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Home My WebLink AboutPermit Electrical 2010-3-1 'Eli.>ctricaI Permit Application 225 Fifth Street. Springfield, OR 9747H PH(541)726-375H FAX(54 1)726-3689 SPRINGFIELD ~ ~l&~>-"., ..-..' ,. ..-.; ~,.'", .L"';!;@f~ .&!.. ....~ ~~,i "~.__ _ ~,. ~ ,0'. DEPAl~TMENT USE ONLY 1':._ .' C6lN1 ~O(O. =0 Z Permit no.: Date: 3- (- 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. .','.' .. 'L.:OCAL'''GOVERNMENT 'APPROVAl:]" v'-'rn':)'\7 ~jc<;.~;r1Eq~}~~~;fft~1~~::'~': I3E_E~;SC,HEP'_U l.'1E 1,:'l::8;%~~~~~0r~;,~~~:~~~'i' " ' ,':.,' ",,' '-,I >"_ . ,':('.'-~~:;; ..!,;;' Zoning approval verified? DYes DNo ", '. '," ,-.-, . . Cost, Total ;.l'!umber'~f:inspecti'~nsperitJm,(.r ~:{ Qty.' :,. ',:;' ",~,"CA TEGORyrOf;~CONSTRUCTION"~'..: ,. . " ~. '-',." _".. . . .' ,I, .' I" ,- \_ '.'^, . _'c ;.\'ea:. . . cost , . ~sidential I 0 Government I 0 Commercial Residential, per unitt service included: 1,000 sq. ft. or less (4) ( IN ~~~!~'!J_OB:~.SI,!:E\;HNFORI\I1A,!:IONr:'ANDmGOC'AliION~'!>i.ii~E $134.00 $ Job site address: <1)2. Rj- Each additional 500 sq. ft. or portion '5 $ 25.00 $ 75 thereof City: "'J)f:~q J,'r!,J State: tJ..P. I ZIP: 9'77'/ g-' Limited energy (2) $ 32.00 $ Reference: , I Taxlo!.: Each manufactured home or modular "'DESCRIPTION. OF WORKi'--''''', ;:\;,,:,-~\ ~':i'\...'~. J-_I'" ;'.., dwelling service or feeder (2) $ 63.00 $ , ' - - . ,_., . . -'-'~-"~;' ,:',' ;11-;./ J~ c.1 /)""" "".../.;<: W,'VL Jf Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 'PROPERTY ,OWNER .. 20 I to 400 amps (2) $ 95.00 $ Name: ;-:/)~J-1 / /lc..,L_ 2 , '<=. /d.~ 40 I to 600 amps (2) $158.00 $ t' Address: <Il) ,b 5'7 / 60 I to 1,000 amps (2) $205.00 $ City: S?dM EI/ State: t:1.)l I ZIP: t?? j?;;( Over 1,000 amps or volts (2) $469.00 $ Phone: } j~)- 7 J 6 -5""/.,....-;1 Fax: - - Reconnect only (2) $ 63.00 $ E-mail: T./ /1' (jC?;;': AAI;>~ Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property 200 amps or less (2) $ 63.00 $ owned by me or a member of my immediate family. T is 201 to 400 amps (2) $ 87.00 $ ,ro~" ,,""' '"""d'~".'- 'lI\JW 40 I to 600 amps (2) $126.00 $ 479540(1) and 479.560(1) -,.: .... '-A1ft-J Signature: I, ~ ,:!t Ouill_ Over 600 amps or 1,000 volts, see services or feeders section above CONT I 0 Aew ncM. -.d8c ~Branch circuits: new, alteratIOn, e'ttenslOn per panel Business name: ~IIOJIUO~OO-JOO-~ a. Fee for branch circuits with purchase ofa service or feeder fee: Address: ~:': '..d ~:;,ri'~ Each branch circuit $ 6.00 $ City: .JiiQj~ M8I Up~ :NOUNw'Y1 b. Fee for branch circuits without purchase ofa service or feeder fee: Phone: - - I Fax: - - First branch circuit (2) $ 55.00 $ E-mail: . - ----.. Each additional branch circuit $ 6.00 $ CCB license no.: , 1 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 ~ircuit or a limited-energy panel, $ 63.00 $ NOn : " :alteration, or extension (2) wmtl<d~i~i~.nalins.~ection:,(I) _ ........ , $58:00. $ THIS PERMIT SHAll EXP1RE If TIre AUTHORIZED UNDER THIS PERMrT 1.\NnT1f~~~~ltj~tj:'i:~~ARR12ICAr~n:i;USEl;;~,~Ji..l,i~~i~-.t;~A'il:c.:th~~, '7 COMMENCED OR IS ABANDONED F :)R.) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ 20 '7 ~ ANY 180 DAY PERIOD. (B) Enter 12% surcharge (.12 x [AD $ z-so 8 - 21<1; ,'\) (e) Technology Fee (5% of [AD $ /01{ TOTAL rees and surcharges (A through C): $ 24'-{S ~ ~~o/ 440.2584-J (9~) Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00261 ISSUED: 03/01/2010 APPLIED: 03/01/2010 EXPIRES: 09/01/2010 VALUE: 225 Fifth Sh'eet, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5122 B ST ASSESSOR'S PARCEL NO.: 1702333201800 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Relocate panel and rewire house Owner: KLUG TYSON Address: 5122 B ST SPRINGFIELD OR 97478 Phone Number: 541-337-6919 I CONTRACTOR INFORMATION ~ Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION ~ R-3 # of Stories: Height of Structure Type of Heat: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: nla Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: . se\lU 'did ~~ 819 8'" ~ pe OP :NOuN'3U:-d ~\\\O uoll8~1 /llUI)~ijq)jst: O\i\OA SlUl # Street Trees R11d: Paved Drive Rqd: % of Lot CovCI'age: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLICIMPROVEMENTS ~ Sidewalk :rype: ..,. ,.~""-~:"Y':,.