HomeMy WebLinkAboutPermit Electrical 2009-10-14
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" ElectricaIP~rm'itApplication
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225 Fiftb Slreet.Spri~~fi~l,d, OR..n~7?:~.P~(541)726-3753. FA:X(541)726-3689
li~~kDEi1AR'iMENT'uSEdNl yO :;'t,t
SPAINOPIELO ~ ... :..30z-.,. ';".'::;", r _ .;'__." ,.. ./' ". .~::''''',./., -t,~,_;
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This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuanfe or if work is susp~nded for: 180 days.
I;:;':";.' ~~""*.' L::OC"~[GOVERNMENTiFAPPROV A(c;;~17;~,.,' 'i"~; 1
I Zoning approval verified? DYes D No I
,1-"~,~";,,,;._::Cjl,TEGORY;OF:,CONSTRUCTION,!':~,:" ", 'I
I ~ Resid~ntiai<"':"FD Government I 0 Commercial I
I'::~:.::JOB; SITE~INF.:ORMATION?AND;;lOCATION~'.: . ,f 1
I Job site address: ILR 0 51o;C I
I City: ';i:l'fJJ j State:Oj<, I ZIP: 9.'1+18 I
I Reference: 1'lt!L.",5ScjJ;; I Taxlot(J6,aJ!
1'<i;~",;,~t.-':-?~DESCRIPTioN~OI;:WORK ",c.~,. ". 1
~/>fa'DL[;d ;<<~Co gu-t'.JJt7-rz;D t:./l2adrl
I Ik;A'.f1"Elhcf? t!' CUII2/[!/( I
I:~ "..... ~"'"',- :,>:s,,,,,, "ROPERTV~OWNER7~"""~' " "'~' '"I
;',...;...-fi<,~,~~ - "'H,,,,'.L,.'o~r:;. .. LI,;~ . t;;:",.. _: "..<m.-o.._'-~'.r" '4_
I Name: I LJe,c./Py i:! t'/ruHd5 ,I
I Address:lbo 5/fT I
I City: 5/> f'tJ I State: t'J ~ I ZIP: 7'9# r d" I
I PhoneG1! -yIp.. oa3"L I Fax: I
I E-mail:t.J::}ch ,'}oIer5p)(',CeC(,f'vJlf'e. rJoe:f I
This installation is being made on residential or fann property
owned by me or a member of my immediate family, This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 4~,560(1~ /1 '
S,gnatur~~~. (/, c.?J..4.-,
..=CONTRl(tTOR"INSTAI1L:ATION\\o:"fY~::~,:-;" ~I
I Business name: ?
I ~ddress: /"0'/
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City: -_'_'_' State:,.,/ ZIP:
I Phone:-'-"-"-:::,,-I:F.ax~
I E-mail: .~..// ..-.-................
I CCB license no,,:......., I BCD license no,: ~"
I Signing.sup';~isor's license no.: \
I erin(~ame of signing supervisor:
......1 Signature of signing supervisor:
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\,W ~~ \\J~
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440.2584.J (9108/COM)'
I\:(,.'~' J'.~~!;)!'::?;;!j,t't' FEE;,SCH EDU bE..>
,~.~'~'nfb:r"~fi~~t~~~.~!~rl~~.~e; i~'cni ~ ), /~I Qty. r
Residential, pcr unit, service,included:
':"-;','.;..'~:I
Cost, I 'Total, 'I
'ea. . cost. :
I
$134.00 $\ cl
, ,.-0
$ 25.00 $ :='-.1
$ 32,00 $ 1
I
I
$ ,Y /1. <-~
$ I
$158.00 $ I
$205.00 $ I
$469,00 $ I
$ 63,00 $ I
I
I
I
I
I
I
I I a. Fce for branch circuits with purchase of a service or feed~r fee: I
I I Each branch circuil I to I $ 6,00 I $ 6> 01. c;0
I I b. Fee for branch circuits without purchase of a service or feeder fee; I
I I First branch circuit (2) I $ 55.00 I $ I
I I Each additional branch circuit I $ 6.00 $ 1
I I Miscellaneous fees: service or feeder not included . I
I l Each pump or irrigation circle (2) $ 63.00 $ I
I I Each sign or outline lighting (2) $ 63.00.$ I
I I Signn] circuit or a limited-energy punel, $ 63,00 $ I
alteration, or extension (2)
i ';:~;l~;;;~~I;~~~;~:~ANT~SE. . ,.$~:;~ .~,.~ .f ,I
I (A) Enter subtotal of above fccs / / , II G'IJ
(l\.'linimum Permit Fee $58.00) $ / (R'" ___
