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Home My WebLink AboutPermit Electrical 2005-4-1 225 Funl STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 :'~;~::::UC~~~P~~~g~ . Date tr/rfO'l .. 1. fti!oCATli5N'ol{,iNSTMJiA>0~'> 3. [[".,.~,C,..,",'..",':9,..,.......,.~,.',.,"','.:,!.?,:~,"::,::;":1:.,',',',',."L,'~.,.,~.,.~.,,...,:,,','".".,.,',',',~"IG,;,.'~~::,'t'fj,t;;",',',",.,<v,t",.,r, !wu,.,.'.'~,'<',' R,',.",V..,',T..."LE,,:.,',',',..',..p,,::e.,'.',:"L,..,,:,'"0",:,.,,',,.,',... 1;t'ti;;;,.'f-4,'_Si~i"8~.~".:,:$liK};::::;;,S!;h,b:,).nt%h~~'-0:;,kJ<'!.~,~,.0.;'ii';';"'~*:JKL::_:'" ,=..,:;;. ..',v""..-;:......;;..mH ....,.,' .Y -'. '.~' . .-'<=~" =:..;:.~;,.".::~ c' :;:,;.'-~. ",.,~..,. 1-" II <)L( / J )' vit/ I)ry %/)/"%" ' A. ,.' ~Jgl ,.':;-' .::..-%'i,>,~>;;~:.:_:ti:';i.{~~J;;;;tr~_.:;;..,.~'^%:~,&.;,.., 01) ~/i-I'l e Service Includt!a>ry ".. ,s/)f:i! ry I;it ~' KJ "1)$' ,s II; 1000 sq. ft. or less ()I')<t/~ ., '- I" 4JYo~0 Cr "I(' f) oj.-:> L Eac~ additional 500 sq. ft~~ ...... ,~~v,s& ""'~{l /\.A.~':> f//hve:L 4: .5 c \ rLL.-<--I.. ; 'j S pomon thereof ~ 'p- $ 19.00 I ' , ,~ Permits are n.on~transferable ~nd expire i~ work is. Each Manufact' d ~ome.sou to ~ ~ "'" ." not started Within 180 days of ISsuance or If work IS Modu8V\ \aW~~CWit'l ~~ 00 Suspended for 180 days. :T1E.t-rnoN', ~rd b'i tile oregonset ionh " . rules a ation ~ , R 952-001- , Oiies 0 in ~~~~C6r e!i~ e telephone /,(501j\J, ~ou ~e~~~oo e. I~~ti'icat\on , callIng \or4,@UeAM.~~~~<?S~~4). nUl i\ber i.s ~ .8ul{)- ce~r JrnlpS to 1000 Amps Over 1000 AmpsIV olts Reconnect Only LEGAL DESCRIPTION i70SZb3'3 0052- 7 JOB DESCRIPTION 2. L $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Electrical Contractor Address City Phone Supervisor License Number C. Signature of Supervising Electrician Installation, Alteration or Relocation 200 Amps or less 201 ,Amps to 400 Amps 401 'Amps., to. 60qA;mps. [- ' , ~ . '-. ' .' '-,. ~ Over60Q Am s.Q( 1<000Nolti'~e~ ":S"above. D. $ 50.00 $ 69.00 $100.00 Expiration Date Constr. Contr. Number Expiration Date / i. N ~~' Alteralioh. lot'cExtension Per Panel One Circuit Each Additional Circuit or with ~? / I Service or Feeder Permit U jkLv'\. t,\ '-^ 101 5>f E. $ 43.00 Owners Name L- A 1/\0 ,'2- ~ Address II 5 Lf ) S 1- City 5> ?F", "'3 $ 3.00 01 Phone 747-tZl{( Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~ers Signature: jU/hu M_~ Aj7h ~k(~./~ 4. 72 c::, 0 '-i 7Z0::.0 8L/~ 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application 1-03.doc CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2005-00380 ISSUED: 04/01/2005 APPLIED: 04/01/2005 EXPIRES: 10/01/2005 VALUE: ' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1154 1ST ST ASSESSOR'S PARCEL NO.: 1703263300527 Springfield TYPE OF WORK: Electrical Work Only " TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Sub panel and 3 circuits Owner: LANORD BARNHURST Address: 1154 1ST ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION. Contractor Type Electrical Contractor OWNER License . ',"I.'. ,., "'~'.. ", . # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction,Type Secondary Construction Type: # of Bedrooms: I BUILDING INFORMATION I ' ,/ oArfENTION~ef~~ requtres yo~ ~ "lallow rule~~ttWrmeOf1egon Utility ~ificatlon ~'i!~ rules are set f~ I 'OAR 952-0 :tfO~ fHfOugh OAR 952-001 ~090. Vi"O U m~~~\} Bopies of the rules by callin'g the ~~e ~~~~~. tel~~hone Jly~h~r fnr tli~ C)r~oon lJIffityNotlflcatioW I DPEUID~~.4.!fION . , Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-747-1249 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: 11 91 IIOWBLIC IMPROVEMENTS. ATUHIS PERMIT SHALL EXPIRE IF Sidewalk Type: THORIZED UN THE Wfl~K COMMENCED DER THIS PERMIT IS fl~Jf'nspoutS/Drains: ANY 180 DAY ~E~:~tBANDONED FO~ ' Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pal!e 1 of 2 Value Date Calculated _~~8t~~~I~'9'.J__. _"'~~ it ' . ,.' ' , .. - --,' , f' 01 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00380 ISSUED: 04/0112005 APPLIED: 04/0112005 EXPIRES: 10/0112005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project L Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.20 4/1/05 1200500000000000410 $5.04 4/1/05 1200500000000000410 $9.00 4/1/05 1200500000000000410 $63.00 4/1/05 1200500000000000410 Total Amount Paid $84.24 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. LReouired Insoections . 