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Home My WebLink AboutPermit Electrical 2003-10-17 . ..", ., '0' UN' G" P'IELD' O''''RE' "G"ON'., J '[,.".' . " , , ,~ i:'> "'" . .~ \ J~". , f ',,~'" ';'''' ',<It ,,~'.............a. ., ',;'.' " >{ ,~ ,. _"" ;". :..'\! ", :,.....: . ".~, h. ~:'>' -. . . . . submitted has the following 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . G~t1~A'l::~Cg9 require specific land use ELECTRICAL PERMIT APPLICATION Zoning L- t> oIL City Job NumberCOI'l12DO'3 -0105'0 Date Ir -Yo:3 Date 10 - \ 1 - 0 3 \ "'. __~.__ "P'" . '~,'" --- '-.-.- " ~---..,".__..-AuthoriZ1W..siJma!llr~' -,'" . .- .<..~~W. I. 'LOcATIONi'iFINSTALLAJI0N'. ,;~.:: 3. 'COMPiEiEFEE8(;H./;JJULbn1;Luw'", ..' "" "-,,,..;< :~.,~_._"~ :__.::....: ..."....:-......._ _l.. _-----s...--2..:.:.-. t....v;. --ti.~._._,:.-.-:.~_ __._..:....:..... ';',.;.'_ ~.~___._ _ :':...J2......-.: . ,''';:''. .t', /O'-fl I)/VI/I/\.C'I C S-+- I i LEGAL DESCRIPTION 170'3 2 bLf I /OOOLJ JOB DESCRIPTION 1241 S /.r j/Y/ t1-S') rl-t:lif\ Permits arc non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. r--:- .~--- --,"'---"'---,-- . --..- ._~-.- "---:---,-.71 2. CpI\n}~Acr:.ORINS.!4LLA1.JPllfoNiY; L. """"-__--..L___._...___~.~....~'-_ Electrical Contractor Address City Phone Supervisor License Number , t ~ J~ Expiration Date 7)v Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name A ~ A J-' d . Address ( D t./- I 0 I '1 ....A-,l 0 f. 1 l I City Sr"1-h~ I d Phone 1t.f1-, 60 b 2.--- -.. .' OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. :J:22tuLJ 'uU \ Inspection Request: 726-3769 t-v;;;.--~' -. .',.vc .::..J"~,., -,_, _c "''-:. '-..;. .' "---~."'" ....-,.- ," ; A. \- Ne".,Reside'iitial .1';Singie""or Muiii-F.anlIi,~per~ dwt'lling.'uilit.I,"'/ I,.'_~~...~'~- ,..,'l...... ...'~.4...!'..':J...""-:...:;...w."...A~..:._.o..i~_ _...~.... .;t~...:lI.~..I',.':.;:;,.. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 (-.- - ---_.__._~ .- ...:.- -- -- . -- --. -....--. B. Ii Services or'Feeders -'Installation, Alterations or Relocation: L:"""c,,,~, ..:...._---'-- __~'":,,,-_. ._"....:_.......:.._ . ._ ~...___ 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps _ E V/'JP,I\$125.00 ~Oltrh~~sr't,~o't'6-ID)\S'\RE If ~~~ ,C' Mn1$163.00 1\1I!:1.,\l,tlMohmi'~pJ~\1\S PER ~ 'r8P $375.00 JI,\l~n;,~{%IiIJ'R IS MIJI,NOONr.tI. i $ 50.00 50 C.?~~~lUP.I~l~I;)~~~~riFeciIers~:---: '" ~::'~~;-:J ~IW~... __..~~ _,~_. .~___ .~"_. -- ..'- .._,.1':.... -. - ,'-' Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. ''''\,"'''-:''-':-:",''',--r~.'-''~'- .--- -........- -..--" .....,..~.""1T -..---:----......,....-: ..----:-l D. :,Br'aneh Circuit, '. ,~: . New A1t;;:;;ti;;;o~ EX~'1~<!,nJRer-"P~~~t\~Ot,~--- - - L -- , ,.Aregon'''' gon Uti I 1 , :rr18Il,\,@buw .~cI. b\l tl'16 Or9 , 'r,,\,$ 4,.00 fi. r:~t,Il&-j\li1'iOn'1lFcirc1l~WfU'lUh; are "", '-6 to\loVS~rvices!ifieede;r~~lt haM" 952-0 $ 3.00 '\Iotitica\lOIl oQj 0 ttlroUg h (ules \ n 0!J'f~~~;;~iis1(SeAq1>$~\~;~:i;fii~lied) -E;~l-;J';stall~fi~;' < 0090 'fE)U1lll'''' - --. -t~ote.. . - 'fi- ation- - - - - - _0 '. the center. UtilitY ~ot\ IC ca~i1i\IP or llTI~~l).egon 223AA\ $ 50.00 nu!S'llg~~1lm€lHglftirt'lflO.33 . $ 50.00 Limited EnergyfResidential $ 25.00 Limited EnergyfCommercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges r -:-..-- -~_.._. ._~--_. --_.- -.,,---' - ---.,--' 4. "Sl.1B]'OTAL' OF ABOVE .( . -- -.---.. _.---.----- 5"0 ::3';-0 s-co 7's8E:-- I Shared Drive(T:)IBuilding Fonns/Electricnl Permit Applic3tion 1.o3.doc 7% State Surcharge 10% Administrative Fee TOTAL . Status Issued 225 Fifth S~reet, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . CITY OF ~rKll'\juN~LD Building/Combination Permit PERMIT NO: COM2003-0I050 ISSUED: 10/15/2003 APPLIED: 10/15/2003 EXPIRES: 04/1512004 VALUE: SITE ADDRESS: 1041 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703264110004' PROJECT DESCRIPTION: Raise mast head Springfield TYPE OF WORK: Elcetrical Work Only TYPE OF USE: New Rcsidential Owner: ARD JEFF W Address: 1041 OLYMPIC ST SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER # of Buildings: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VN Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction I CONTRACTOR INFORMATION I OUtO . , laQU11,"" '/ lll.i\iW O enon \a.lI'CiS~"~lI~on ~xll~ration Date Phone O~. I" '0'/ tn9 Ie S0\ · ._CN!