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Home My WebLink AboutPermit Electrical 2010-4-1 Ele.ctrical Permit Application 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753' FAX(541)726-3689 . .. --. . . . DEPARTMENT liSE ONL.Y Permit no.: tf}/tJ.- 'fl} I Date: 'i I () This permit is issued under OAR 918-309-0000. Permits are nontra\lsferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. .L.OCAL qO\lERNMENT ApF'.ROVAL'i....' Zoning approval verified? 0 Yes 0 No . ' ..,CATEGORY:;OF.CQN$TRUC'fION ,dResidential 0 Government 0 Commercial (~)I~Ji':J.QB.;fSITJ::.INFQRIV!A;rI<:lNt'ANIil(:iLQ:CAtfbN~?ihi~#i' Job site address: i I & to .::S- City: :::,. State:'f:7a1- ZIP: l c R'--~ r- r -<<- PROPERTY ,.OWNER Name: ~) -.---rv 1'/ . . Address: City: Phone: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, leas~, or rent. OAR 479.540(1) and 479.560(1)'1 ../ ~ ~ Signature: / Business name: Address: City: Phone: E-mail: CCB license no,: ZIP: Pax: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~ l\~$~ ~& 440-2584-J (9/08/COM) ~ {, I: ',i:o,H:(~;r~\;~it~~~jt:;::'r:f:E,~~~;5C.H EJjJH3E~:,.::;.~:;:"j{t(;~i~~/\;\S~p~~Ff~t~~ Num~er ofi~spections periterrOQty. ,~~~t ~~1{ 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 $ 601 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 less (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, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ r-.<; $ 6.00 $ Miscellaneous fees: service or feeder ~ot included Each pump or irrigation circle (2) $ 63.00 $ 63,00 $ $ $ $ Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alter,!tion, or extension (2) Each additional inspection: (I) {;\:l,(!M~~!;.~1~t~AgeLiQANt;;'i.JSEVi~;~; $ 63,00 $58.00 "':fj'j~-f::;X~~~~;;;; '. (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) (B) Enter 12% surcharge (.12 x [AD (C) Technology Pee (5% of [AD TOTAL fees and surcharges (A through C): $ ~yD<- $ u "I!::- $ ').'iU $ (,/77'" ;.,.,;, , , ~...~ CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00401 ISSUED: 04/01/2010 APPLIED: 04/01/2010 EXPIRES: 10/01/2010 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ....- ,- :' ~,rr;Y: "~,... ... , SITE ADDRESS: 1166 J ST n \ful'ingfi~laST~. 9F WORK: Single Family Residence ASSESSOR'S PARCEL NO,: 17032<jffi1l!~IJII.ON', ore{~d by the Oregon \orth , \o\loW rules ad~~r, Those rules a~~k_1!i~F USE: Alteration Residential PROJECT DESCRIPTION: I cJrcuitlo'Mibelij)V~_oo~ 0 through ~tthe rules by \0 OAR 952 ~g" nh\a\n CoP\e~. e ,o\pnhOne Q09U lVU'. ~ tar \NU"~'" \'fcat\on Owner: DILLON L H & PHYLLIS -bailing the cen o;egoO Utility NO)" Address: 1166 J ST mber!or the, 0_332-2344 . SPRINGFIELD OR 97477(1U center IS 1.80 . >.,,,.' I CONTRACTOR INFORMATION I'."" .--';" - Contractor Type Electrical Mechanical Contractor OWNER MARS HALLS INC 25790 h10i\~FHLDlNG INF~~O$ V'J~~~ \~ RMll Stll-\L.1.. pl:R \S 1\1IS PI: !""~N~R 1\1\S 1:0 rOil. fl,\l1\10R\ ~bl'f$rl\.&tt~OON COMMI: ,~~dt!\~D,' fl,N'I 130 ter Type: Range Type: Energy Path: Sprinkled Building: License Expiration Date Phone 12/23/2011 541-747-7445 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basenient: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATlO~ Front yard Setback: Side I Sethack: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: . , Paved Drive Rqd: ".. % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: .'. ,.1, ~ Notes: ';-,n,:q tl' (" 1;:.:1 .. ~ 'r Pa2e I 01'2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM20I0-00401 ISSUED: 04/01/2010 APPLIED; 04/01/2010 EXPIRES: 10/01/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description ~ Description Type of Construction $ Per Sq,Ft c, or mult,iplier ~, .. , Square Footage or Bid Amount Value Date Calculated Total Value of Project Fees Paid ~ Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number, $6.96 $2.90 $55.00 $3.00 . 4/1/10 4/1/10 . 4/1/10 4/1/10 2201000000000000302 2201000000000000302 2201000000000000302 2201000000000000302 ,. Total Amount Paid $67.86 I Plan Reviews I t.'