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Home My WebLink AboutPermit Electrical 2010-3-12 225 Fifth Street. Springfield, OR 97477+PH(541)726-375HFAX(541)726-3689 . DEPARTMENt USE ONi.. Y ;',.,-":..;'. - Electrical Permit Application ,_.,,+ _'l~.! ...;~C- """" ~',:,,{1~-.$. "-~~,..,--;.. '~" i:___';~t.f~"'~H:' ~~ t:it "-'7#1~- :,..qr!~:QF-"~J;>~~G~~Eh'P~~~~G~~:' ;;" Pennit no.: C. 10 - Dat6: This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. . .;',': ," ">lrOCAL~:G0VERNMENT:M~~OVA8!,:,V?'f:\~V'\\'lf. -"':':::"'j,,{c:,"R_"*,"''''''-PFEE9S-CHE[jUI!lE''''1:''^-'''''W~-il~:~'''v)'~r~ i";;'/;!'\;',r:>(:1';0~,"~~~'':i:?f;'.~,j ".J? ,..' . __ <'_.' . 'f;/},~-''.. ';A(fg!,'.~){J:',';;\'!/&tj~~~.,,&-~ Zoning approval verified? DYes DNo ~Nuniber'-of:i~spe~ti~'n~iper.It~'~~d .'~.x. 'Q;ty",' Cqst;L Total :;"'.!!i':.:;,:;;;~CATEGORX,jOF.;CONSTR\JCtI0Ni\k\' '-:/:' , i','" '",,'~.':':,'~'I :":". ." .' ~:: "",'-:,'i\'.;:rtv "'.:1.",' '\":)~-"'" ".. '_",' ..i ~"ea.1J . : .,' cost c .,.:. IISl Residential I 0 Government Residential, per unit, service included: o Commercial 1,000 sq. ft or less (4) $134,00 $ ~~:tt~;I:J,OB}!$IT:E'~INfORMAjIloN~'AN[jiitiOC'AtlC:> Each additional 500 sq. ft. or portion Job site address: "--/ (; 6'5 ihlUr2-?1li1 FJ; $ 25.00 $ thereof City: s: ~ '''AtLU State: (J 1J ,;; I ZIP: 0'1tt7l( Limited energy (2) $ 32.00 $ Referenof' I I Taxlot.: /10d35/J ~( 1c@ti)manufactured home or modular $ 63.00 $ C"'c'" '" ....DESC~IPTIOI\kOF'WO~K';:;;'.\,",.;";'>:i;:!?\'.'", welling service or feeder (2) I () 1\ /f-tt1n ,If r7 / 11/ fr' ~ SIll/) Services or feeders: installation, alteration, relocation ! I 200 amps or less (2) / $ 81.00 $'6\ :PROPI;RT'r' OWNER ," '. 201 to 400 amps (2) $ 95,00 $ Name: (1:\61/) \J (~MLItt, 1-c-L 401 to 600 amps (2) $158.00 $ Address: -; h ~("" -r~IIJIA 'J 60 I to 1,000 amps (2) $205.00 $ City: ''''/~^'~A'\iYcl Stat~:C= 'tU; I ZIP: C!ltfl5! Over 1,000 amps or volts (2) $469.00 $ Phone: fS.L/j/ '7'(/ /13/ I Fax: Reconnect only (2) $ 63.00 $ - - E-mail: Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or fann property 200 amps or less (2) $ 63.00 $ owned by me or a member of my immediate family, This 20 I to 400 amps (2) $ 87.00 $ ,,".,",,,"", ~'tr'~" ,~. "' ""' OA' 40'1 to 600 amps (2) 479.540(1) an;c;..5 I). L $126.00 $ Signatu~:OT .'~....;. ., tJ__, u\ Over 600 amps or 1,000 volts, see services or feeders section above IH!a<l. II"~. Br..Pi _P.tie~E~fr~e.ii:'rJ~n o' p~lWl,:'. . 11\ :1'1 I n'v.--.::o, .1=01 a F'e~""'ihi3~iliee'i'lig;r~1Jnb!rg~'\lr# !\l'SrsiJ.tfwrtfFder fee Busmes . II'-L.~_ __ ,_ . n R .o\.-UIVIIVICI~v"U UIl '" llacG~!i2rOO~-0010 through f".' ~ $ Address:, "', < on n '" b. ~(.blf.l\,L~)il-~r~~~'tgf~ ~ 'Offe r feeder fee: City: nl\ll .v State: T ZIP: Phone: - - I Fax: - - Filful'lib'er l\!lF~hi!i2\Dregon Utili!' Noti IClll\Qr.bo $ E-mail: Each additi~fl!,\l,!n~ ~f/{llllt~~<:-" ,,*,*). $ 6.00 $ CCB license no.: I BCD license no.: Miscellaneous fees: service or feeder not included Signing supervisor's license no.: Each pump or irrigation circle (2) $ 63.00 $ Print name of signing supervisor: Each sign or outline lighting (2) $ 63.00 $ Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ (if{$;rr,~1~%~ZX~~~k~:!~j,~~'AR_eIzIcANr~:OS_E~1.~!~1~~t~gitEf~::i1:~Y:t';.c.." #'~ (A) Enter subtotal of above fees $ '2l1 (Minimum Permit Fee $58.00) ?5~' ~ (B) Enter 12% surcharge (.12 x [A]) $ <'I :T2... ~. (C) Technology Fee (5% of [A]) $ 4.06 ~ TOTAL fees and surcharges (A through C): $gL}.II ~ 440-2584-) (9/08/COM) " . <- -IIAi:C~iii ' ........... ; ',,,,,,, ,,' ...' '," 'y,,_' .~ '."e ' ;.~ .. Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00314 ISSUED: 03/12/2010 APPLIED: 03/12/2010 EXPIRES: 09/12/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 7655 THURSTON RD ASSESSOR'S PARCEL NO.: 1702351100900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: 100amp service/feeder to shop Owner: Address: CARMACK ROY JAMES JR & ROSALIND 7655 THURSTON RD SPRINGFIELD OR 97478 I CON'fRACTOR INFORMATION ~ Contractor Type Electrical Contractor OWNER License Expiration Date Phone I BUILDING INFORMATION ~ # 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 REQUIRED PARKING Frontyard Setback: Overlay Dist: Total: Side I Setback: NOrlCE: #~rr.eet Trees Rqd: Handicapped: Side 2 Setback: THIS PERMIT Paved' Drive Rqd: ATTENTION: Oregon lawq~f!is you to Rearyard Setbac)<UTHOR/ZED SHAll EXPIRE IF iJiHB'W(l)~l(verage: follow rules adopted by the Oregon Utility Solar Setbacks: ~\OMM'-' .___ UNDER THIS PERMIT IS 'NOr' 'Notification Center, Those rules are set forth v '1"^,I'~1l nn ".. '" "m: ' ~ M ~. ~^""nc~ ^' ANY 180 DAY PERIOD. I PUBLIC IMI'ROVEMEN1QO. You may obtain' copies of the rules by ~allin(J,,\!le 9.~l!tjlr, (Note: the telephone Street Improvements: numbllf'rdr'tffll' OregDn Utility Notification Storm Sewer Available: Dfm'dSfidiit~/ti~1i'1lI1li2-2344). Special Instruction: " I DEVELOPMENT INFORMATION ~.." Notes: .1 Valuation Description ~ Description Tvpe of Construction $ Per Sq Ft or multiplier , Sq uare Footage or Bid Amount Value Date Calculated Paee I of 2 Status Issued 225 Fifth Street, Springl1eld, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less Total Amount Paid -: il .~, I . f . > . '.<<", ',,,.- " .'!' .'..... 3/12/10 3/12/1 0 3112/1 0 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00314 ISSUED: 03/12/2010 APPLIED: 03/12/2010 EXPIRES: 09/12/20]0 VALUE: Receipt Number 1201000000000000225 ]20]000000000000225 120]000000000000225 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. Total Value of Project Fees Paid ~ Amount Paid Date Paid Electric Service: Approval required prior to utility company energizing service. ..1: . $9.72 $4.05 $81.00 $94.77 P.lan Reviews I "r:..,:.. , ~ ~ ~... ",- ..,'.> . .:,~' I Reouired InsDec~ 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 Springl1eld 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 tbe Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance witb 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, alld the approved set of plans will remain on the site at all times during constructi n. 1;.;lfr .>.~:;;". ,. 'l\~';'" :\;;;.....' ",..,.,i,',:,';,. I ,~ , . ~ ...':"", Paee 2 of2 Date ~//2- /;0 / 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 e. . . . . . . . . " .' . . Pennit#: '0 - I Address: \V5l.:;> 1V\l\r~tnn Qil. Issued bYlSP&- ? ki- Date: 3- \ () , \ 0 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: IS] I. I own, reside in, or will reside in the completed structure. IKI 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. 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 ~ 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 to. Property Owners about Construction Responsibilities on the reverse side of this form. Q~ Q~~ 3lf)~ .h.f2J Utgnature of permtt apphcant) ( / ~ (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 06-01-04 Acting as Y our'Own GeneraR Contractor? ~ INFORMATION NOTICE TO PROPERTY OWNERS (ABOUT CONSTRUCTION RESPONSIBiliTIES J " . ., '.1_ L . 