HomeMy WebLinkAboutPermit Electrical 2009-8-3
Electrical Permit Application
II
225 Fifth Street> Springfield, OR 97477> PH(541)726-3753' FAX(541)726-3689
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I Permit no,: ~~... \ \\\.0
I Date: PY:rcP\
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.
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1 Zoning approval verified? DYes D No
1~11i[GAi)[1:G.!:)J~';Y:i!:!f,'~!:J:G5.N$51iB:\!J.Plt;IQN~~~i!l'~
l Residential, per unit, service include'd:
f~-;l~~~~tmEmIN~~;~~ili;N;~N~lJ,~~q~;r;~;~~ 11,000 sq, ft. or less (4)
I Job site address: \'L'l..~ ::J'(y(cA I I ~~~~oafdditiona1500 sq, ft. or portion
1 City: ~~\\~ l State: D\0 I ZII>: Q1~1 ell LimIted energy (2) 1
I Subdivision: \ n (reO CA. I Lotbl: \'-'\0 \ I Each manufactured home or modular I $
I~Qi:SC:;RIBmI0JlIAE!Ii!'~W0RJ<:;~~~~1 dwellmg servIce or feeder (2) 63.00 $
~ ('[)(\t\-ed" - Wfufu.r L.:tl..lYvJa.J ,I Services or feeders: mstallatlOn, alteratLOn, relocation
\T 1 200 amps or less (2) , $ 81.00
( 1f~~~~et{~B!;RJ::~4i~WN!;Rij;'L~~~~~~lf~1 201 to 400 amps (2) $ 95.00
\~'Na;"e:,=hJ(YlrS /1aav;!c;,.J.<<- 1 401 to 600 amps (2) $158.00
I :1 Address: /,:2-2.:; /0 33 ~ ..5/ I 1 601 to 1,000 amps (2) $205.00
i (I City.<~' /' ..,~ / 1/ State0:E? [ZIP' 9 -,y / ,.,,-t;/ lOver 1,000 amps or volts (2) $469.00
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\,1 Phon~ ~- ~ ~ ~6) 1 Fax: _ 1 I Reconnect only (2) 1 \ $ 63.00 $IO~I
~.! E-mail:J ~ LJ-ek- /,0 m -0~ /I} ~O;"-- 1 1 Tempor"!y.~x!m'Rr,.f~~~~~~0ff:Wa!~~,~q!~~a~I~~ ~~location '
This installation is being made on residentiai or farm property I 200 amHS~o.r)~s~'(.*)~s adopted bv thle orr!dli63.OOIilf" $
owned bJ: me or a member of my immediate family, This '\ 201 to !\jJ9~~i5's:t~~ ~:"nt:!.> Th.ose I Jles lr$' 87:0o)Jlt~
property IS not mtended for sale, exchange, lease, or'rent. OAR I ... .-' .. , .........<-. v,", I 'vv I V 1I t,l UUlJ.1 r UjllM tI:J':::~lJUI1-
479.540(1) and 479.560(1). ' 401 toe~QJ!'JllP~JtlmRv nhlRln rnn;, c nf h$.126;00, ....$
Over 600ra.nipSlQT )i~OOO ivolts!seeFserViceifor feeders-'s~c-ti;;l above
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B h I I.UI I IWtt::l IUI tI['e ur.p.Qnn IIT!IlTV I\lnt'tir.ati'on
. rane_ c~rcul s:ffb~a~!er~t~o0(fNftJ~!ffnz,e.rppnel
I a, Fee for branch cireu-its with" purchaSeofaservi~e or feeder fee:
I Each branch circuit I 1 $ 6.00 I $
I I b. Fee for branch circuits without purchase ofa service or feeder fee:
1 1 First branch circuit (2) $ 55.00 $
I 1 Each additional branch circuit $ 6.00 $
I I Miscellaneous fees: service or feeder not included
1 I Each pump or irrigation circle (2) $ 63.00 $
I 1 Each sign or outline lighting (2) $ 63.00 $
[Signal circuit or a limited-energy panel, $ 63.00 $ I
alteration, or extension (2)
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [A])
1 (C) Technology Fee (5% of [A])
1 TOTAL fees and surcharges (A through C):
Signature:, ,
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1 B~'slQ"liie~E: .>>
I Addres~ERMIT SHALL EXPIRE IF T.HF/WORK
1 City: ~~ I H'~ UNDE~ Sta'tlJlBfRMI~ iBp-dOT
1 Phone:~~:~I~v~~~~~:,~ ~ ~11'f1.R:ONED FDR
I. . '''~ I I vv unl rcRi3~
E-maIl: . /./- ...............
