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Home My WebLink AboutPermit Electrical 2009-8-12 Electrical Permit Application r~~.;,._+__",-,:~~,~,~"r,':-f~'~W''''~;<:_~;~~~iI'U~~.. ' . ""j ,?],""tDEeARJMENT"USE'.ONlhYi' .11 ~J;';d"~-'h;",,_,;,,~!,,;:,;,':'l.':j,,::~~_"i~:e"':\:&~~~3?'~~;. ~~ Pennit n~: ln~zr;d1-t:D-;}/,J.1 I Date: '6I\<Llm '< , 225 Fifth Street. Springfield, OR 97477.PH(541)726-J75J+FAX(541)726-J689 This permit is issned 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. 11~=:~:~~~~~~~~g~M6W;:~~~~;9g~i:' ;~=~;~f:~I'~;I=~~I~~1 1=:~;mgGiR~~~::~:~mR~O~::::~~llr~:~:;i:::=:'~~':~~~:~~~A~H~;g~OiUli ~~~:;:~llE(~~rv1~~;~N~~ffQ:t~;ijIQN~~EII ~~;;~d:i:~:~I~S~O(:~ ft, or portion :1::::::1 ~ll~.~~1~. _.~~.'{ =.N:..._.~.l.te.'~1.,b(j)(pb.,~::::t. : J ~~~;:~;n e~;;;;)~ Fe~~:r (~)odular : :::::: II _~""i?L~l!llI,l)!D.gSG.RJBml(:)I).I",.O~W.0.R~~_~~ U rdiJ)J) "3tu?\<<e\,,- . I Services or feeders: installation, alteration, relocation .1 I - -I 200 amps orless (2) $ 81.00 $ I 1~1lr~~eR(:)~I;Rml(.]!iiWN]::F{'Jt!~~~~~;;[l.'i!r~ I 201 to 400 amps (2) $ 95,00 $ I I Name: ('p \.p-w LGJONl:. . I 401 to 600 amps (2) $158,00 $ I I Address: ~ ~ -:r- ) I 601 to 1,000 amps (2) $205.00 $ I I City:~. "-11& r State: rJf- I ZIP: tt1-+:f~ I Over 1,000 amps or volts (2) $489.00 $ I I Phone:~\-i \00'\ IFax:'t\l~ llr:f1S I Reconnectonly(2) I $ 63.00 $ I I E I r \L ~ , A... r;.. l r I Temporary services or feeders: installati.on, alteration, relocation I "mai : .p l"IJ'.llA 0 W VLU, ()jv. t 200 amps or less (2) $ 63.00 $ I I 201 to 400 amps (2) $ 87.00 $ I I 40 I to 600 amps (2) $126.00 $ I ) Over 600 amps or 1,000 volts, see services or feeders section above I l Branch circuits: new, alteration, ex(ension per panel I I I a. Fee for branch circuits with purchase of a service or feeder fee: I I Each branch circuit I I $ 6.00 I $ I I b. Fee for branch circuits without purchase of a service or feeder fee: I I First branch circuit (2) $ 55,00 $ I I Each additional branch circuit $ 6.00 $ I ) Miscellaneous fees: service or feeder not included I I Each pump or irrigation circle (2) $ 63.00 $ I Each sign or outline lighting (2) $ 63,00 $ I Signal circuit or a limited-energy panel, $ alteration, or extension (2) $ 63.00 I Each additional inspection: (I) $58,00 $ j{'j,1\K! ~~"""'>>:R~j~tl:;~Nifl/FLU~~_~~1 (A) Enter subtotal of above fees '(Minimum Permit Fee $58.00) This installation is being made on residential or farm property owned by me or a member of my immediate 'family, This property is not intended for sale, eX,change, lease, or rent OAR 479.540 an 479.560(, ,Signa ~: . 1"''I'l'''-'~.G..0..N'=m'o'^'G,;r,0.cR''''I.N'S. "''''' ':i'''\'''i6N''~1''''''''''''7''',h?"" 1tliK~.n:t:~_, ",J,IM;'\, JI1.; ,_L';jj_,_",jl:~__ L:::.I;\'''11,~,,~~~5.;:f7H':;'; I Business name: '-' I Address: I City: I Phone: I E-mail: I CCB licens~ no,: I BCD license no,: ,I Signing supervisor's license no.: I Print name of signing supervisor: I Signature of signing supervisor: I State: I Fax: 440-2584-J (9/08/COM) I ZIP: ~ .~~ ~~ (B) Enter 12% surcharge (,12 x [A]) (C) 'fechnology Fee (5% of [A]) I T<n AL fees and surcharges (A through C): d() $ 6(f.' .2 -If 0 (/)1,90 .(;7l~ $ $ $ -~'~;~ci;;~e;e$ "M' " '1 ' Status Issued CITY OF SPRINGFIELD Building/CQmbination Permit PERMIT NO: COM2009-00764 ISSUED: 06/0812009 APPLIED: 06/01/2009 EXPIRES: 01/2912010 VALUE: $ 6,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1004 5TH ST ASSESSOR'S PARCEL NO.: 1703352103100 Springfield TYPE OF WORK: Interior TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Remodel interior stairs Owner: Address: CELESTE WONG, 1004 5TH ST SPRINGFIELD OR 97477 Phone Number: 541-988-1005 , CONTRACTOR INFO~ATION , Contractor Type General Electrical Contractor OWNER OWNER License Expiration Date Phone BUILDING I~FORMA TION. VB # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft l,st'Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occnpancy Gronp: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Sethack: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: , Total: . Handicapped: , .Compact: '. Street Improvements: I PUBLIC IMPROV~MENTS I ' A I I I:: NTIOS'!d' nrPl~k0Tn l"II! reqUires you to I ewa ype. 0 Ul'I't follow rules adoplea uy me regon I I Y Notification Downspouts/Drains:; 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 telephone number for the Oregon Utility Notification Center is 1-800-332-2344). Storm Sewer Available: Special Instruction:,- . l'liU I 1\1 . THIS PERMiT SHALL EXPIRE IF THE WORK Notes: AUTHORiZED UNDER THIS PERMiT IS NOT COMMENCED OR is ABANDONED FOR ANY 180 DAY PERIOD. Page I of3 Status Issued. