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Home My WebLink AboutPermit Electrical 2009-7-1 I I 1 I 1 I I I I I I I I I I I I I I I I I I I I I I Each additional inspection: (I.) , .' I $58.00 $ I ~~~Ji:Rgi!jj~i'l;f~ftS~bJi;!;!il~1 (A) Enter subtotal of above fe,:s -.- . i/- ~ (Minimum Permit Fee $58.00) $ ~ ( . I (B) Enter 12% surcharge (.12 x [AD $ .t.f - () ,- I (e) Technology Fee (5% of [AD $ c:;' . '72- I TOTAL fees and surcharges (A through C): $ Clq.. 77 Electrical Permit Application r~'1gfr8~r~~~!~m~BI<<1 I Pennit n~: (! {I --- 9' 7)... I I 7 ;..- 0/ - Ole I Date: 225 Fifth Str'eet+Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689 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. l=p~~~~~~~Eg~M~:;.~&g~~"\I~~~~ _ ,.', '~~i~ 1"'~~~C::AffiEG0R;Yl"0!;;.4C::-0NsmRI!JGmloN~'ffi~~~,""<l1 ~llI;,",,,,,,,,, ,,',-~.,~" "" . . ~2&~~:___.""..L.,_ - _~.__,_fi\l._"i#i_:~_.; - _~~_'_.M_ ,-"----- ---'~~ ..'-f',~"$i I Residential, per unit, service include'd: 11~~'ReSld~n~~I_jj ,.lgGo;e~e:.,__I" c:J Comm. ..e:~al . '.'11 11000 sq ft or less (4) 1___ . $134.00' $ ',tl0S'lSlffiE IN!;'0RM:4;mI0NIiAN8"11!!0e"Am,'10N~(t1'.fi! ' .. ' w I JO~ s~te ad;es~::,:f705~Ai{;~~- A ;e~j:~.. I ;~~~:fdditionaI500 sq. ft. or portion l-;r $ 25.00 $ I City:S; ~("'rl('\C1~:~~ I State: O('Q., I ZIP: ") f'tT81 I Limited energy (2) I $ 32.00 $ 1~~~N~0E~W~~~~~~:i 1 ~~~~I~:"S~~~~:~~~~~:r(~)odular 1 $ 63.00 $ I 50 Q. p e. \" C\... '* Q. M. e. -.\-e. {' C- 0 }" ~~ eJ I Services or feeders: installation, alteration, relocation 1~~~RR9p';ERf&:iO-:WNER~'ii1~~~.,w~):~~ '1 ~:~ ::~oo:;: ;:; : ::::: .: I Name: R",,,,u\~ -:S-'\D\\e,NA~R.... 140lto.600amps(2) $158.00 $ I Address: ?:, '/0<:, (, A/l..O~1Il I\0eY\l\A{2.. I 601 to 1,000 amps (2) $205.00 $ I City:~.-~ "'<;. ~: ~\ d [. State: Or- e. , ] ZIP: 'I / 4-' 7 ~ lOver 1,000 amps or volts (2) $469.00 $ I Phon;;S'tF)~ Cr i '1 ( I Fax: I Reconnect only (2)$ 63.00 $ I E mal'l' t- '\ \ ~ I' I Temporary services or feeders: instal/aNon, alteration relocation - . " Q,oVA""IL':S"'Cl.JC,OLC':'..n, ' Th.. 11' . b' d -'d' 1 Ii I 200 amps or less (2) $ IS msta atlOD IS emg ma e on reSl entIa or arm property 63.00 owned by me or a member of my immediate family. This I 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). . 401 to 600 amps (2) $126.00 $ ~ Signature: ~ \-~~ ~ lOver 600 amps or 1,000 volts, see services or feeders section above r~=~Ni1lM'~j1it;fR~I~SjJ"rlK~Wt.\:iil~t;J~~i;,*,1i'Ji :r;::~o:i~:~~~ :i::~i::t::::r:~::s~~na~:~::~r feeder fee I Addtess: .// I Each branch circuit I I $ 6,00 I $ I City; ------...........~ I ~tatf( I ZIP: I I b. Fee for branch circuits without pur,chase of a service or feeder fee: .----. "I I I I Phone: "><,, Fax: First branch circuit (2) $ 55.00 $ E-mail: ,/" ''--.., I Each additional branch circuit I $ 6.00 I $ I CCB license.no:':" I BCD"lic~nse no.: . I Miscellaneous fees: service or feeder not included I Signiq.g-fupervisor's license no.: ~ I Each pump or irrigation circle (2) $ 63.00 I Priii'i name of signing supervisor: \ I Each sign or outline lighting (2) $ 63.00 I Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) $ $ $ $ ~\?~ <\ -I); ~ ~ Cfit. .s-- 440-2584-1 (9/08/COM) _S~A!N"''''J,~~.; ~.'