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Home My WebLink AboutPermit Electrical 2010-2-26 Electrical Permit Application .~~"<.~ ~ _~_,:i.: ,<7 _. .-....";: ,..--~ ._~.,.. ~ :'S'.,;.~o- ~':. '"f.!I<~""'_i,:f_~"',<Ii: ;"Grr-,y HE S'~RlN(iiEIEbD;~;OREG.ON; 't^. ,.,.---- ~.~. __' ;-:0 '" ~ :: -.f...... ....r,;..~...L:--_ ;;c" -~-', ~ 1. _-~'" 30'" :."" '-. - 225 Fifth SlreettSpringfield, OR 97477tPH(541)726-37S3+ FAX(S41)726-3689 >< DEPAFnMENtl.lsE ONLY ,. '. .r'.' Pennit no.: U - 1531 Date: 2-20 -10 This permit is issued 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. . '. "tOCAl;:GOVERNMEN'T"A~PROVAG~.>.:+l"'~d;;~:.\'" Zoning approval verified? DYes D No ,; ,;;'-C,tI.'TEGORY(';OF; :;CONSTRUCTIONE:,'z' ,.. Residential D Government D Commercial ...."'.n.OB..SIT "I'NF'ORM'AT'!'ON"'A"'N' D'['O'C'A''!i'ION''''''{'v "" ,&~g.r}rR>X;r;:". , ~it, ,::I;w ",'. __ '. ~ "J', ,';;i <'." . f -' , ~!;.,_!Jtf:_~~ /35 f. City: Phone: E-mail: - (4"11' This installation is being de on residential or farm 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 479.,56 I. Signature: D . CONTRACTOR INSTAllATION. Business name: Print name of signing supervisor: Signature of signing supervisor: i-9 r>jV~\V V~ 440.2584.) (9/08/COM) '(~P:!;~'_;~:~:~.fjj'~~~H{~S".{i;, f:EE"\SC,R Eb.U Ii!Et~f,$j~~i;~i~~~~~~6~'3(;~~~~; .. . .,' ., '>, Cost: Total ...r~u~,~~r' ?ri~spe.ctio.?}'~e[,~tt\rr._'P.. d-: 'Q~Y, i "'ea;:, . .. cosL :. Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81,00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 60 I to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or Jess (2) 201 to 400 amps (2) 401 to 600 amps (2)' $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, altera/ion, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $'9l:l' b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuil (2) Each additional branch circuit $ 55.00 $ 2$? $ 6.00 $g" Miscellaneous fees: service or feeder !'lot included Each pump ?r irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alteration, or extension (2) $ 63.00 $ $ 63.00 $ $ 63.00 $ Each additional Inspection: (\) $58.00 $ "."',~J:1Ji,~:",);1iil\V~'k*A"rip;"IC' .A....N. T"'U"'S' 'E',';f1~"!i,'~::!"';~""c.,';,,", '.", :).,;~~".'TM'.~:~~'l>",;c)ill," ~';{, . I':...,L . . .I,~< _ _ '5":z.,;:"xJt:"," :~':'.V,:5i.. ";t--';' '. ': (A) Enter subtotal of above fees (Minimum Permit Fee $58.(0) (B) Enter 12% surcharge (.12 x [A]) (C) Technology Fee (5% of[A]) TOTAL fees and surcharges (A through C): $ - $1.8 j2(t-- $ '1 $<'7?;;z$ Pennit#: ((0-(53 't Address: 1135 &4)'f SfrJ & q7L/77 Issued by: Date: 2 - 2 &r I () -. . . . . . . . . " " . . 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 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare 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 I and 2, and either box 3A.or 3B: gl. I own, reside in, or will reside in the completed structure. D 2. 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. 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 hereby certify that the above information is correct and that I have read and do understand the Information Notice toPropefly Owners about Construction Responsibilities on the reverse side of this form. ~~ ~JJ (Signature of permit applicant) 2-2cP ~ 16 (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 Acting as Y OlUlR" OWJt1l Generall Contr3lct4n? liII'FORMATION 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 awn cantractor to con'struct a new hame .or make a substantial improvement ta an existing structure, yau can prevent many praolems by being aware of the fallawing responsibilities and cancerns. 