I (B)EnterI2%sarcharge(.I2x[Aj) $ "7_q,'5
I (e) Technology Fcc (5% of[A]) $ Iv ,It '2---'
I TOTAL fees and surcharges (A through C); $ / (",4( 9'7
t,OOO sq, II, or less (4)
Each additional 500 sq. ft, or portion
thereof
Ir~
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, ,
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Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$ 63.00
$
Sen'ices or feeders: inswllmion, alteration, re/ocalion
200 amps or less (2)
f
$ 81.00
$ 9S.00
20 I 10400 amps (2)
40 I to 600 amps (2)
601 to 1.000 amps (2)
Over 1.000 amps or volts (2)
Reconnect only (2)
Temporary sen'ices or feeders: instatlarion, alteration, relocation
200 amps or less (2)
$ 63,00
$
$
$
20 I to 400 amps (2)
40110 600 amps (2)
$ 87,00
$126,00
Over 600 amps or 1,000 volts. see services or I~eders section above
I Branch circuils: new, alteratiun, extension per pane!
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CITY OF SPRINtJ'1'1ELD
Building/C~mbiIiation Permit
PERMIT NO: COM2009-01280
ISSUED: 10/14/2009
APPLIED: 08/31/2009
EXPIRES: 04/14/2010
VALUE:
. Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 160 51ST ST
ASSESSOR'S PARCEL NO.: 1702333203700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Hazardous Wiring Complaint
Owner: CHILDERS MICHAEL R & WENDY D
Address: 160 N 51ST ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
<;:ontractor Type
Electrical
Contractor,
OWNER
License
Expiration Date Phone
BUILDlN~ 1N,FC,>RMATlON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type: '
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage: .
REQUIRED PARKING
Total:
I, Handicapped:
, Compact:
. I PUBLIC IMPROVEMENTS I
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Streepmpro,,~m.elll$::.n ''''' '-'1' " "'t
:,', '-;s'~,,~~ ",:~"'..ni;'-j Gytha Or"con U\i',l'
,JJnOll< ......P!""'13D'lft' rules are ~8t 0, DownspoutslDra\,ns:
~S"~l;i'lltlostMtni@.r. iO:U hOAR 952-<ll .
n OAR ~S2-00'-OO1~ttl ,Il oPhe llJi~s NOTICE: PIRE 1FT HE WORK
)~~15~'Y0t.l mil)' ohtaln CO~~'Q \~e?hono THIS PERMIT SHAll ~\S PER~'I\T IS NOT
, -r.-..... .....f'J.!!!f. (Not ,. ,.., r ... . ,,~""DI7"[) IINDER~_ ~"n
n~;t;~ lor the Qr-9'JGn Ulll\~_~"~"'~-I"- . ;'~~;;,nFNI' ED OR IS AtlAIWUl''''~ , -"
is: _r'G~'-:';~2'<:, .,4" . ValuatIOn DescrIp,tlOn !JAY PERIOD.
f"\\'Il1 IV.....
$ Per Sq Ft, Square Footage
or multiplier or Bid Amount
Sidewalk Type:
Description
Type of Construction
Value,
I,
,
Date Calculated
Page 1 of 2
CITY: OF St'1(ll~GFIELD
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Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-01280
ISSUED: 10/1412009
APPLIED: 08/31/2009
EXPIRES: 04/14/2010
VALUE:
225 Fifth'Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
, Total Value of P~oject
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$16.92
$7.05
$60.00
$81.00
10/14/09
10/14/09
10/14/09
10/14/09
1200900000000001142
1200900000000001142
1200900000000001142
1200900000000001142
Total Amount Paid
$164.97
'1 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 1l,eouired Insnections ,
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Electric Service: Approval required prior to utility company energizing service.
