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Home My WebLink AboutPermit Electrical 2009-6-16 Electrical Permit Application 225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689 1!1;~~;:\""'''~~:!;:'~';~i~r;'~r.:zi~~iW~~~ ;jit;,'k1a,,~~.~~~~~J~~t~2:tj~!i~~~~~1 I Pennitno.:C'<7- S07 ./ I Date: 6/;?/e/ I , This permit is issued nnder 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. IlIl(i1'llP~"orO-",~,miil!-_-O'V'- . N'M'EN. 'ili'~' - . n ril\ll'.~_~Jlil ~,~,*"'''''''""",''.' _",~11-1,,-G.' ., mER .! ~~RBR~V~I!!..lj,,,l',,\!Jil!!!\\,,., I Zoning approval verified? 0 Yes 0 No . ~J:~0~'TII;~:0RYAXQF'.I0:QN$1liRI!J~j1]IQN;~'1lll~1\!t~ I Residential, per unit, se:rvice included: ~ Residential I 0 Government I 0 Commercial 1l'~{9GI3'!lSlml;lllt:lIiQBMAfrnQNf1@I:,)II!!QGA'IjIQN:il!t&ii! 11,000 sq ft. or less (4) ii $134.00 $ I Job site address: i 51-1 i-lA VDSN (3-f(\OG,[" (JJA Y I ~~~~oafdditionaI500 sq. ft. or portion $ 25.00 $ I City: C:J::t<ii'~'(:'rl.:;lf\ I State: ne I ZIP: q "141'7 I I Limited energy (2) $ 32.00 $ i=;~~~tiE$G~Ia,f:IQN![Qf'JiWJ~~~~~~lifj I ~~~~I~:'S~~~~~r~~ fe~~jr (~)odular. . $ 63.00 $ I :0'" -- c I I Services or feeders: instqllation, alt!!ration, relocation /;.Il'" FIFnr\r' I~ ;:)14i?[\ l-~",,,,,,,.'""nR-o.nER:rVl!i.'O:W- -N.uEmR.".""""":"'b1.-~"""'Jt;it0'fC','jl II ::~ ::;oo~e:: ~:~ $ 81.00 $ 1'=:"~::r~:!(1 ::\.~i:lVd'. .. . "'~~Jfk_;A~"f'''~d11 401 to 600 amps (2) ~1::::: ~ I Address: If-L1 UP,\./f\;:C~ BRIDr,p_{l\I1V I I 601 to 1,000 amps (2) $205.00 $ I City: Se&J)'\ C i='IFII\ I State: () R I ZIP: '1 r4r'7 lOver 1,000 amps or volts (2) $469.00 $ Phone611l-,1If(-17<::Z .1 Fax: I Reconnect only (2) I $ 63.00 $ E'j I 1 /:\ I Temporary services or ~.'.eeders: installation. alteration. relocation . -mal: \<'IA" !'A,,;qqLl/.J (l"'M~.l~~-r This instalMion is being made on residential or farm property 200 amps or less (2) $ 63.00 $ owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchfujge, lease, or rent. OAR :~:~::~lt):Jr~(I)" }r>,- ~/ ~~:rt:~~::::~~OOo volts, see services or fee:~r:6;~:tion :bove 1~~:~Nill~~~~~INsr.:.lS~~8mIQN~jfll~~~j : :r;::~o:i::::~ ~i::~i::(:i::::r:~~s::~na~:~::e:r feeder fee I Address: I I Each branch circuit I $ 6.00 I $ I City: State: I ZIP: I I b. Fee for branch circuitsiwithout purchase of a service or feeder fee: I Phone: I Fax: I I First branch circuit (2)!' ($ 55.00 $ ')~ '1 I E-mail:. I I Each additional brandi' circuit $ 6.00 $ I f CCB license no.: I BCD license no.: I . I Miscellaneous fees: serv,~ce or feede'r not included I Signing supervisor's license no.: I I Each pump or irrigation Circle (2) $ 63.00 I Print name of signing supervisor: I I Each sign or outline lighting (2) $ 63.00 I Si&nature of signing supervisor: I I Signal, circuit or a H!TIited-energy panel, $ 63.00 $ alteratiOn, or extenSiOn (~) " I Each additional inspection: (I) $58.00 $ !~ARem€"WNiTanjSE~'j\;~ I (~i~:~~u~~:~i~;::,;;;:,~e;). .. :~~r;o I (B) Enter 12%. surcharge:( 12 x [A]) $ h 9 {, I (C) Technology Fee (5% .of [A]) $ :.2- ~ I TOTAL fees and surcharges (A through C): $ t. 7 ~:. .,~\:\\)~" \g' l&~ ~~ \J 440-2584-J (9/08/COM) $ $ Status Issued U 1 t' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00867 ISSUED: 06/16/2009 APPLIED: 06/16/2009 EXPIRES: 12/16/2009 VALUE: 225 Fifth Street, Springfield, .oR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 184 HAYDEN BRIDGE WAY ASSESS.oR'S PARCEL N.o.: 1703233304400 Springfield TYPE .oF W.oRK: Accessory Building TYPE .oF USE: Alteration Residential PR.oJECT DESCRIPTI.oN: Elect. only- extend one circuit to shed ^TTr-"'lTlr"lfl.l. f"\..........nn 1-';l\M ronllirpc: \lnll tn .owner: GARLAND J.oHN J & L.oUANNEIDruJes adopted by the Oregon Utility. Address: 184 HAYDEN BRIDGE WAY Notification Center. Those rules are set forth SPRiNGFIELD .oR 97477 in OAR 952-001-0010 through OAR 952-001- ..........nn v,..." n"\~\1 ,...ht~in f"nnip.c: nf thp. rules bv r~lIinrt tho ,..