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 c.~rd is located at the front of the property, and the approved set of plans will remain on the site at all t=;:&~/V&/~-,~ (Jlh/~ ~, ;?L?~S Owner or Contractors Signature Date Pal!e 2 of 2 Address: I , S- i-( '""b ~. -oc)"3:.&'O I~+- :)1- Date: lf It /0 r . / 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 #: Co vV\ '2..-0 <- Issued 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 thefollowing 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 apIHvpriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ~'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 ~B. I will be my own general contractor. If I 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 ofthe 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 ofthis form. ~A14:'~ .~ <bAP , (Si ature of permit applicant) t1fk;/L I. ZO~~ (IJate) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 Acting'as 1 our 'OWn General.Contractor?: . .! . I _' " , .~',;-' .,; . "1. ' . , INfORMATION NOT~CIE TO PROPERTY OWN EFtS . ..', .' , ABOUT CONSTRUCTION RESPONSIBILITIES '" ~ . " NOTE: This Information Notice to Properly Owners about Construction Respc/nsibilities was developed by the Construction Contractors Board in accordance withORS 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 being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most ins~ces, be ruled to be an "e~ployer" 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 structure. As the employer, you must comply with theJollowing: . . Oregon's Withholdiug 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 froll,l your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment InslllJraJmce Tax: As an employer, you are required to pay a tax for Wlemployment 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 combined, n.Ul1J.ber for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsDav.htmll for the appropriate foTITIS. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must oQt.a~n workers' compensation insurance for your 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 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 federaliricome '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'--800-829-4933 or visit their web site at\v'\vwoirs.l!ov. ; - " . c. . .: Other Responsibilities' and Are~s of Concerns, Code Compliance: As the permit holder for this project, you ,are responsible for resolving 'anyfailure to ~eet code requirements tbat may be brought to your attention, through insp~ctions. ' ..\ . 1 ",. Liability and Property Damage J[lllsnrance: 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 pWlctures, fire or work that must b~ redone. , \ ... \ . . Time: Make sure you have sufficieht time to supervise your employees:' ~ ,'-0- '" . .. ~ . ~. '-. . Expertise: Make sure you hav'e the skills to act as your own general 'contractor, to boordiriate 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 (503-378-4621) 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 Cfi1!Y of Springfield Official Receipt 'if~~~'felopment Services Department Public Works Department Job/Journal Number COM2005-00380 COM2005-00380 COM2005-00380 COM2005-00380 Payments: Type of Payment Check 4/1/2005 RECEIPT #: 1200500000000000410 Date: 04/0112005 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By LANORD BARNHURST Item Total: Check Number Authorization Received By Batch Number Number How Received djb 5040 In Person Payment Total: Page 1 of 1 12:08:16PM Amount Due 63.00 9.00 5.04 7,20 $84.24 Amount Paid $84.24 $84.24