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00764 ISSUED: 06/08/2009 APPLIED: 06/01/2009 EXPIRES: 01/29/2010 VALUE: $'6,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I V ~I~~t,ion Descrh?tio~.1 Estimate Tvpe of Construction Estimate $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 6,000.00 Value, $6,000.00 $6,000.00 Date Calculated Description 06/01/2009 Total Value of Project ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $63.05 6/1/09 2200900000000000589 + 12% State Snrcharge $11.64 6/8/09 120Q900000000000630 + 5% Technology Fee $4.85 6/8/09 1200900000000000630 Building Permit $97.00 6/8/09 1200900000000000630 + 12% State Surcharge $6.96 8/12/09 2200900000000000914 + 5% Technology Fee $2.90 8/12109 2200900000000000914 Add, Alter, Extend Circ $55.00 8112/09 2200900000000000914 Minimum/Adjustment Electrical $3.00 8112/09 2200900000000000914 Total Amount Paid $244.40 I Plan Reviews I Initial Review 0610212009 06/02/2009 APP LLH Structural Review 06/02/2009 06/05/2009 APP CJC As ooted on plans 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 P~I1I.,irp~ '~tj?n' I Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Footing: After trenches are excavated. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Page 2 of 3 -.~!'~~R"!,~i~2/ ~ft \,. ' Status Issued CITY OF SPRI~(jl'l1'.LD Building/Combination Permit PERMIT NO: COM2009-00764 ISSUED: 06/08/2009 APPLIED: 06/0112009 EXPIRES: 01/29/2010 VALUE: $6,000.00 225 Fifth Street, Springfield. OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line By signature, I state and agree, that 1 have carefnlly examined the completed application and do hereby certify that all information hereon is true and correct, and I fnrther 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 permissioo of the Commnnity Services Divisioo, Bnilding 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 froot of the property, and the approved set of plans will remain on the site at all ';"(i'~':"':' 4 ~(dQ0 O~r c-on;ra~tor: SignO Date Page 3 of3 '" , : '- C. '0/_ /<J Permjt #: -/' lJ? f ~OO.L./ SP1' ,. ~ r _. s::..d f j Address: .. / . ' <.) r if - Issued ~ /1 Date: cft;;;/8 7 / () Statement: Information Notice to Property Owners About Construction Responsibilities , -,' , ' , , . , , , " .' " .' 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 Note: Oregon Law, ORS'70l.055(4) requires residential constroction permit applicants who are not licensed with the 'Constrodion Contractors Board to sign the following statement before a building permit cali be issued, THis statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under 'ORS 701.0 1 0(7)~ need not submit this statement. This statement will be filed with the permi!. Fill in the appropriate blanks and initial boxes Land 2, and either box 3A or 3B: ISZf I. I own, reside in, or will reside in the completed structure. o 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale ~efore or on completion. o . 3A. My general contractoris (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structUre must be lifensed with the Construction Contractors B6ard. ' OR &( 3B. J will bemy own general contractor. d",,~\~ . If! 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. , , . that the above information is correct and that I have read and do understand the Information Owne'is about Construction Responsibilities on.the reverse side of this form. /\ "^ .) )')2-/09 (Signature Otpermi~~licant)" (Date) , (White copy ~uing agency permit file, pink copy to applicant) Property_owner,doc 06-01-04 : ~',: ~ ...-~.. - . , "'Jo. n _ ,~.. : - . .. 4cting:-a;~<1( Olllr .Own' General Contractor?" . , - ',,"--)\.