-onttJor INntp.: the teleohone n I "C.oNTRACroR INI10RMAffIOr.t11 ion" Center is 1-800-.00~-~044). Contractor Type Contractor License Expiration Date Phone Electrical. .oWNER BUILDING INF.oRMATI.oN I # of Units: Primary .occupancy Group: Secondary .occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure NOTICE' Type of Heat: .' VI hr . . Water Type' " THIS PERMiln~~;f:ypef-XPIRE IF THE WORK AUTHORIZEJile'rg)[ia1hTHIS PERMIT IS NOT COMMEN(~i>}ii!K!e(J)Bu'ilding:ONED FOIi/a Lot Siz~: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft .other: .occupant Load: HI'.' ."" "..... ,., ....... I DEVEL.oPMENT INF.oRMATl.oN I Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Sethack: Solar Setbacks: .overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING . Total: Handicapped: Compact: I PUBLIC IMPR.oVEMENTS I Street Improvements: Storm. Sewer Available: Special Instruction: Sidewalk Type: , Downspouts/Drains: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page I of 2 Status Issued CITY: OF SrKu"IGFIELD Building/Combination Permit PERMIT NO: COM2009-00867 ISSUED: 06/16/2009 APPLIED: 06/16/2009 EXPIRES: 12/16/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Tutal Value of Project Fe~.s Paid I Fee Description + 12% State SUI'charge + 5% Technology Fee Add,Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $6.96 $2.90 $55.00 $3.00 6/16/09 6/16/09 6/16/09 6/16/09 2200900000000000678 2200900000000000678 2200900000000000678 2200900000000000678 Total Amount Paid $67.86 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All insp~ctions r~quested before 7:00 I " a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ' Reollired Insnections I U ndergronnd Electric: Prior to cover Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, th;t 1 have carefully examined the completed applicatio.i:and do herehy certify that all information hereon is tfue and correct, and I further certify that any and all work performed shali 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 are in compliance with ORS 70.1.005 will be used on this project. 1 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 locat;ed at the front of the property, and the approved set <if plans will remain on the site at all times during construction. / / I, /f 11 ,-1 II //' ~ !~-;,{ /-1J/t::../\c:'-/~- ~OOl 1/ . Ownevor Contractors Signature Date Paee 2 of 2 '.:::.r ... e. . . . . . . ". .,' " " . . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 . Salem OR 97309-5052 Phone: 503-37804621 Web Address: www.ccb.state.or.us Permit#: '(!'7- de.. 7 - . Address: /6'( II~o(;/J ..6.e.1 DeE !AJaf Issued by: f":.J.x:Z'_-- Date: ~7 Statement: Information Notice to Property Owners About Construction Responsibilities . .. Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not .' t ,- "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 app>vpri~te blanks and initial boxes I and 2, and either box 3A ot ~B: , Cf?il. QJE1 2. ~q o 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. 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. I ". , 1'.0,'\. If I hire subcontractors, I will hire only subcontract~rs 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 thanhe above information is correct and than have read and do u"nderstand the Information . Notice to. Property Owners about Construction Responsibilities on the reverse side of this form. ClJJ_ ~(~jAP fa -I &,- 8-, OO~ f (Signature of permit applicant). . . (Date) (White copy to issuing agency permit file, pink copy t? applica.nt.) ~ if ' Property_owner.doc 06-01-04 " Acting as Your Own' GelIlleraU' Contractor?:, .'. " f >.... '"', .' .~'~:.' 'r;--~ii;"ll .....-.~ , : "''-'INFORMATION. NOTICE TO PROPERTY OWNERS I. , ABOUT. CONST~UCTIONRESPONSIBILlTlES '. , ,;. - . .j, ,,;:.. '. .. \ ~, . \' .