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Home My WebLink AboutPermit Electrical 2006-5-11 SPR_IEL,_ D --:---l ZON ~ ,'--./......... INITIALS . ", ~'~ 225 FIFTH STREET 0 SPRINGFIELD. OR 97477 0 PH:(541)726-3753 0 FAX: (541)726-3689 "'~" '-..-, SOURCE ELECTRICAL PERMIT APPLICATION CityJobN:mber ~lMZC:,O~_ O~.S-b~_ ___ ,. . _ ~~a:-,.~~(0_~ 1. LOCATioN OF INSTALLATION, '", ,: -', 3.Cq,Mp'LET]l FEE SCHEDULE BELOW .....:'... -I.' ':.:.::...&_ ._'_"M:".<. ,.r .,' ."':'.,j,;,_'...~.-'h>L:.::'.__'.. l___,..~........- .. .~...-.~....--.- -, - '.--,- q{,Cf. LN D/'l,"'-P;t.. <.I- ~,~"tr.,j1J.... "11"71_r "C _~ " _...,' _' . _ 'u ." LEGAL DESCRIPTION A. : l'i'e,;: Residential :-Singie or Multi~F:imily per, dwelling unit. ......._ .,_ _', _~~.._ __~ __ _ _', . __ __ __. _. __4: _ l~. __ I 7 0.3 Z 7"3 ( 0 Z. \ 0 f Service Included JOB DESCRIPTION $106.00 1000 sq, ft. or less ATTEEach.additional500 sq, ft, or II ,.. I~.J"". urenon fa . t:::'~;'^-' W~"''''''-~.- ~l>u"""'O> follow portion thereof wreqUlresyouto t \', ,u,,,~ daopled by the Or ' , Permits are non-transferable and expire if work is NotlfICaiEachf'MariUfuct'd,Home,OfsegOn Utility . , . . "V~~ "'" are s t f h not started within 180 days of issuance or if work is In OAR ~M6diilarE>weJling.Service,orR e art $5000 o '-v'~",uu!J"UA 9<;?nn, Suspended for 180 days. 090, Yclteedo;ry obtain co - ' . _ calling thee," f -"'- _'f.I.e~ qft~f:l ruJ:;!s blf -'. .' -- ,.~- 2. "d>..ifiR1:.C!"?~I1fs~4~jjf!~. qN.~~~, num:!l,"r IserJic~t6r FJrd~rs{htTnsial.hiti.~I)i:'Alteralions or Relocation: C:~t l>-WregdIHJtllrty-f\1olification-'- - . .'- -. 200 A~J~ MeQg-332-2344). $ 63,00 201 Amps to 400 Amps $ 75,00 401 Amps to 600 Amps $125,00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50,00 $ 19,00 Electrical Contractor Address City Ph01\' \6 ,.,. Supervisor License Number \' if C ~~~ ,"' --, -;:......."_.,.~-...,..~~,.....-...._-..~.--:-- .. C. l.T~~~!1r?'::~;,~.~~r:VJi~~_~.!:~~e~~f!~_~._.;.~~~ _ . '--j-:-~~- ~ ~ - ....- -"-.-.' Expiration Date Installation, AJteration or Relocation Constr. Contr, Number 200 Amps or less $ 50,00 NOTICE: 201 Amps to 400 Amps $ 69,00 1m:, t"tRMIT SHM1..Il"'rtJpl:trr.6001\mp~uAI1I6 $100.00 AUTHQ . c. "'" 0= I tit; YV\7I\\\ RIZED UW'CO TO' 0"" "~!:l"ll1'ono ,7-1- "B-- b l,;UMMENCEO QDR(jv,c{r^"r,AIi''('I-G~";f!.';;;,C~h'f/I<t.~ see "" a..?ve: A . ~ '-Hranc 'Ircunsf"J:ttl . . NY180DAYPERrou:--~-':"""''''- " ------ New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 ;f t.f3~ Expiration Date Signature of Supervising Electrician $ 3.00 Owners Name J<"'1;l...... ~......kL Address q Act w (") I '1J"'''i '- S+- City 50(": rwC~\J- Phone fS-.{( J5<.{..,~ '&5 "b ( ~ ' E. 'J'1is~~IIall~~uJ,,<S~r~ice(~e~~er_ '!~t included) -Eac.h InSl~'l1at!on. , OWNER INSTALLATION Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited EnergylCommercial $ 50,00 $ 50.00 $ 25.00 $ 45,00 The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. ' SUBTOTAL OF ABOVE .. - ,-..-,.- ~ 8% State Surcharge 10% Administrative Fee t!;0'S02-- 4'~l.o ..{ t..1~;;' ~5'3~ Inspection Request: 726-3769 TOTAL Shared Drive(T:YBuilding Forms/Electrical Pennit Applicalion 1-06.doc . .CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00560 ISSUED: 05/11/2006 APPLIED: 05/11/2006 EXPIRES: 11/11/2006 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 969 W Olympic St ASSESSOR'S PARCEL NO.: 1703273102101 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Instan heat pump Owner: KYLE KRAKE Address: 969 W OLYMPIC ST SPRINGFIELD OR 97477 Phone Number: 541-543-9838 . .-.. +.... Contractor Type Electrical Contractor OWNER '.( ':\,. ur ':-'1)11 'c..l,": I....' .~-..-- J I CONTRACTOR INFORMATlON"1 U,Jilty ''''-''1'' 1 I 'J 0IV,'...J .......... set forth 'J'v.,., ""''''''^80~?aOh . " Gel', Uli10 throl!l;lcense ~. 'Explratlon Date Phone i:~. l.' ':(,~;', j"lav c~ ~~~'.I11 cC:;,..;s of tho r~le~ _uy VN . - . ,," ,--.. ~.........t"" .-..- I BUILDING INFORMATION. Notlilcation nUIIIL.J~\ lUI ",.... ~. --' . # fS--t ..,'... i51_oUO-332-2344). o ones: 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 GaragelCarport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: Total: # St';~et'Re~s Rqd: IF "[\-IE. WCWlandicapped: Pav~!