-., To Request an inspection call the 24 hour' re'c(jrdlri'g at 726-3769. All inspections requested before 7;00 a.m. will be made the same working day, ins'J'l~ction's requested after 7:00 a.m. will be made the following work day. '~1'''' : ReuuiredJnsDections ~ Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I furtber certify th~t 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 10 the work describcd hcrein, and that NO OCCUPANCY will be made of any stru~lure without permission oflhe Community Services Division, Building Safety. I furtber certify thaI only contraclors and employees wbo are in compliance with ORS 701.005 will be used on Ihis project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, tbat 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. ~ "-.b'~ C' /1 . ex:: t. (I/'--(/~' ......... ~ Owner or Contractors Signature " r ~! ,~cl) .>;~)1: .,;;Jf!. r /1 /! J I " '. ' i~ ',\lJ'~ ;1 ~ . ,. " Date '-'.,! Pa2e 2 of 2 "r,~'~ 0'" ,. 22S.Fifth Street .-. Springfield, Oregon 97477 541-726-3759 Phone iil.'~;ji. . ....:.... ~ .' '6.!(,; . - ~"__ 0'__.0-_.-'---. ~, -. City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000302 Date: 04/01/2010 II :40:22AM Payments: Type of Payment Check Paid By PHILLIS DILLON Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 55.00 3.00 6.96 2.90 $67.86 Job/Journal Number COM20 I 0-0040 I COM201 0-0040 I COM20 I 0-0040 I COM20 I 0-0040 I Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 12% State Surcharge + 5% Technology Fee Amount Paid cjc 932 In Person Payment Total: $67.86 $67.86 . " "";>'': ; ,or.. i'iti-, , ~~. cReceintl Page I of I 4/I120IO "f ",,' A Information Notice to Owners About Construction Responsibilities (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following 'responsibilities: . Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees, As an employer, you must comply with the following: . Oregon's Withholding Tax Law: Employers 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. . Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to htto'//www.oreoon.oov/DOR/BUS/docs/211-055.odffor the appropriate forms. . Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their 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 workers 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. . Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal ErN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.oov. Other Responsibilities of Homeowners: . Code Compliance: As the permit holder for a construction project, the homeowner is responsible, for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may, be ,found through inspections. · Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. · Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. f/property-owner adopted 12-04-07 CONSTRUCTION CONTRACTORS BOARD 700 Summer SI NE, Suite 300, PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 - Fax: 503-373-2007 Website Address: wwworenon aov/ccb This Copy for Permit Applicant '- ", -, Property Owner Statement Regarding Construction Responsibilities Oregon law 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. (ORS'701.055 (4)) 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 Please check the appropriate box: ~ I own, reside in, or will reside in the completed structure and my general contractor is: ~J~--. ~jf~ Name CCB# Expiration Date D I will inform my general contractor that all subcontractors who work on the structure mu'st be. licensed with the Construction Contractors Board. or 1,.....1.........1 will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I 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 select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. L-e-G VI) / p~ Print Name of Pennit Applicant ~~ ;r(//j~;t~ -, 4- ~ J - / () Signature of Penni! Appldnt V Date Permit#: dlo - LfO I II roc:> -T Issued by: ~Date: '1 Address: This Copy for Permit Offices a!'1:Q~.:-'...ELOii... ~_.; ~","-t..,- 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: II :40:22AM 2201000000000000302 Date: 04/0112010 Job/Journal Number COM20 I 0-0040 I COM20 I 0-0040 I COM2010-00401 COM20 I 0-0040 I Payments: Type of Payment Check cRcceintl Description Add, Alter, Extend Clrc Minimum/Adjustment Electrical + 12% State Surcharge + 5% Technology Fee Amount Due 55.00 3.00 6.96 2.90 $67.86 Paid By PHILLIS DILLON Item Total: Check Number Authorization Received By Batch Number Number How Received cjc 932 In Person Payment Total: $67.86 $67.86 Amount Paid .' ~"i$. Ok',i .. " f.,' 1 ....~ I ;1.,;,;',tJi' 'j '..... '. .~. , . Page I of I 411/20 I 0