. ~n . -.1; ~ f L/p(y <, V\(-I'.O. ~r~-- CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2009-00972 ISSUED: 07/01/2009 APPLIED: 07/01/2009 EXPIRES: 01/01/2010 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3705 GARDEN AVE ASSESSOR'S PARCEL NO.: 1802064200800 Springlield TYPE OF WORK: Electrical Work Only TYPE OF USE: New, Residential PROJECT DESCRIPTION: wiring garage Owner: Address: TOLLENAAR RONALD J & MARY J 3705 GARDEN AVE SPRINGFIELD OR 97477 I ~ONTRACTOR INFO~MATION . Contractor Type Contractor License Expiration Date Phone BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Heightof Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I, DEVELOPMENT INFORMATION I Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Comp_let: I ~UBLIC IMPROVEMENTS I S11TE~W)lN: 9regon law requires you to '1u'1l0~~ uid'I&'bopted by the Oregon UliIity ~Db'{i.nspoiits/Di'aiiis:Those rules are set forth in OAR 952-001.0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the lelephone number_for the Ore~l.o~ _U_t~lity Notification Street Improvements: Storm Sewer Available: Special Instruction: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK l\IIT~n1~m:n 11~ln~p Tl-lle: D~pnnlT Ie: ~lnT COMMENCED ORII~ A!:jMI!)UI\I~.U f-UK . I ANY 180 DAY PEJ .:.~:?I~litJon Desc~lptlOn '-''v''''...'' '.... , vvv .....v'- ..........,',. Notes: Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of 2 Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00972 ISSUED: 07/01/2009 APPLlED: 07/01/2009 EXPIRES: 01/01/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $9.72 $4.05 $81.00 7/1/09 7/1/09 7/1/09 2200900000000000745 2200900000000000745 2200900000000000745 Total Amount Paid $94.77 Plan Reviews ,. 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 Relluirecl I~~rec~io~~ 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 ofSpringlield and the Laws ofthe 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 Contraetors 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 P . # (1rJ. _ C?'f' -7 '-c, : enmt: . I / =f.... Ad~es~:.37OS 6--civ;!'P/v~ Issued by:---IJ /YI./ ~ fJ^-,J Date: 1'-- () /- 0 ;; /" /. . l1 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 1 and 2, and either box 3A or 313: .~ 1. o 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 Hcensed with the Construction Contractors Board. OR ~ 3B. I will be my own g~neral. contractor. (E/..,e.ife I C~ [ ") If! hire subcontractors, I will hire only subcontractors licerised 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 nnderstand the Information Notice to Proper~ .Owners .abont Construction Responsibilities on the revers~ s.ide of.this form. ~. \-'5\~ ... - ~ (Signature of permit applicant) 7 / I I O"C1t I (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 06-01-04 '. ) ,........ -'" ... ~ :..-. " ~ A~ting' as Y~UJIf ,OwD"Genelt"aR Contractor? " ~. INFORMAl'lC:)N 'NOTICE TO PROPERTY OWNERS ,.,' " '. <',;fABOUT;CONSTRUCTlON RESPONSIBILlTIES:~", " . . \.. - . .'.;.' ,_..' -;" .~ :.. ~ " NOTE: This Information Not/ce to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701,055(5), passed by the 19.89 Oregon Legislature. ~. . ",' t .'. J." "'''J " ,. . - ,',. " - '. ' ". " .1' . ;." ~ If you are acting as y~ur own contracior to construct a new 'home or make a subst?ntial improvement to an existing structure, you can prevent.many problenls.by being aware of the followingrespon~ib'ilities ~nci 'concerns. Employer R~sponsil?ili~es .' T J.'" -, . \ . '.': . '.. + ,-' .'. ,," 't'" . ." .t..- . '.. r, - :" ." '. '" . " You will, in most instances, be ruled to be an "employer" and the contractors you contract wiih will be "employees" if . . _ ,_",. . ;. .' _;. . , . u '. . I . .. ~ .,'.'