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Home My WebLink AboutPermit Electrical 2005-6-9 Date <,.",'" ," "'.1""" ,",0' '..,.. '. ."" 0' 'RE'G"O . '. "... . , ".., . "crrYOF~ 'RIN D :1I.T""" ' .,...:.~. _ ;.~. ;".:. L 'l.~, . '. ., , . ~it',Y'i",,"'~(:'~~;t',~, ,'t ':.' ,,. !>"J .. '. 'I.,..'. ~., . ; ~. ,,- "~,':'..,~' ~" ~ " ~i ;. 225 fiFTH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 '/:/' ~ \ ~qj'>. . 't."-, If ,,~--~' . b 1::;- ( c:jfi~0 ~0 Q' ._. ..,..., __",,' .,"""Y' -". ,~f;i -(", ~. 3, :.'COMPLE[E'FEE SCH~D,ytE B . . .. -. - ... ........._..~-'P--J~ -. - ,\(" 1.,:,> '. ~~ ".' ~ - "', ,: . '~'i-;'_~i:"~-"~' _.,f':i' . l..fQ" ....' '; . A. ' New Residen~ial;-Single or MuJ(i.Fa~li.y per dwelling unit. - -' -~_.~ ", -~'. ...... \.~.- /".~ . :J:.)j.. .. - ... . . Service Included ,;~ ." 'ELECTRICAL PERMIT APPliCATION City Job Number COt-(,( 'lDO' S- - OC> b r '7 ~ ~.' ,... \'" '.~_"" . .;,:....""'"f'... '",.1'- -' "~-":'1' / ;:~~:1S~;~ ~GALDESCRIPTION D3~oo . /703 Z:Z.L{t-f.--_.. J06 DESCRIPT'tON - $106,00 ~/o( ~ 1000 sq. ft. or less / Each additional 500 sq, ft. or t:&A ~-portion thereof , Permits are non-transferable and expire if work is Each Manufact'd Home or , not storted within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder 2 . CONTRACTOR .ci\istAir.A:Tld%invbY' B. ~ Se~vi;e;~rFe~:Ie;s':"ln~i;;;i~i~n, Alt;;'ti~~~'~;R:'oc3tion: , .-~_':;'rL -'<'~ .2"-,,:::,,:,,. '~''\\*.~~<J'\'''; ,"'_'_"',-""';":""--~.:....,,__"_r..,'_~'__"::;:'-_ Electrical Contractor . ,olQ.'i:. \'i-_,~\,\ \S _ 200 Amps or less $ 63.00 ~ ~\>.\.\. '\:--\~\S 'i''\:-\;~'V 'i-\l\' 201 Amps to 400 Amps $ 75.00 Address:\\~;',,~\\ S,.\\'\'i:."- ~ ",~'V<J 401 Amps to 600 Amps $125.00 ~v YV' \)"" Sl"v ,\1\\':> CI'i\$ 'V <J"- '-n'V.' 601 Amps ~1000 Amps $163.00 City 1\\\'\1'1 .c.I<.c,<:2 . o~JPlione ~0C3~~r&ll. MYPsIVolts $375.00 . c,CI\'l\\\~<;} \)1" ~~~b\J~(ftoglit1l.w ~ $ 50.00 \>."''{ ~\\()1j~~~~~::.Cl)~.-.7"'Y7'- ',' . :' , T"" -,. , Supervisor License Number / - . .€~N\\~' ll) ~\I@l Qtl!il!!':re'?~0~':" .,?,V':e~~_ I,,:. ',::_." ," .l.~..t~ . - ' ,v"~f,.p.gS2.(lt)'-\IV ftcO~o'I~ ~ . . Expiration Date / ill~.... """ maY dO\aI .wo'tS~ ~ ration or RelocatIon / \1\1"-' """'1.0>.. \,. '"",,= calling \he ...... QfeQOl\ Utwuy s or less ConslT. ConlT. Numlier _J!"hAfJOf \he. ~-80()-33~ s to 400 Amps i.. ceOWl "" 401 Amps to 600 Amps Expiration Da Over 600 Amps or 1000 Volts see "6" above. Signature Supervl'sm' g Elecm'cian D. "'B;i~~b~Cir~~-it;~~::~::~_~:~-l:~~~; ~:':~l~~.~~": ~l-.;~T.'~i:.~.~:~ ~'. I..:, .::..._"-....;.:.1>..,"".... ..." ,'~'..<.o.;.:,j._,...;' ..:."..'-,:.~.,_'.. ."....:~:...~:"'"j..""'O:,::.;_~:....:...<.:J..:.....loo..:-. . \ St:-(\..CIlC,~ Owners Name b\o.no... e. ~ Address ~~('\ ~--}, \ City .sffi~ Phone~h-06a OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. x rz;/;~#Pa:~ Inspection Request: 726-3769 $ 19.00 I ,S-U $50.00 $ 50.00 $ 69.00 $100.00 New AJteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 r:1":".:"\",' .'''''~l:''''~..r;.rT!'t- ..: ......."":"";r- -i",:--"V,,^n.,.:~-- .1"" -T'l'.~,.--:- ~ E. . J\-liscellaj~~(Sery;~~fee~ei not iit~ludedi.~Each installation ~t.__ .~ ~~_,"......:~ ..:......\._,{~_~.....-:-_.'