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Home My WebLink AboutPermit Electrical 2004-10-21 . ',' %t~. o~ 225 .l'un.tl STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)72tr~~ <9.o~/;. ELEt;l J:<leAL PERMIT APPLICATION l/f h ()<9. ./.. ~/ ~O' 00 g". . City Job Number CC))I1WOL\."';' 0 / {Lf ~ Date ~ .~t~ $",k, \9~,,:~~~U',,-.. r~7fftIl!;;"f{'~;'4~~;>.$~~~~:~~T~~'\~~;,.;::'r.,-'-;;",:;~. ~I ~~~'~ I . , J. - .;:Jl" LEGAL DESCRIPTION J7 02.. .~^ 3' ()tfSDO JOB :j;>ESCRIPTION j. L:..\ 1000 sq. ft. or less . )fV(;,lJoU-pJfrU..} ~~ fC)A~G. Each additional 500 sq. ft. or ~ :liJ6 ~ ~las . portion thereof .. _ Permits are non-transferable and expire if work is J::~\1\~hf~~'d Home or .j,. not started within 180 days of issu~e or if wor~t t.~?\t\t. \MJd~a:fJ>w~g Service or Suspended for 180 days. . \,\01\ ~~\\ S\\~ \\\\S ?~~ rrOt\ ~\)~~~. D. 2. Electrical Contractor Address City Phone Expiration Date EXPiraf.on ate Signatur, of Supervising Electrician .v Owners Name ~ 'lJ & <J -l),w 1'< Address -2 1 0 ~. 4j:.( tk '3?+ · City ~ PLA~ Phone 7 ~7:-i J;.M OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. n;Z:t;/8~ I I Inspection Request: 726-3769 3. $50.00 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps eOPlfeS'lOUI'oo Over 1000 ~~~Ot\ \a~~e ('feaOt\ \) ~~O ReoomR~\"OQV:dopted b'l ~ U\~Cl ate s~~ IO~O ~t\\ ,- fU\es a 'thOse t - R 9~'Z.- C. . In~'lt9~~h~ ~~~;~o~\\cat\on 200 A1O~\;}QE\het \he Ofe90~?-'2._2.344). $ 50.00 201 M\~'g~ \5,\-60. . $ 69.00' 401 Amps to 6q Amps . $100.00 Over 600 Amps or 1000 Volts see "B" above. D. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Pump or inigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges .tI{m~4~~;f~rrrn?h~$EV~ 4. <0ST:JBTQTAE,:€) ,.: ..' , ~t~4il.~1(&;~0J:.~~~i(;~hk~:{fftI7j:)&::;;2i4l_: h> l{lfl b '5".0 7% State Surcharge 10% Administrative Fee TOTAL '7s71 Shared Drive(T:)lBuilding FonnslElectrical Pennit Application I-03.doc SRflU,iG\';;1IEl:1Df -"-,"', ,..."0,~,t'r:"~....~..~r.v;,';;,'l.""-,",,r;":l~ t '\ , , .' ,,'I .,.,. Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01145 ISSUED: 10/21/2004 APPLIED: 09/15/2004 EXPIRES: 04/21/2005 VALUE: L ,'. 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726~3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 210 S 44TH ST ASSESSOR'S PARCEL NO,: 1702323104500 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair Residential PROJECT DESCRIPTION: New meter basel 200amp service Owner: NYLOTIS DAVIS Address: 210 S 44TH ST SPRINGFIELD OR 97478 Phone Number: 541-747-7461 I CONTRACTOR INFORMATION I ~. ;m Contractor Type Electrical Contractor OWNER License Expiration Date Phone I BUILDING INFORMATION. # of Units: . # Of~~~~' ~f 1r\t. 'l'JO~~ Primary Occupancy Group: "01\~3N1\\ Sr\p..UHii~h\~o ~~\\~'fti~S ~O Secondary Occupancy Group~r\\S ?t.~ 0 \.l~Ot.Th'P~O'f ~~=t.O rO~ Primary Construction Type \.nr\~lt. " \~l\Qt\ltwe!' Secondary Construction Type: ~ONlt-J\t.~CtO 0 t~llw\ge Type: # of Bedrooms: . v \80 Op..'{? nt'ilergy Path: f\~l Sprinkled Building: n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: ~, Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Total: Handicapped: . Compact: \0 s 'JQ\) ',N " oP4) ~,e .. \ \"'\\\01 (!r: I PUBLIC IMPROVEMENTS ~ I\O~ \'a.~~; O,e(d~~ ~e\ '~O\.. . ~e,=, 'O'J~~~~~ g~'t.#\l ~\O~. 609\e~&~~:I\~ tU\e~ 'O~ ,,~e ,\}\e~ ~ ~\e"~ ~~~~1t ~~e :~o;'C::~~~~~l\:;~;'~~ . $\ O~ "(O\} ~ fje~\e" eQP~ ~ ~'t~) ()09~~,\(\~ \~\~.. \'C\e 0' ,,!AO~ ..J. ),.. ~\D . ~$, ~\e I Valuation DescriIft)\\n (Ie.. . Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: .