~~;~'(.:~'" NOi1~ .' ' EXt'1~~ ~o~ains: THIS PE~MIT S\\~ll 1M1S PERlAtt \S MO ,;': r>.UTHORIZEO UNOr: ABANOONEO f01\> . ., OR ' . va~IlIYiJ Notes: ' Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I 012 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2010-00261 ISSUED: 03/01/2010 APPLIED: 03/01/2010 EXPIRES: 09/01/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Paid-l Fee Description + 12% State Surcharge + 5% Technology Fee Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Amonnt Paid Date Paid Receipt Numher $25.08 311110 1201000000000000187 $10.45 311110 1201000000000000187 $134.00 311110 1201000000000000187 $75.00 311110 1201000000000000187 Total Amount Paid $244.53 elan Rev.iews ~ 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. L Relluired InsDec~ Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all eiectrical work is complete. By sign.ture, I state .nd agree, thllt I have carefully examined the completed application and do herehy certify that all information her'eon is true and correct, and I further certify that any and all work performed shall he done in accordance with the Ordinances of the City nf 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 ardn compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections';-~}e r~qhested at the proper ti~e, that each address is readable from the street, that the permit card is loc te at the front of,the prope;-ty, and the approved set of plans will remain on,the site at all timesdu~ 3/)0 /// Owner or Contractors Signature Date Paee 2 of 2 , , Address: 51Z2- ~e - 00 Zb ( E sf- , Date: 'J /1 II (:) I 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 Permit#: CDvv1Z0/ 0 Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.05 5(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: ~ ~ I own, reside in, or will reside in the completed structure. I tmderstand 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 o 3B. I will be my own general contractor. If! 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. (sdL- ;1Z/0 (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 06-01-04 , - "'c '0 , \ AdnIDlg ~s '1{ our OWIDl GeIDlell"~liContractoJr? INFORiVl~TIONNOTICE 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 bei!1& aware of the following responsibilities and concerns. lEmployer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with wilibe "employees" if you use contractors not licensed with the Co~struction Contractor~ Board to do labor in constru~ting or to assist in the construction or, improvement of a residen~al structure. As the employer, you must comply with the !ollowing: Oregon's WithholtJing 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, eall the Department of Revenue at 503-3784988.' " . ( . Unemployment Insurance Tax: As an employer, you are required to pay a tax. for unemployment insuranee purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . . . . '. The Oregon Business Identifieation Number (BIN) is a combined number for botl). Oregon Withholding and ' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.doLstate.oLusfformsoav.htrnll 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 fo~ your employees. If you fail to obtain workers' cOmpensation insurance, you could be subject to penalties ana be liable for all claim costs if one or'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 1-800-8294933 or visit theidveb site at www.irs.gov. . , OtheJr.ResjpmlSibiYntBes IUDO! Areas of COi)lCer)Ills . 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, fue or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you'have the'slGlls to ~ct as your own general co~iractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Propcrty_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 #: 1201000000000000187 2:27: 19PM Date: 03/01/2010 Job/Journal Number COM20 I 0-00261 COM20 I 0-00261 COM20 1 0-00261 COM20 1 0-00261 Payments: Type of Payment Check cReccintl Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 134.00 75.00 25.08 10.45 $244.53 Description Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 + 12% State Surcharge + 5% Technology Fee Paid By MCKENZ1E KLUG Amount Paid djb $244.53 $244.53 1106 In Person Payment Total: , ri', ';i:. ~1. ;!Jo"", , ~. ;!' /'., ..;1, Page I of I 3/1/20 I 0