<--..,...,.",.. . Pump or irrigation $ 50,00 Sign/Outline Lighting $ 50,00 Limited EnergyIResidential $ 25,00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45,00 + Surcharges ::-1:". .-::.'i...-rr'....~.or--...;.._... ";:"'_'~j ....".-.... -;.7'"-...- 4. ,SUBTOTAL:OFABOVE;i:'.:,. ..: '_,. ~....'_",:,::~...~:~..,d':..:iJ.t,.:.r.~..~it."1':\.: ;',:,' . . 7% State Surcharge 10% Administrative Fee 50 J!>1O rao S' 8 ~-c TOTAL Shared Drive(T:)lBuilding FormslElectric:d Permit Application I.oJ.doc -Wlr&rl::ICI~ ........... ~ ,- --_:- . . U 11' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00689 ISSUED: 06/08/2005 APPLIED: 06/08/2005 EXPIRES: 12/08/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2755 NOVA ST SPACE 1 ASSESSOR'S PARCEL NO.: 1703224403500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Relocate service entrance Owner: Address: MARIA HERNANDEZ PO BOX 1255 EUGENE OR 97440 Phone Number: 541-736-0627 Contractor Type Electrical Contractor OWNER I CONTRACTOR lr..,uN.lATION I License Expiration Date Phone BUILDING INFORMATION I # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: . -\,,1':. \o.SprinklediBuilding: t\..Il~~, \J~. r\lOIQ~ r IIiL "......::..' 1\-\\S Pl~I'i\\~ UN'D~R 1\-1I~E",E'LOP'MENT INFORMATION I f>,lllt10R\2l: 0 IS 1\\3I\NUUl'I..U ' -. "otv MENCE\) On Front yard Setback: \ (J DP;-< PERIG\). Overlay Dist: Side 1 Setback: Ml'118 # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: % of Lot Cover~:to Solar Setbacks: A:TTENTION: Oregon law requIres y .\' " . . ~ .../....^ n..,nnn Utlltv 1anow (Ult:~ ClV'~t:.~'::'".:z :::. ~ :" ., t' CerltRIJBlI:I(l,WliRE):w!l,w:.",., 1>'\ Notllica Ion Ii 1\\\. \" (, J. u,. . OAR 952-001-0010 tnrougll Ui"' . ~ - 1~090, You may obtain copies of the rules by lIin the center. (Note: the tel~pho~e ~:mb~r for the Oregon Utility Notllicatlon Center is 1_800-332-2344). # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 n/a REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Sidewalk Type: Storm Sewer Availahle: Special Instruction: Downspouts/Drains: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paeelof2 . . CITY OF ~rIUj~GFIELD Building/Combination Permit PERMIT NO: COM2005-00689 ISSUED: 06/08/2005 APPLIED: 06/08/2005 EXPIRES: 12/08/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fp.p.s~ Fee Description + 10% Administrative Fee + 7% State Surcharge Manufactured Home Service Amount Paid Date Paid S5.00 S3.50 S50.00 6/8/05 6/8/05 6/8/05 Receipt Number 1200500000000000797 1200500000000000797 1200500000000000797 Total Amount Paid S58.50 I Plan Reviews , To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 Rp.nuirp.lllnsnp.di~ MH 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 berein, 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 wbo 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 eacb address is readable from the street, tbat 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. . - ti~N~6 Ower or Contractod'Signature h /:;!u~ . Date Page 2 of2 . Construction Contractors Board . 