1 CCB license no.: .//., I BCD ~e no.:
1 Signing supep'mc;,s license no.: ~ '
1 Print n~of signing supervisor:
,[ ~ture of signing supervisor:
440-2584-1 (9/08/COM)
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$134.00
$ 25.00
$ 32.00
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01116
ISSUED: 08/0312009
APPLIED: 08/0312009
EXPIRES: 02/03/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726_3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1223 33RD ST
ASSESSOR'S PARCEL NO.: 1702303407901
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Reconnect Electrical Service due to weather damage
Residential
Owner: HEADS JAMES JR
Address: 1223 33RD ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMAT!ON.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Buildin<ATIENTICh"l. OregcOcBlIp~Il~IJj()ad~/Ou t9
follnw rlllp,e. !:lrl~ntarl hu th", ("\..,.."......"'..... 11+;1]+"
I DEVELOPMENT INFdRMATION c.'mter. Those rules are set fprth
_H _ c_ _~ 1-0010 througrMQllii'{EI):FARKING
0090. You may obtain copies of the rules by
Overlay Dist: calling the center. (Note: tfIi.o'~!~phone
# Street Trees RqdlUmber for the Oregon Utilitl}:t~9.\~~J!P.~.!Ij
Paved Drive Rqd: Center is 1-800-332-~ml'.act:
% of Lot Coverage:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Street Improvements:'/CE
I~VI :
Storm Sewer Av'ii!~,IUel'ERM'T .
Speciallnstructi9,'UTHOR/ZED SHALL EXPIRE IF THE WORK
C UNDER THIS PERMIT IS NOT
Notes: AOMMENcED OR IS ABANDONED FOR
NY 180 DAY PERIOn
Sidewalk Type:
Downspouts/Drains:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination' Permit
PERMIT NO: COM2009-01116
ISSUED: 08/0312009
APPLIED: 08/03/2009
EXPIRES: 02/0312010
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
Service Reconnect
Amount Paid
Date Paid
Receipt Number
$7.56
$3.15
$63.00
8/3/09
8/3/09
8/3/09
3200900000000000562
3200900000000000562
3200900000000000562
Total Amount Paid
$73.71
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
workday.
I Remlired hSlJections I
111.1111111 II ! rl I-f
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 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 ~ill remain on the site at all
times during construction. '-7
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/0Wrier or Contractors Signature ./'
~73~ /
Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477,
541-726-3759 Phone
Job/Journal Number
COM2009-01116
COM2009-0 1116
COM2009-01116
Payments:
Type of Payment
Cash
cReccintl
RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
- + 12% State Surcharge
Paid By
JAMES HEADS
I,
,
<tity of Springfield Official Receipt
Development Services Department
I Public Works Department
I
3200900000000000562
, Date: 08/03/2009
Item Total:
Check Number Auth~rization
Received By Batch Number Number How Received
KR
In Person
Payment Total:
Page I of 1
2:29:09PM
Amount Due
63,00
3,15
7,56
$73.71
Amount Paid
$73,71
$73.71
8/3/2009
: 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
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Iiermit#: ~ - Illlf
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Address: dr.~ .2) ,
Issued 'by:fflYl' )) JI}L...
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Statement: In~ormation Notice to' Property Owners
About Construction. Responsibilities
, Date:
'Ole '3/0 'i
Note: Oregon Law, ORS'701.055(4) requires residential construction permit applicants whoare not
'licensed with the Construc;tion Contractors Board to sign the following statement before a building
permit can be issued. This statement is required fo.r residential building, electrical. mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from licensing under
ORS 701.010(7), need npt submit.this statement. This state~ent will kefilf!d with the per~it.