. _ ~ . ._ . you use contpcto[s,not,1icense.d with the; CqrsIr!Jction C;ontract,ors B.oard to.do 1ab9r, in constructipg or t() assist in the - . .'" ....J.,. 1. .'. ..' . - .... 1'.... .,..... ," ,- ," ..' -, construction or)mprovernent of a.~esidential Stru,9ture.. As tl!e en:tployer,y'ou "-lUst 90mply with thefollowing: . :' . ..... " . ", . . # - '-~"~'." ... . .' ..". - .' . ,. ~. . . .', I :.~ ."\ . . . \ ( "" - ..' '" . ,', . . ~ Oregon's Withholding Tax Cilw: As an employer, you must withhold income taxes fioin 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 inforrnation; calltheDepartme~t ofRev~mie at 503-378-4988:':' ;:;> , ,., ,- ,'" '. ',-,.' Unemployment Insurance Tax: As an employet;'you~are required,topaya.taxfor.unemployment msurance purposes-':, on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488. . . . ' . 0 " ." .J.. . .... : 'l.i' ..' ...:. ...:; ~ ' :,.: ~ : . .' ; , The Oregon .Business Identification Number (BIN) is a coml;lined;n.U111bet. for bo,t.!t ;Oregon Withholding and- Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. .' t .. . ,;"", ,-..'c .'" Workers' Compensation Insurance: As an employer, you.are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your e!l1ploy'ees. If you fail to obtain workers' compensation insurance, y6u iou1g be subject 'to perlaJries' ahdbeliable fo(ailclai'm costs if\me of your eq1l5I.nyees is injUred on the job. For more information, call theWorkers'Compensaiion Division at 'the'DepartIDent or-Consumer and Business Services at 503-947-7815. . \. '-. , - .-....... \ . U.S. Internal Revenue S,ervice: As lm 'employer; you tifilst-\vithho1d federaY'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 1-800c829-4933:or.visit their web site'at wwwcirs,aov, . I'''''' . " _ J .. ....,. J'fJ' . J. ~., , ." , . I; . '0 . ". qt, j' ',' , ,'- OJher:~~spoQsibilities and Areas i>f.ColI1cerns" . , '~1 Code Compliance: As the permit holder for this project, you are responsible for resolving any' faiillre to meet code requirements that may be brought to your attention through inspections. ~'. .....,.., ....... --1..;....-." '. . J.. ~:.' .'. .' r. . Liability and Property' D~mage\insi'i'rance: "C6ntac{yoiir'insurance agent to 'see it-you have 'adequate'insimince coverage for accidents and omissions such as falling tools, paint over spray, watergamage from pipe punctures, fire or I .. \ .- ...... work that must)e r~~ol\~' I \\- " _ ~ --':d-~"" :. oj ./: _, .l ~" /'y , Time: Make sure you. have su'fficient time to supervise your employees" , '. ", [, '" " .'. '. " \ '. . , .' t" Expertise: Make sure you' have the 'skills to act as your oWn general 'contractor, to coordiitate the work of rough-in and finish trades, and to notifY building offici~ls as the apprQpriate 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 atPO Box 14140, Salem, OR 97309-5052. ., , v ~ '. Property _ owner.doc 06-01-04 . I 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00972 COM2009-00972 COM2009-00972 Payments: . Type of Payment CreditCard cReccintl RECEIPT #: 2200900000000000745 Descripti~n Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge Paid By RONALDJTOLLENAAR Received By njm Check Number Batch Number Page 1 of 1 City of Springfield Official Receipt Development Services Department Public Works Department. Date: 07/0112009 12:15:03PM Item Total: Authorization Number Amount Due 81.00 4.05 9.72 $94.77 How ~eceived Amount Paid o l546c In Person Payment Total: $94,77 $94.77 7/1/2009