By signature, 1 state and agree, that I have carefully examined the completed application and do h~reby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall' be do~e in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the wo'rk 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 contractors and employees who are in compliance with ORS 701.005 will' be used on this project.
1 further agree to ensure that all required inspections are requested at the proper time, that each a'ddress 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.
U~O aif~
/i)/I~/~ '7
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Owner or Contractors Signature
Date
Page 2 of2
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Statement:' Information Notice to Property Owners
,..' About-Construction Responsibniti~s .
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Note: Oregon Law, ORS 701:055(4) requires residentiakonstruction permit applicants who are not'
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-licensed with' the Construction Contractors Boare! to sign .the following statement before a building
permit can be issued. This statement is required fon'esidential building, el~'ctrical, mechanical and
'plumbing permiis. Licensed 'architect and engineer applicants, exempt from licensing under
OR~ 701.010(7), need not, submit this staiemerit. This statement will be jiled'~ith the permit,
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Permit#/ /q .
Ad<lre~s: /09 o/.s. 0' 5 ;---
jS~Ued,by:~ed' r'1 - .Date: / 0//9"/0 f'
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Construction Contractors Board
, 700 Summer St, NE Suite 300
., PO Box 14140
Salem, OR 97309-5052
Phone: 503~378-4621
Web Address: www.cch.state.or.us
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Fill in the appropriate blanks and initial boxe,s ,I 'and 2"and,either box 3A or 3B:
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" I own, reside'in, or. will reside in the completed structure.
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I uriderstand that i must become licensed as a cOlistruction contractor if tlie structure is sold or
: offered for sale before or on completion. l'
D 3A. My general contractor is
.,
(Name)
(CCB #)
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I will instruct my general contractor iliat all supcontractors who work on the structure must be
licensed with,the Construction Contractors Board. '
, OR,
,~ 3B., I wil~ ?e ~y o~ gene~lIr contractor. '(&'4cf--xi{' (~,( ), .
- , If! hire ,subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board, If! change niy 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 l:lUilding permit of the
- 'name of the contractor.
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I hereby certify that the above information is correct and that I,have read and do und!!rstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form..
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(Signature ofpe11J1it applicant) , ",' (Date)
(White copy,to issuing agenCY pertnit file, pink copy to applical}t)
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, Property _ o~er.doc 06-01.04. ,
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A~ting as your', Own G.eneraIContr~ctor?
.INFORMATION NOTICE"TOPROPERTY OWNERSl ~.'
ABOUT"CONSTRUCTION'RESPONSIBllITIES :',.
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NOTE: This information Notice to Property Owners about Construction Responsibilities was developed by the
Construction Contractors Board in accordance with pRS 701.055(5), passed by the 1989 Ore'gon Legislature.
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If you are acting as your own COl1tfact,or to c'onstrucl a new home or imik'e a substantial improvement 1'0 ail existing
structure, you can prevent,many ptoblems by'beingiware ofth{!ollowingresponslbililie'sand'concerns.
'Employer Responsibilities
:'. '-;: '.: _',. ,:....~ '. ..' . "~~ \, ,oi .j~" ,:,-;-.C,,", ....._. ,',' . ~... '.' .. ''''_',~:-. ' .' .. ..'
Y ouw,jJl, in tnosUnst~ces, berule;d; to'Qr,~m.",e!TIploYer.".aI14 the. contra~tors y?u.yontrac.!\with.will be "employees" if
you..~~e cOJ1tr~c~or.s not, Iic~n~ed ,;i!R,\heplns~.S?l:),n Cop.trl!o?,t~f~ B.Qarcl.tO$Q ,1.abpr .i!1 C?J1S,~Clillg or to ~s~i,st in the
constructIOn or tmprovement ofa,resldenual structure. As'the employer, you must comply With the followmg: '
';-'.,...,:..\.,.'r.: "...\,. :-;.,'._';"" .~: >:",': ~ ~.' . ". ")-'.. ." . - - .~. -. j,,'~h,' "'- '..