700 Summer St NE Suite 300 I) PO Box 14140 . . Salem OR 97309-5052 \, ./ Pbone: 503-378-4621 . ". ....' Web Address: www.ccb.state.or.ns Pennit#: COVll' z.cA -00 b r <=t Address: to' 7~) No vt4- S +- Issued by: ~ (5 Date: b - <1( -() S- 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 befiled with the permit. Fill in the a.....v...:ate blanks and initial boxes 1 and 2, and either box 3A or 3B: p;rL ~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 licensed with the Construction Contractors Board, OR QQ 38. I will be my own general contractor, If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, If! 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 bereby certify tbat tbe above information is correct and tbat I bave read and do understand tbe Information Notice to Property Owners about Construction Responsibilities on tbe reverse side oftbis form. l/f1ltbl &1/:.1/1/4/;? , (Sign'at of permit appticlint)' A/~ /n,~ tt>ate) (White copy to issuing agency permit file, pink copy to applicant) Property_owner,doc 06-01-04 AdnIID~ &1l~ ft11llIr' ([))WIID G~IID~Ir'&1ln CC!IIDttIr'&1l~ttiIDIr''l INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES 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. 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 many problems by being aware of the following responsibilities and concerns. lEmjplloyer lRe!ljpollll!lftlbfillWe!l - I You will, in most instances, be ruled to be an "employer" and the contractors you contract with wiII be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As tbe employer, you must comply witb the following: Oregon's Witbbolding Tax 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 even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance 'fax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488, ' The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsoav.htmll for the appropriate forms. Workers' Compensation Insurance: 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 could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815, U.S. Internal Revenue Service: As an employer, you must withhold federal 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 1-800-829-4933 or visit their web site at www.irs.!!ov. <(JJ~llneJr lRe!lJPionn!iJfiJbifillfi~fie8 mnnl[jj AIrem8 of ConnlCeIrnns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. !Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. JExpertise: Make sure you 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 a",,, ~".;ate times so they can perform the required inspections. If you havc additional questions call the Construction Contractors Board (503-378-4621) or writc 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 COM2005-00689 COM2005-00689 ,COM2005-00689 ! . Payments: Type of Payment Check 1 r 6/8/2005 . RECEIPT #: Description + 7% State Surcharge + 10% Administrative Fee Manufactured Home Service Paid By MARIA ROClO HERNANDEZ ESTRADA "~""'_IILD , it., '"';'.'.~. '. ,-' "-. -.,'--.....~.... --. - I, - \ .""." ~., . f . ,; City of Springfield Official Receipt .elopment Services Department Public Works Department 1200500000000000797 Date: 06/08/2005 Item Total: Cbeck Number Authorization Received By Batch Number Nnmber How Received djb 535 In Person Payment Total: PaJ(e I of I 8:l5:2lAM Amount Due 3.50 5.00 50.00 $58.50 Amount Paid $58,50 $58.50