~ri~~~\~~\ S\-I1\\.L EXPIRE MI"[ IS ~!S~mpact: % ofll!:ot CoverageUNOER "[\-lIS PE.R rOR ~~:~,~~~~(~n OR IS 1\B1\NOONED I PUBLIC IM'P,R'O\:EMENTSIUU' Sidewalk Type: DownspoutslDrains: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Notes: I Valuation Descrintion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page I of 2 . .lTY OF SPRINGr I~LD . Building/Combination Permit PERMIT NO: COM2006-00560 ISSUED: 05/1112006 APPLIED: 05/1112006 EXPIRES: 1111112006 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 F~~s ~ Fee Description + 10% Administrative Fee + 8% State Surcharge Add, Alter, Extend Circ MinimumlAdjustment Electrical Amount Paid Date Paid $4.50 $3.60 $43.00 $2.00 5/11/06 5111106 5111106 5111106 Receipt Number 1200600000000000641 1200600000000000641 1200600000000000641 1200600000000000641 Total Amount Paid $53.10 I Plan Reviews I 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 Renui~ Rough Electric: Prior to Cover Final Electric: When an electrical work is complete. By signature, I state and agree, that J have carefuny examined the completed application and do hereby certify that an information hereon is true and correct, and I further certify that any and an work performed shan he 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 an 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 an times during construction. Owner or Contractors Signature Date Pa!!e 2 of2 _,1 \ .: " .' '. " , , . Construction Contractors Board . 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit #: c:...oMz-cL-oo 96'7 6IYYY'tJ~c- , , biS Date: 7/1/Cl C- Address: Issued by: 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 3B: ~l. ~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 #) 1 will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. ~3B. OR I will be 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. q;l~ ~"/ oS / III Db (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) -" Property_owner. doc 06-01-04 :. . A~~nll1l~ ~~ ] ([))lillIr ~Wll1l G~ll1l~Ir~n CC([))ll1l~Ir~~~([))Ir1 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 19a9 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. lEmjplloyeIl" Re!ijplolJD!iJillJlJimfie!i You will, in most,instances, be ruled to be an "employer" and the contractors you contract with will 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 the employer, you must comply with the following: Oregon's Withh~lding 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. I Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposeit"' on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. I ....... The Oregon Business Identification Number (BIN) is a combined nwnber for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-809] or www.dor.state.or.us/formsnav.html1 for the apI" VI" ;ate 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 503-947-78]5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages._ You will be Iiable:for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at ]-800-829-4933 or visit their web site at ww\v.irS,QOv. <Otll11eJ1" JResjpolIllsiilbiiilliitiies amll Areas of COnnCeJI"lIllS Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that inay 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. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish tradcs, and to notifY building officials as the al'l"VI',;ate 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 ]4]40, Sa]em,!OR 97309-5052. Property- owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-~759 Phone . J;~~ WiL, CiIw'f Springfield Official Receipt "opment Services Department Public Works Department , Job/Journal Numher i COM2006-00560 COM2006-00560 COM2006-00560 COM2006-00560 Payments: Type of Payment CredilCard cReceint 1 RECEIPT #: 1200600000000000641 Date: 05/11/2006 Description + 8% State Surcharge + 10% Administrative Fee Add, Alter, Exlend Circ Minimum/Adjustment Electrical Paid By KYLE KRAKE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 628009 In Person Payment Total: Page I of I 3:06:59PM Amount Due 3,60 4,50 43,00 2,00 $53,10 Amount Paid $53,10 $53.10 5/11/2006