Fill in the app.vpriate blanks and initial boxes I and 2, and either box 3A OI)B:
~." I own, reside in, or will 'reside in the completed structure.
D 2. ,I understand that I must become licensed as a copstruction contractor if the structure is sold or
offered for sale before or on completion.
D 3A. My general contractor is
(N~e)
(CCB #)
I will instruct my general ~ontnictor that all subcontractors who work on the structure must be
J)AJicensed with the COl!struction Contractors Board. . ,
/'. OR
. ......../ I
. Z? : :.,~jll ~e 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.
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Property_owner.doc 06-01-04
A~ting
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INFORMATION NOTICE TO ,PROPERTY OWNERS I',
ABOUT CO,NS\TRlJCTlON RESPONSIBILITIES, " I,
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as:Yomr Own Gcncrall Contractor?~
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NOTE: This Information Notice to Property Owners about Construciion Responsibilities Was developed by the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
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If you are acting as your own contractor to construct a new home or make a substantial improvement 'fo an existing
structure, you can prevent many problems by being a.ware of the following responsibilities and concerns.
, !
Employer Responsibilities
. ,"), ".J. " , J I"'.
You ,will, in mostinstl\llces, be rul\,d to qe~n':ernployer" an'! the c<:mtrl\cto~s you 9<;mn;ac\ wit? wiJI,?e"emJl.loyees" iJ
you use contractors not licensed with the Construction Contr~cto~s Board to do labor, in constructipg or.to assist in the
. . . '. .. . ~ ,..).' . . '" - .'. '
construction or \mProvernent of a residential stru'il1.!!:e._As the wnployer, YOD must comply witl! the following:
,"' '. \ ..' ~. '." '..l "" '" - ,-"'. "J! - '. J '~. .
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Oregon's Withholding Tax Law: As an employer, you must withliold income taxes from employee wages at the time
employees are paid. You will be .liable for the tax payment~ even if you dOfJ't actually withhold the tax from your
employees. For more information, call'the'Departffient'ofRevenue at 503~3'784988." " ":":r ',; '." . " '.'
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Unemployment Insurance Tax: As an employer;'you are required to.pay a tax,for unemployment insW'ance purpos~s..
on the wages of all employee~. For more information, call the Oregon Employment Department at 503-947-1488. \ .
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The Oregon Business Identification Number (BIN) is a combin~4, nUll!ber: f<?!.,bp.th. Oregol} , Wj!hho!ding and
Unemployment InslU'ance Tax. To file for a BIN, c,all 503-945-8091 or www.dor.state.or.us/forms1)av.htmll for the
aP'P'JVpJ.~ate fonns. ",.;. '.. ~.:. i , .
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Workers; Compensation insurance:' As a~ employer, you are subject to t.he Oregon Workers; Compensation Law,
and must.'obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation
insurance, 'you co'til<he' s~bje'ct to'penalties aui:lbe'liable'forliilCl'aim cos~s ifone of yoUr errlployees IS 'injured on the
job. For'more information, call the Workers'Compensation DiVision at'tl1e'Depilrtrii'ent of (!:onsurrier and Business
Services at 503-947-7815.
U.S. Internal Revenue Service: ,. As an employer, you must withholi:l federal~in(iome:tax from 'employees', ~agJ~..:
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"800-829-4933 or'visiHheirweb siteatW\,,:w_irs.~ov. p,. . . " _,', ,';';,'"
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~'." '. QtherJ:lesp~m~ibUjties aD,d.^li~~S of Concerns <", " . .
Code Compliance: .As the permit holder for this project, you are responsible for resolving'a:ny'f~ilure to meet code
requirements that may be brought to your attention through inspections.
.f . . . ,,), ..',
Liability and Prop~rty Damage Insurarice:"Corit1ctyouhnsurance agent to see'if you'have~adequate insurance
coverage for accidents and ('missions such as falling tools, paint over spray, water damage from pipe punctures"fire or
work that must:be r~done. _, \
Time: Make sure you have sufficient time to supervise your employees. '
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Expertise: Make sure yo~"ha~e tn~'skil1~'io 'a~'t as'ybui"~wri'geri6faf'contractor; to c60rdii1~i~ 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 questions call the Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052:
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Property _ owner.doc 06-01-04