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Home My WebLink AboutPermit Electrical 2007-7-3 3. ZON \ (1 V INITIALS N i"V'\ ~ DATE '-1 -()_~ - 0' ( 'a11 SOURCE l{);: ~ rr7 COJUPLETE FEE SCHEDlILE BELO'W 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 Electrical Contractor 200 Amps or less 201 Amps to 400 Amps Address _ ~es yOU \l@l Amps to 600 Amps ~iTENT\ON~ Oregon 'aw\h~egon Ut~mps to 1000 Amps City t~r6bfI~dopte~~IU'esareset1Bgt~ 1000 AmpsNolts Notification Cen\er'10~gh OAR 95~~wnect Only \n OAR 952 obta\n COP~ 01 :~~one " Supervisor License NO~f YOU ter. lN~e. .\he No_ucifmporary ServIces or Feeders camn the Oregon ~344). Expiration Date nurn~70~\er is 1_800-332-2 Installation, Alteration or Relocation 200 Amps or less Constr. Contr. Number 201 Amps to 400 Amps 401 Amps to 600 Amps Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 OWNER INSTALLATION Limited Energy/Residential $ 25.00 The in.stallation is being made on property I own vNm'CE~ Limit~tt~~lM&M'OR~ $ 45.00 ~ nol mtended foc "Ie, \"" 0' ,en!. THIS pliQ!llA1;~. 1Elt"i'\t!s~el\lJ\\4<\e i, $45.00 + Su"ha<g" Owne" SignaMe . j\UTH~~~ ~~R ~ 2 V r'L::, ~v ~-:t-~ COM OOtR''f!ftdtcharge _ b )b /" I ANY 18 '1b% Administrative Fee ~ ;?c:. 5% Technology Fee -I/D /60 ~ ELECTRICAL PERMIT APPLICATION City Job Number Co.,.1.Az.oo 7 --c:::c:::q I<S 1. LOG4TION OF INSTALLATION: bMLL(-:JI~ /070 LEGAL DESCRIPTION: I/O:> ~7~7.. 06 500 JOB DESCRIPTION: SlA. v:J R-1-N~L I {(,rCV\.1 fr J . Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Expiration Date Signature of Supervising Electrician Owners Name -..c.cR-c.<=, 0Slr-J ci <1C. .J Address 10 '7 c - j) ,..;J ;>':'.: . ", \ City (), ;::: t<~ I 7 I I r (1)'(>.. I '-; ,- b I 0 Phone Inspection Request: 726-3769 Date A. New Residential- Single or lVlulti-Family per dwelling unit. 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. Services or Feeders - Installation, Alterations or Relocation: I '70 ~ 1;) JO $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 "3 $0/00 12- E. Miscellaneous (Service/feeder not included) -Each Installation TOTAL Shared Drive(T:)/Building Fanus/Electrical Pennit Application 8-06.doc Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00985 ISSUED: 07/03/2007 APPLIED: 07/03/2007 EXPIRES: 01/03/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line -! SITE ADDRESS: 1070 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272200900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Sub panel and 3 circuits in garage Owner: GEORGE ESTRADA Address: 1070 DARLENE SPRINGFIELD OR 97477 Phone Number: 541-741-6996 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: U # 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: VB n/a I DEVELOPMENT INFORMATION. Frontyard Setback: Side 1 Setback: Side 2 Setback: - Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: ~I~E. Storm Sewer . . Special Instru . . ~MIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT Notes: COMMENCED OR IS ABANDONED FOR ~. I PUBLIC IMPROVEMEN~NTfON: Oregon Iaw.....ot.-. w r~d\.<<tiI~l\y .-tUff,", yw to Notification -center. , __Oregon UIlJ1ty In OAR 95R'OO1SWtUt ~-"'" are set forth 0090. You may obtain COpfea 0AR852-G01- Calling the center. (Note: .:ttaerufe8 by number for the Oregon ~==: Center 'S 1-80o..,~_~.. AJ. -I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pae:e 1 of2 Status Iss u ed CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00985 ISSUED: 07/03/2007 APPLIED: 07/03/2007 EXPIRES: 01103/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $8.20 $4.10 $6.56 $12.00 $70.00 7/3/07 7/3/07 7/3/07 7/3/07 7/3/07 3200700000000000448 3200700000000000448 3200700000000000448 3200700000000000448 3200700000000000448 Total Amount Paid $100.86 I Plan Reviews I 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. Reouired Insoections I Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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. .