\ . ..~...d ...1<15 3 _~n..nO ,"illJILDiNGlNKORMATIONJI' Q~~;~U\0S \ '\ic3\\u" ~ \_ou IV . ~es 0\ none lot\ j>,1f(>f'Sfufl~~ ob\a.in c~re', \ne \e\e~Icb.O&:Slz.: \ ~(f!ejght ?f;:;g-6'.';;tl!1"e ~~ \Jtlli\'! ~ot) Sq Ft 1st Floor: .)0 Ty.~Jrl}lea't:e Qlegon "'32._2'344. Sq Ft 2nd Floor: C~.I' ",' .)'\ <>00-" w~l~ype. i5 \-0 Sq Ft Basement: n~~ge 1)>JJe!P.I . Sq Ft Garage/Carport Energy Path: Sq Ft Other: Impervious Surface Arca: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay D~~OTICE: !'I,I~QRK # Street Tr'\"~~~tRMI1 SHAll EXPIRE IF ;'f.j\l!~ed: Paved Drive Rqd:ORIZED UNDER 1HlS PER ~ cr: Jl,U ,t1 ABANDONED fU % of Lot c'IT~~\,g!A;:NCEO OR IS ANY 180 QAY PERIOD. I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspoutsffirains: I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee I of2 . . UJ r OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2003-01050 ISSUED: 10/15/2003 APPLIED: 10/15/2003 EXPIRES: 04/15/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Ff'f'S tiWU Fee Description + 10% Administrative Fcc + 7% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 10/15/03 1011 5/03 10/15/03 1200200000000002317 1200200000000002317 1200200000000002317 Total Amount Paid $58.50 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 Reauirf'd Insnection.... I 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 will remain on the site at all times during construction. Owner or Contractors Signature Date Pal!e 2 of2 -. . . \ .: "'. .,' ", ..' , . 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 Pennit #: ('0>11 ZO_ - (:), 0 S-a Address: / 0'-1 ( O/YY"I), '- ~ r- Issued by: n(J Date: r ~,;:; 7 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: %1- %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. D 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 ~ 3B. I will be my own general contractor. In 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 propeL^r about Construction Responsibilities on the reverse S~d~ 7 :h;?~m~ ~ (Signature of permit applicant) , (I.late) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/11/03 . . A.~ttnnng m~ 1{ ~\lllIr(Q)wnn GenneIrmll C~nnttIrmd~Ir? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: T~is Information Notice to Properly 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' If you are acting';as your own contractor to construct a new home or make a substantial improvement to an existing structure, YOll can prevent many problems by being aware of the following responsibilities and concerns. EmpBoyer JRespolffisfibiBfities 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 Withholding 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 a State Business ill number, call the Business Information Center at 503-986-2200. Unemployment,Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of &11 employees. For more information, call the Oregon Employment Department at 503-947-1488. 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 cl)Uld 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 al 503-~47-7815. I, 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 866-816-2065 or fax them at 801-620-71 15. Other JResponsibilities and Areas of iConcems Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements tha! 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. " Expertise: 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 3ppwp.;ate times so they can perform the required inspections. Ifyoll have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 03/1 1/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-0 I 050 COM2003-0 I 050 COM2003-0 I 050 Payments: Type of Payment CreditCard Paid By JEFF ARD ih~; ~! ~..' .: Receipt #: 1200200000000002317 Description + 7% State Surcharge + 10% Administrative Fee Service Reconnect Received By djb Check Number Batcb Number Authorization Number 000195 301468 City of Springfield Official Receipt Development Services Department Public Works Department Date: 10/15/2003 8:54:21AM Amount Paid 3.50 5.00 50.00 $58.50 Item Total: How Received In Person Payment Total: Amount Paid $58.50 $58.5U . .