\-. , " ;; j 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, .' .: .' . _' ''. "', . <"l~ .' .' .. If you are acting as .your own contracto,r to. construct a new home or make a'substlntiai impr?vementto. an existing structure, you can prevent many'probiems by'being aware of the. following resiJOnsibilities and c;oncerns. . Employer Responsibilities ,i, _' ..... ~',., 0' .'1' - '. : ~ .. . _ ... '. . You will, in mo~t\jnstances, be r\Ile~,!9 ,pe an, '.'emp!oyer'\\lnjI.the. contractors you contract 'Yitl:t wi}! bF;'emp!oyees" iJ you use contr~9~ors nqt licensed with the, Constru((tion Contractors Boar~ to do labor in constJ11cting or to assist in the . ~ _' '. . , _ . 0:. .". . . . _ . . construction or, improvement of a residential structure, As the employer, you must comply with the following: '.~ ,",~." ~ .... '.I...~".' -... ,". _ . . 1. ", " ", '~-'. .,' .. . .~~.~., .\, ",' " .~.'", ""_".~'. ~)-~., ' . "P'- - _ '.. l~" J " Oregon's Withholding TilX 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 ~ven if you don't actually withhold the tax fro~ your employees, For more information,"cafftHe'Departri1ehtof'Revent'i<ht 503:378-4988. ',",' . " ' ;' '. . 'UnempJoymenHnsurance Tax: As an employer; you'are'required.topay a tax;for unemploylnerit insurance purposes " on the wages of all employees. For more information, call the Oregon Employlnent Department at 503-947-1488. . . " . " ... .~. ~'uf _,'; ~.:~ ..t)~ '~..."r';l"': ..,":':'''l~ ....."C J \ A ., ~. '.J The Oregon Business Identification Number (BIN). is a comg!l1ed number for both Or~on', Withholding and Unemploylnent Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the applv.t-'J.~ate forms. I , t" '.' .'i. .:J [': .,'. ~,.' Workers' .Compensation Insurance: As an employei,iou are subject to the Oregon Workers' Compensation Law, 'and must obtain workers' compensation insurance for your employees. If you fail to obtain workers ~ compensation '''\' :. . r..... ,'.'., .' "\' . ,").... '. , ~ .', ',"" ..'. ..' insurance, you co.uldbe subjec(torpenaltie~ and'be liable for all claim co~ts if one of your .einployees is injured oil the job, For more information, call tne Workers' Compensation DiVislon'at.the Department of 0onsumer'and Business Services at 503-947-7815, U.S, Internal Revenue Service: As an employer, you must withho!a federal ihcomii tax from employees' wages! You will be liable for the tax paylnent even if you didn't actually withhold the tax. For a Federal EIN number, call thc I IRS'at 1"800"829-4933.or visiHheir'w.eb.site at W\vw-irs,!!ov,";c' ,.' ,. ,.1,} . . ' .!: '.t'- .l'~~t.:i -<l;~ ... . -.... "fr,h- ..' .~ . , ;', ,. ,.., Other: R~sponsibmti~~,;md Area,s,(}f,foll!cer!1s ..~.. . Code Compliance: As the pennitholder for ihis project, you are responsible for ref(oi'vihg any failure to'meet code require)l1ents that may be brought to your attention through jnspections, ~ "d' ",:. ~ "~ .-~ _ . ~. . .~. (.,.....: j,.~'. .":""'.:~~ " Liability and Prophty Damage ritsurani:e:' Clintact yoUrlnsuranc'e agent to'see 'if you h:lveadequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage froIl! pipe punctures, fire or work that must be r~40ne. .., . ' i ~ ..' ~/:.... .:_- -~: ._-~ --...'- -.- ...... ". ':- '" .;." Time: Make sure you .have sufficient time to supervise your employees. ;" ,', '.' ,., " : . \ Expertise: Make sure you"h~~~lh~ silih~ to ~ct as )but o\;n gerie~~f con~actor; to'coordina;e the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections, If you have additional questit;>ns call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. .!i'.r. '..1 ~.~ Property- owner.doc 06.01.04 "...p.j:.O.._._F~.~. .',.. ; '. .' ~i ..:- .. 225,Fjfth ~treet ~. Springfield, Oregon 97477 541-726-3759Phone Job/Journal Number COM2009-00867 COM2009-00867 COM2009-00867 COM2009-00867 Payments: Type of Payment CreditCard cReceiotl City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: Date: 06/16/2009 9:44:16AM 2200900000000000678 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Amount Due 55.00 3.00 2.90 6.96 $67.86 Paid By JOHN GARLAND Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid cJC 00591 b In Person Payment Total: $67.86 $67.86 Page I of I 611 6/2009