Ore~on's Witbholdi&g 'Tax i~~: ''A:'a'h 'eIiq,loyii: yo,'i~ustwithh;']d incoin€{ilxes from le~ploY~~'wages '~t 'the time
employees are paid, You will be Jiab1eJor the tax,payments ~ven.ifyou dOl1't a.ctually :mt~oldthe tax from your
employees. For more informatiOli, 'cali the:Departmeht ofReveoue,'at 503.378'-4988;".'" ''. ",,', : <:1",'1 . ,.
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Unemployment Insurance Tax: As,an employei)Yoiltar~ feqli;;'~d-to paya.tax:fo;' unernployi!ient.insurance purpOS\lS~:
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488.
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The Oregon Business IdentificatiOn NutI1ber (BIN) is a combi,nednumper, for.,botl.1!, Oregon. Wit1$olding and
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the
ap,'" UP' :ate forms.
,____.__~__.... ,_.,....._.... _ ,<. .~.\;.i_,. _,.~1 _
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Workers' Compensation Insurance: As an employer; 'you are subject to the Oregon W?rkers' Compensation Law,
and must obtain workers' cu"'p~usation insurance for your employees., If you fail to obtain workers' compensation
insufan';e~ ~ou:;;ii'~i(] .be sulijciN toj5enalb~~ ahd be liaBle 'f(jr.all cialm 'c6sts' if'oneofyolfr 'bmpioyeb' is 'iIijured on the
job. For more 'information, call the Workers' Comperisation 'DiVisiorl'at'the'Depai1mentl'of 80nsumet and Business
Services at 503-947.7815, - ~
U.S. Internal Revenue Service:~sah employer" 'you ~gsQv:;hhOlQ feilenil income;tlj~'fr6inemPIOyeeS' 'w~ge;:<
You will be liable for the tax payment even if you didn't actually withhold the tax. For a F5'deml EINnumber, call the
IRSat.l~800"829'4933 orcviSit'theidVeb site at w\vw.irs,gov. , :,,'. ,> ., ,fl : ,~,;, ' ......'. ' .'
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;,':r.", , Othel: R~s.ponsibijities,!llll(l!Areas ofCoricerp.~ :;,c. ;L~),
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Code Compliance: As the pennit holder for this project, you are responsible for resolvirtg'anYfailtireto fheet code
requiretnents that may bc broughtto your attention through'inspections. .
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Liability and Property Damage Insurance: Contact your itisunince' agent 'to 'see if Y<1P have 'adequate'insuraiice. .
coverage for accidents and omissions such as falling tools, paint over spray, water damage':from pipe punctures, fire or
'work that must be redone.' ',', "', ',. ,j, ' r. \
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Time: Makesureyouhaves~ffici~nttimetosuperviseyouremployees:' " ..! ", ,., '''i, ," .,- ,
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Expertise: Make sure you ha~dfih'e ~kills to ac(as y~u~ own"genera'j contractor, to'c~ordi~te: the work of rough-in
and finish trades, and to notify building officials as the appropriate times so they can perfoctn the required inspections.
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If you h~ve additional questions call the Construction Contractors Board (503-378-4621) oi. write the agency at PO,
Box 14140, Salem, OR 97309-5052, '
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Property _ owner.doc 06,-01-04
225 Fifth S~reet
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield ,Official Receipt
Development Services Department
Public Works Department'
Job/Journal Number
COM2009-01280
COM2009-0 1280
COM2009-0 1280
COM2009-01280
Payments:
Type of Payment
Check
cReceint I
-RECEIPT #:
1200900000000001142
Date: 10/14/2009
Description
Perm ServlFdr 200,amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
WENDY CHILDERS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
2022
In Person
Payment Total:
NJM
Page I of I
9:47:17AM
Amount Due
81.00
60.00
7.05
16.92
$164,97
Amount Paid
$164.97
$164.97
10/14/2009