- ','I' --- ~ ;1 Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee 1 of2 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2004-01145 ISSUED: 10/21/2004 APPLIED: 09/15/2004 EXPIRES: 04/21/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line LFees Paid' Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6,30 $4.41 $63.00 10/21/04 10/21/04 10/21/04 Receipt Number 1200400000000001495 1200400000000001495 1200400000000001495 Total Amount Paid $73.71 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. I Reauired Insoections . Electric Service: Approval required prior to utility company energizing service. 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. Owner or Contractors Signature Date Pal!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' Permit #: COVVl Z.OD ""- -0 1I L( i- O <::::::: ( /1 If..- L.... Address: '7.. I . ...:> , -, "7 Issued by: D 13 Date: /0/21 ~ l.J I I Statement: Information Notice to Property Qwners , . 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. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ;ful. ~,2. I own, reside in, or will reside in the completed structure.' 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 - .A 3B. I will be my oWl1 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 ofthe 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. Y1~~ I {Signature of permit applicant) If) ,- ;LI --" Of (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 \' '. ActiligJa-s,~"i'Ol!r;Own General Contractor? ." ) .. ..- :' ~ -:jNFORMATIO~fNbTICE' TO-PROPERTY OWNERS " AB0I11'CONSTRUCTI.oi\i RESPONSIBILITIES , . .~\<:.\ \ '. .' _________ t NOTE: This Information Notice to Property Owners about Construction Responsibiffties was developed by the I Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. '.' If you are acting as your ~wn' contractor to cons~ct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Emplorer Responsibilities . '.' You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of.a residential struc:ure. As th~ employer, you mu~t comply with the following: Oregon's Withholding 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, call the Department of Revernie at 50J..378-4988. Unemploymel[]lt Insurance Tax: As an employer, you 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. . The Oregon Business Identification Number (BIN) is a comb~ed number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVJ11pensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' cvmpensation insurance, you could be subject to penaltIes and be liable for all Claim costs if one of 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 af 1-800-829-4933 or visit their web site at w\'vwoirs.l!ov.. . .' . , -- . , . Other Responsibilit~es and Areas .of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolvirtg'any'failureto meet code requirements that may ,?e brought ~o 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, fire or work that must he ,redone. Time: Make sure you have sufficient time to supervise your employees: . , ". . . ..'0 ' ElLpell"Dse: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and firush 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 (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property- owner.doc 06-01..04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-01145 : ' r COM2004-01145 I COM2004-01145 , I I Payments: Type of Payment Check .-. ., 10/21/2004 I'\~ty of Springfield Official Receipt ~velopment Services Department Public Works Department RECEIPT #: 1200400000000001495 Date: 10/21/2004 2:31:46PM Description + 7% State Surcharge . + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Amount Due 4.41 6.30 63.00 $73.71 Paid By NYLOnS DAVIS Item Total: Check Number Authorization Batch Number Number Amount Paid Received By How Received djb 3248 In Person Payment Total: $73.71 $73.71 Page I of 1