- : . '" . \'. .-.,.. \' INFORMATION NOTICE TO ,PROPERTY OWNERS ,. ABC?UT C?~ST<~~,CT.lqNRESPONSIBILlTlES'- '. . '. . ~ " ...-~ . .' ~ "J 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, ~"I'~";"~-' .~; } : ~,' , ..,.... '." ..~~/. .. ,. ~, .'. r' ,"'-;-,.' '1' 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 ihany problemS by beipgaware oflhe following responsibilitiesandcbncems, Employer Responsibilities ... ~'. '. ~\- \' '~'.'!' . .,'.>..... '; \. .:.~~..~ ":,".,,: ..~.~.. ~ You will,\in m,OS! instances, 1;>e ruleq,to,pe, an:'.employer"'aml.t~e con.trac~ors,you coi1ttact"witp-wil!,be,"~mployees" if you,pse c,oJ;ltracto,~ not lic~nsed ~!h.the C~mstructi~n Cortractors Board to d~ labor in cons~cting ?r,to ~ssist in the constructionll.r,,improvement ofa re$idential j>tructure,,, t\~ ~he employet:, you must comply )Vith the followi\lg: I,'. '..J"" ,_ ..'_ " . I .,' _,,~..h " , , '.. ',_\. 'I'. ,-:: ." "- .' _..l;'--.':1':~\":"'~",""\"'N'i, ..,!~;.~' . ,''':' -' ,',' "r.,,,.,: ._.... 1....1\. l"~ ..... Oregon's WithlioIiling Tax Law: As an employer, you must witlihbld 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 more information, Jail the-Department of Reveriue;at 503~378-4988. ' . :' '. "J ,. --:, ," : '-. Unemployment Insurance Tax: As an employer,you'1are reqliit~d.to'pay:'a tax for unemploynient insurance purpos~s': on the wages of all employees. FOI\more information, call the Oregon Employment Department at 503-947-1488. .0')'- .r,:': _!'}')!':! ':j...-'~i~,t"-i,:' ..n._" ".,1: ,..- \I...'~;'.."~......., ''''. ..,J: .'J.'~~' . The Oregon BusiJ;less Identification Number (BIN) is a combin.ed..nUl)lb!;r, for, 1:>otj'l :~!;~ql1' Wi!!1!lOlding and Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or wl'vw,dor,state,or,us/formsoav.htmll for the appropriate fonns, " :Jl).)" ~r'" '~~'f.' " .~,.-,,:..; . "1~.~;;"~" '-, Workers' Compensation Insuranc~: 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 c~tild be s~15ject tb ;pen'a1ti~s and be liable f~r all- claii~r bosts' it-orie of your empl6yees is'inju~ed on the job, For mor~ 'information, call the Workers' Compensiltion Division at the'Department'(jf Consunier'illld Business Services at 503-947-7815, U.S, Internal Revenue Service: As an employer; youirii.ust withhold;federal income~taxfrorri'Jerilpi<iYees' '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 1'800-829-4933-or-visit their web site atwww.irs.l!OV, -' .',. '. V J J,';- .~'-.) . .' .. . I '-;-!.. fr- f .' '. "-.~': ,j;:-' '. .,. " .",Other Responsibilities alllld Areas ,of CQncern~ ' " x ..... " Code Compliance: As the permit holder for this project, you are responsible for f~soiving'~ny,'failure to meet code requirements that may be brought to your attention through inspections. , '" .: ;. 'f _ '.' : -.' ': :, .;.......: : '. '~'" ~: --: . . .~. " C( Liability and Propi\.:ty Damage 'in~uran~e: Confact yourihsurance'agenhb'see if you 'have adequa't'ein:5urnnce' coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be-redone:, ,\. '., i ' " - , ' I I" - /, '. .. ~ _ _ .. . _. _ . ~ .., __". . _ -'- --' .. _I .".J' "'__-:." . .-..:--1 Time: Make sure you have sufficient time to supervise your employees, ,,~,:-~ ,:_ , I'!. .' . , . ': \ Ir. , :. " .' \.\. '.' ,. Expertise: Make sure yo:u have the skills to act as your own general contractor, to coordinate 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 caU the Construction Contractors Board -(503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. ',. ...-,' " "Property _ owner,doc 06.01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00764 COM2009-00764 COM2009-00764 COM2009-00764 Payments: Type of Payment CreditCard cReceintl RECEIPT #: City of Springfield Official Receipt Developmept Services Department Public Works Department 2200900000000000914 Date: 08/12/2009 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fe" + 12% State Surcharge PaidBy CHARLOTTE WONG Item Total: Check Number Authorization Received By Batch Number Number How Received NJM 024517 024517 In Person Payment Total: I Page I of I 2:46:01PM ' Amount Due 55,00 3,00 2,90, 6,96 $67.86 . Amount Paid $67,86 $67.86 8112/2009