'Employer Responsibilities , . You will, in,mast instances, be ruled to be an "emplayer" ~nd the cantractars yau cantract with will be ':employees" if yau use contractors )lot licensed wiih the Construction Contractors Baard ta da labor in constructing .or ta assist in the canstruciian or imp!avement .of a residential strUcture, As the employer, you mu~~ comply with the following: t. .' Oregon's Withholding Tax Law: As an emplayer, yau must withhold incame taxes fram emplayee wages af the time emplayees are paid. Yau will be liable far the tax payments even ifyau don't actually withhald the tax fram yaur emplayees. Far mare infarmation, can the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an emplayer, yau are required ta pay a tax far linemplayment.insurance purpases~ an the wages .of all emplayees. Far mare information, call the Oregan Emplayment Department at 503-947-1488. .J "" The Otegan Business Identificatian Number (BIN) is a cambined number far both Otegan' Withhalding and Unemployment Insurance Tax. Ta file far a BIN, call 503-945-8091 .or www.dar.state.ar.us/formspaV.htmll far the apprapriate farms. Workers; Compensation Insurance: As an employet yau are subject ta the Oregan Warkers' Campensatian Law, and must abtaip w()rkers' campensatian insurance far yaur emplayees. If yau fail ta .obtain warkers' campensatian insurance, yau cauld be subject ta penalties and be liable far ail claim casts if .one .of yaur emplayees is injured an the jab. Far mare infarmatian, cal1 the Warkers' Campensatian Divlsian at the Department .of Cansumer and Business Services at 503-947-7815. u.s. Internal Revenue Service: As an emplayer, yau must withhald federal incame tax .fram emplayees' wages. Yau will be liable far the tax payment even ifyau didn't actually withhald the tax. Far a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site 'at www.irs.uov. . Otllller JResjponsibfiJlitfies anndl Areas of Com:ernls Code Compliance: As the permit halder far this praject, yau are respansible far resalving any failure ta meet cade requirements that may be braught ta yaur attentian thraugh inspectians. Liability and Property Damage filsurancc: Cantact 'yaur insurance agent ta see if you have adequate insurance' ' caverage for accidents and amissians such as falling taals, paint aver spray, water damage fram pipe punctures, .fire or work that must be redone. ' ' Time: Make sure yau have sufficient time ta supervise yaur employees. " .''-'' .. -' Expertise: Make sure yau have the skills ta act as yaur awn general cantractar, ta caardinate the wark .of rough-in and finish trades, and ta natify building .officials as the apprapriate times sa they can perfarm the required inspectians. Ifyau have additional questians cal1 the Canstructian Cantractars Baard (503-378-4621) .or write the agency at PO Bax 14140, Salem, OR 97309-5052. " Property _ awner.dac 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone iif~ - - . .... - City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000176 Date: 02/26/2010 1:34:47PM Job/Journal Number COM2006-01538 COM2006-01538 COM2006-01538 Payments: Type of Payment Check cReceintl Description Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee Paid By NEIL GOSSWILLER Check Number Batch Number Received By KLK '.' Page J of 1 Item Total: Authorization Number How Received 671 KLK In Person Payment Total: A mount Due 84,00 10.08 4.20 $98,28 Amount Pllid $98.28 $98,28 2/26/20 I 0 MINIMUM SETBACKS - INTERIOR LOTS All measurements are from Property Lines -Front yard to House 10 feet ---' -- -Front yard to Garage 18 feet -Side yard to.House or Garage 5 feet -Rear yard to House or Garage 10 feet P.U.E. MAY CHANGE SETBACKS I! 'agM 1 3Id: • ' i • - - • 41(lb.. i DATEPECEiv , 11A''� � _ r a> ,{ 6.ON 4 91V iTrsi _ C�f 3 "` f LOAD STORIES LEGAL i1ESGR_ IPTiON r coo AODRES� WNS OTHE . CONTENTS ERE ON HAVE BEEN REVIEWED, _ _. i- - AL ER ONS N�DIIC TED'ON COLOREDPENCIL. ES40 OR ALTERATIONS MADE TO THE APPROVED DRAWINGS'OR PROJECT AFTER -TH.E.DATE. BELOW $HALL BEAPPROVED-BX r --- THE BUILDING OFFICIAL. . - - - - - RE: CITY OF SPRINGFIELD:', OREGON: '-SPRINGFIELD:',�o R. -APPROVE6-B1F DATA 1 , I. 1 STORIES LEGAL i1ESGR_ IPTiON r coo AODRES� WNS OTHE . CONTENTS ERE ON HAVE BEEN REVIEWED, _ _. i- - AL ER ONS N�DIIC TED'ON COLOREDPENCIL. ES40 OR ALTERATIONS MADE TO THE APPROVED DRAWINGS'OR PROJECT AFTER -TH.E.DATE. BELOW $HALL BEAPPROVED-BX r --- THE BUILDING OFFICIAL. . - - - - - RE: CITY OF SPRINGFIELD:', OREGON: '-SPRINGFIELD:',�o R. -APPROVE6-B1F DATA 1 , I. 1.