~ g~.~fL .-/~ I Owner or Contractors Signature -; Is/o, I I Date Pae:e 2 of 2 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 Address: Pennit#:CdvvtZou 7-0~ '7'gr . i) /tfu.E1I/~ AI Date: 7 /J /~-, , I /fJ7 <.) b6 Iss?ed by: 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 be filed with the permit. 1 '.I'. . Fill in the appropriate blanks and initial boxes land 2; and either box 3A or 3~: ~ ],' . ] own, reside in, or will reside in the completed structure. ~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 subcontr~ctors who work on the structure must be licensed with the Construction Contractors Board. OR yB. I will be my own general cpntractor. . 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 offke 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. .!t~ ._4~ - . '7 (Signature of permit applicant) 7h/o7 ( / (Date) (Whit~ copy to issuing agency permit file, pink copy to applicant.) Property _ owneLdoc 06~0 1-04 .._~,Actilig~~~ Yo'ut'I' ,'! '-i:' ,,-}) ,) .t.;.: . L. .INFOR~ATION ontractor? OWNERS RESPONSIBILITIES oJ' ." ~ ~. '\ -;' ,-: \. . . \ \ . \, \ , - NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in passed by the 1989 Oregon Legislature. .' . If you are as o\vn'contractor to construct 11 new structure, you can prevent many problems' by being aware a substantial im}fIOVement to an existing responsibilities and ~oncerns. ." ". ., .~ . .'" . contractors you contract with ~il1 be "employees" if to do labor in constructing or to assist in the yo~ mu"st comply with the fQUowi~g: YouwiU, inmost be ruledto be an "employer" you use contractors,not l,icensed with the Construction construction . . . 'of a residential - As Oregon's employees are employees. L~~:'As an employer, you must You will be liable f()f the more information, call the . . . ...,..~ ," income taxes from employee wages at the time even you dOl}'t acnm.By withhold the tax from your . at 503-378-4988. on Tax: As an employer, For more informatiDn, to a tax for 'unemploymeht insurance purpDses Employment Department at 503-947-1488. , . IdentificatiDn Number TO' file a ,nlJ:!TIber for .Doth. Oregon Withholding and Dr w\vw.dor.state.oLus/fDrmsnav.html1 for the Insurance: As an ~ompensation subject to pena1ti'es and cantlie Workers' to the Oregon Workers' Compensation Law, . you fail to obtain. workers' compensation one ofyotif employees'is injured on the 'at/the' Department of Consumer and Business and Service: As an employer, the tax payment even visit their web site at \v-\nv income tax from employees' wages. the tax, For a Federal EIN number, call the""": .' ''''':,~ .... ~ you are . , for resolving any failure to meet code Insurance: such as to see'if you have adequateinslirance . water damage frDm pipe punctures, fire or . \. \, ~~' 't .~~) :,,:;.-<~~. ~. .~ . ....;,)', .\w.."",: . Make sure time to' yaur . , . . Expertise: Make sure you the skins to' act as and finish to' notify as to coordinate the wark raugh":in can perform the required inspections. If you have additional questions the Box 14140, Salem, OR 97309-5052. 06-01-04 (503-378-4621) or \\tTIte the agency at PO " . 225 Fifth Street Springfield, 'Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007 -00985 COM2007-00985 COM2007 -00985 COM2007-00985 COM2007 -00985 Payments: Type of Payment Check cReceintl RECEIPT #: 3200700000000000448 Date: 07/03/2007 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By LINDA ESTRADA Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2190 In Person Payment Total: Page I of I 8: 13:56AM Amount Due 70.00 12.00 4.10 6.56 8.20 $100.86 Amount Paid $100.86 $100.86 7/3/2007