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 construci ~ new home or make a substantial improvemenfto an existing structure, you can prevent,many probiems by being aware of the following responsibilities and concerns. Employer lRespolllsibiliti.es You will, in most instances, be rul<:;d to be an "employer" and the. contractors you contract with will be "employees" i~ you use contra,ctors not licensed with. the Constructi~n Contractors BoarQ,to do labor in cons.tructing or to assist in the' construction or improvement of a residential structure. As tlie employer,yqu must comply with the following: , '. . . ~ . . < .' - ' Oregon's Withholding Tax Law: As an employer, you must withhold i~come taxes from employee wages at the timer employees are paid. You will be li,able fqr the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of ReveniIe at 503~378-4988. . Unemployment Insurance Tax: As an employer, yoaare required to pay a tax for unemployment insarance purposesl on the wages o~ all e~PIOyees'J ~or more infO~tion, cal,l the Orego~ ErnpIOyment,Depa:nne~t ~t 503-9~7-1488. I The Oregon Business Identification Number (BIN) is a combined, number for. both Oregon' Withholding an~ Unemploymcnt Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnspav.htmll for the appropriate fonns. . _ t.' .! . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insw:ance for your employees. If you fail to obtain workers' compensatio~ insurance, you could be subject to penalties' and be liable for all claim costs if one Ofyow-enipldyees is injured on th9 job. . For more information, call the Workers' Compensation DiVlslOn at the Department o~ Consamer and BUSineS] Services at 503-947-7815. . ' . U.S, Internal Revenue Service: As an employer~ Y,?~ must Withhold federal income tax from empioyees' wages( . You Will be !table for the tax payment even If you 'dIdn't actually WIthhold the tax. For a Federal EIN number, call the IRS at-l-800-82~-4933 or visit their web site at\V\vw-irs.gov. . .;, '","_0 I .. " . . " , 'Other .lResponsibUities and Area,s of Concerns Code Compliance: As the pennit holder for this project, you are responsible for resolving'any-failure to meet code requirements that may be brought to yoar 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. '\ - _\."'."':. .....J .. Time: Make sure you have sufficient time to supervise your employees. . - , , Expertise: Make sure you hav~ the skills to act as your own general contractor, to coordirtate the work of rough-in! and [mish trades, and to notifY building officials as the appropriate times so they can perform the required inspections. 'II If you have additional questions can the Construction Contractors Board (503-378-4621) or write the agency at PO I Box 14140, Salem, OR 97309-5052. " Property_owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 1201000000000000225 Date: 03/12/2010 11 :28:04AM Job/Journal Number COM20 1 0-00314 COM2010-00314 COM2010-00314 Payments: Type of Payment Cash Change Description Penn Serv/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fee Paid By ROY JAMES CARMACK ROY JAMES CARMACK Item Total: Check Number Authorization Received By Batch Number Number How Received KR In Person In Person Payment Total: Amount Due 81.00 9.72 4.05 $94.77 Amount Paid $100.00 ($5.23) $94.77 Job/Journal Number COM2010-00314 COM2010-00314 COM2010-00314 Payments: Type of Payment Cash Change cReceintl Description Penn Serv/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fee Paid By ROY JAMES CARMACK ROY JAMES CARMACK " .,. ._ '-f 'I~> Check Number \ r, Ii "~ ~,.'. Received By, '\ Batch Number .Ie. .: Item Total: Authorization Number How Received In Person In Person Payment Total: "KR ~1:/' .:'1,1 ~ I, ,~' I:.."!.~' ,;. 1. Page 1 of I Amount Due 81.00 9.72 4.05 $94.77 Amount Paid $100.00 ($5.23) $94.77 3/12/2010