'~ ,', ~. _ .' , ;.... ': . ' : . ,- . -~- -- INFORMATION,NOTICE TO'PROPERnr OWNERS .' , ..:.:?\ '. .... ABOUT-CONSTRUCTlON'RESPONSIBILlTIES-:.", I . . ~ NOTE: This Information Notice to Property Owner~ ~bout Constructj~~:IResp~nSibilities w~;'dev~loped by the' Construction Contractors Board in accordance with ORS 701.055(5), p~lssed by the 1989 Oregon Legislature. . . . . ".. 'r . : ~."... : '-, .' ~.: iI- ~ ..' . . . If you are acting as your 0\"~:\~9n.l[,actor t~ ~?nstru.. ct a. new ho~z. or~~e as\r~sta~tial i~pro,:,ement to im existing structure, you can prevent.manY'Problemsoy bemg aware of the followmg r~ onslblhtJes and concems. '. . :!Employer Responsibiliti~s' . You wil:l, i~'~ost.j~stan~s:"b~:~~I~d!~, l?e 'an"e~ploy~r";and.tpe 9.qniract~;~1 yo~, cont~act ~~ w:ii ~~.:~e"JP;?yees" il you use conn:a~tors not Ijcen,sed ~th the Construction. Con,tr.~c~or.s B~ard to \ 0 labor in ~onstructing .?r ,to assist in the . construction or imp~ovement ofa.resid~ntial structure. As the_employer, yo~ must comply l'\'ith theJoUo~i~g: . . ... " .J. ....' _, , ... I. ~ .' _' \ ..' .., ...J - .' ~ .. '. '. 1 ...,. ~ . . '" ,-. ,," .~\<, . .. .. . '., '... . . ...... . '. ' , ,- j ....... "- '\ . . .:. , --;"- , Oregon's Withholding Tlix Law: As an employer, you must Withhold incom e taxes from employee'wages anhe time employees are paid. You will be liable for the,.tax paYJl1ent~ even if you ~i n't actually withhold the tax from your employees. For more information, call the D'epariiTIetit ofRevehueat 303-3'714988." ';, . c~ -,' .."_, . l'r. .. ',. Unemployment Insurance Tax: As an employer: you~ifre~iequiied to;jiay a tl x for unemploynient insurance purPose~ on the wages of all employees. For more information, call the Oregon Emplo] ment Department at 503-947-1488. " u; ..ij' .{.I'.....' '._,'~ .. _ I. ~..,: .)~;i...4...1. Ji'~...;:.,.."T;' The Oregon Business Identification Number (BIN) is a cOtllbinednlJllli ~X. for. b9th ;Oregon.'~ Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or wv.! v.doLstate.or.us/forms1)av.htmll for the appropriat~fon~IS.____. _______._ ] ._ "",.'~., ."'., I, ~' '. '-, - .. ~ i Workers' Compensation Insurance: As an employer, you are subject to th,' Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If y,.u fail to obtain workers' compensation insurance, you co~idb{subj~cff~ 'p~n~\t;d arid'b'e'Iiablef~;'ali cliiim costs If one o'fyour empioyees'is 'injured on the job. For more information, call' the Workers' Compensati'ort Division' at the' Departnient of Consumer arid Business Services at 503-947-7815. ,,~. ( .. . U.S. Internal Revenue Service: . As an employer, you must withhold' fede; al income ,tax from 'enlployees' 'wages. - You will be liable for the tax payment even if you didn't actually withhold th" tax. For a Federal ElNnumber, call the IRS at. 1-800-829-4933 or visit'tIieiT web site at \Vww.its.l!ov: L ;".: " '.1 . . . . . . ".'_ '.:', ,....~....._, ,"., - ,"~', . " .. ,;1";.1..." "11 ~ :.. i ."c.:__ -. .Othell',Responsibilities,and,Ar;easoj ,C~nc~rns.. .. . ." c,1 I ,,-,' ,'" -, Code Compliance: As the permit holder for this project, you are responsibt, for resolvinl:i'any failUre to meet code , requirements that ml!y be brought to your attention through inspections. . .... .,.:.... -.,. ~ .,," :. " f. ',"" . f -~".':' I . '. . " .' _ ~ .. ....,..; '; J:.. ~ ,I . Liability aud Property Damage Insurance: ,I Conta2t yo~r 'insur~nce agent to see if you have adequate ';~surance coverage for accide!1lS and omissions such as falling tools, paint over spray, wi .ler damage from pipe punctures, fire or work that must be rtdone. '-.- ,\ , . . i' '. 'l':"' ...J Time: Make sure you.bave.sufficient time to supervise your employees. , I Expertise: . Mak~ sure you ha~~ lh~ ';kill~ i~ aCt'1s' yohr oWn gen~r~1 conirailtor, t~ coordinate the work of rough-in and finish trades, and to notifY building officials as the appropriate times so th~ y can perform the requited inspections. If you have additional questions call the Construction Contractors Board (503-i 78-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. I ".t ~,l-., '';. j' . , PropertLowner.doc 06-01-04 j I 225 Fifth Street Springfield, Oregon 97477 541-726-3759Phone Job/Journal Number COM2009-00587 COM2009-00587 COM2009-00587 COM2009-00587 Payments: Type of Payment Check cRcceintl City 'jpf Springfield Official Receipt Development Services Department Ii Pu'blic Works Department II Daiie: 04/30/2009 II: 13: 16AM " RECEIPT #: 1200900000000000322 Description Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + ) 2% State Surcharge Paid By ELIZABETH MCGUIRE Received By cjc Page I of I II I, , ii Item Total::; Check Number Authorization Batch Number Number]; How'Received 2067 Ii In ~erson :: Payment Total: " " I' " , Amount Due 81.00 6,00, 435, 10.44 $101.79 Amount Paid $101.79 $101.79 4/30/2009