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Home My WebLink AboutPermit Electrical 2007-7-10 ( 3. .) 1- ZON L.L')'/ INITIALS 1'-; (,/\ a;, ~~~CE-~~::fC,;- 7~47 ' / / COMPLETE FEE SCHEDULE BELOW 225 FIFTH STREET. SPRINGFIELD, OR 97477 0 PH:(541)726-3753 . FAX: (541)726-3689 ELEcl KlCAL PERMIT APPLICATION City Job Number CCIAA !-CC 7 - 0 {(.:) ( ~ 1. LOCATION OF INSTALLATION: 4 b \" .S~. l{ 7+k LEGAL DESCRIPTION: 17DZ- 3Zl(J JOB DESCRIPTION: D b 70D 8% State Surcharge r p 10% Administrative Fee 1 ~- , 5% Technology Fee \~ I '] .~ HIS PERMIT SHAll EX"!Hf IF THE WOrK ) 10 726-3769AlrTHORIZED UNDER THIS ffffi~rr IS r~OT , . I ." , r',";N 'l'~ENCED OR IS A'lAl\!"'O~'Er' ~~Dnve(T:)fBUlldmgForms/ElectncalPenrutApphcatlon 7-07.doc \_HJ,',':nn I... l'iU.ll1 l.J run ..$E1L-\ltu= ~t-L.o*,(.........E~T 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. CONTRAcl uR INSTALLATION ONLY Electrical Contractor Address City Phone ,..:~ Supervisor License Number ~l ( / ..J /1' Expiration Date f""t\) ./ l. / Constr. Contr. Number / Expiration Date Signature of Supervising Electrician Owners Name ';}04, ~ I~r' . h\f "-J~~_""~ Address c'J ,,- lI,' -J' '1 !'; -,. City , r - j,nn, II \,,,,t 10 , ,/ I i';. (:/'(1, '( ;. ') (/ \ ,[ -' -;, Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ! ~ ~~ ~inatu~7' f),.", I (L ^ t, c"l.,/ I /r. ( 1/ ,\ , ' , Inspection Request: Date A. New Residential- Single or Multi-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 $117.00 $ 21.00 $55.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 -<:: S- I C. Temporary Services or Feeders Installation, Alteration or Relocation ~ ~8rl. requIres you to $ 55.00 A:rrE~! ';W~~\t ~9D<~egon UtilitY $ 76.00 Iv,l,o.w r~H~1.bn ~ulfjSJ Bfluet tom $110 00 Notlflcatioil'v.:l'1fWBl,S . b O~R.952.o&1.. . ii', OAR 95~~1 W3>Yi2~O(JfU~.bove. 0090. VIW Jd the.... calling the \. number ftY.ettlalOifiDeflI JJ er anel Celititett&J.r8' $ 48.00 Each Additional Circuit or with Service or Feeder Permit $ 4.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges .. 4. SUBTOTAL OF ABOVE S-S I.( If 0 (5-0 ~?r ANY 180 DAY PERIOD. Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01019 ISSUED: 07110/2007 APPLIED: 07110/2007 EXPIRES: 01110/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 465 S 47TH ST ASSESSOR'S PARCEL NO.: 1702324306700 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Service reconnect Owner: DAVID NOWAK Address: 465 S 47TH ST SPRINGFIELD OR 97478 Phone Number: 541-521-9933 I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I VB # 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: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 n/a I DEVELOPMENT INFORMATION I 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: Storm Sewer Available: Special Instruction: AllcNTI~P=-~~M:mI, follow rule ! 8. !&!.. . Notification Center. Those nllel are set forth In OAR 952-001-0010 through OAR 852-001- 0090. You may obtain copies oUl1e rules by calling the center. (Note: the telephone number for the Oregon Utility NotIfIoatIon Center Is 1-800-332-2344). Sidewalk Type: Downspouts/Drains: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount NOTICE: TUI~ DI:QUIT S,HAlL EXPIRE IF THE W(~K AUTHORIZED UNDER THIS PE:KMl I I;) l'iOT COMMENCED OR IS ABANDONED FOR ANY 1 Rn nAY PERIOD. ""\laTue Date Calculated Notes: I Valuation Description I Pa2e 1 of2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Service Reconnect Total Amount Paid Total Value of Project Fees Paid' Amount Paid Date Paid CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01019 ISSUED: 07/10/2007 APPLIED: 07/10/2007 EXPIRES: 01/10/2008 VALUE: Receipt Number 2200700000000001109 2200700000000001109 2200700000000001109 2200700000000001109 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. $5.50 $2.75 $4.40 $55.00 7/10/07 7/10/07 7/10/07 7/10/07 Electric Service: Approval required prior to utility company energizing service. $67.65 I Plan Reviews I I Reouired Insoections I By signature, I state and agree, that I have carefulIy 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 ofany 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 tM:tJtru~ Owner or Contractors Signature Pa2e 2 of2 I /10 /07 I I . Date 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 #: COwtZ-C.o 7- 0 10 I cr Address: '-I b S- s, Lf 7-i-k ~ t b~ Date: 7!~ 7 / ~ 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 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 wil~ befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: Gq--l. ra--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. 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 CohstruGtion Contractors Board. OR ..a- 3B. I will be my own general contractor. IfI hire subcontractors, I will hire only subcontractors licensed w~ththe Construction Contractors Board. IfI 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 ofthis form. {j)/J,{.jJ . .. ! /1~IaJ (Signature of permit applicant) t (Date) (White copy to issuing agenGY.permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 ,)~ " .. . Aaing"as-Y;QJ.I'r Own' General Contractor? . j~ '-', ..'" "' t , ~ J INFORMATIO~\NOTICE TO PROPERTY OWNE:RS . '\ ,... - ,'" AB~UT .CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction- Responsibil[ties 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 contJ;actor to construct a new home or make a substantial improvement to ari existing structure, you can prevent mariy problems by being aware of the ;following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" an4 the c~:mtractors you contr,act with will be "employees" if you use cOntractors not licensed ~ith the Construction C~ntractors Board to do labor in constructing or to assist in the construction or impro,vement of a residential structure. ~~ the employer" you must 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 Revenue at 503~378':..4988. - , Unemployment Insurance Tax: As an employer,'you are required topay.a tax1'or 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 combined ,number, f,?r both. Oregon Witl$olding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or \vww.dor.state.or.us/formsDav.htmll for the appropriat~ forms, . ~~ . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obt<l;ipW"orkers' 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 Depattmen(of Consumer and Business Services at 503-947-7815. U.S. Internal Revenu.e Service: As an employer, you must withhold federal income tax from employees' wag~~~ 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 visittheil' web site.at \\~vw.il's.gov. . ,j. , ((:1)~lh1eIt JRe~lPon~iibliUtiies anui! AJr~a~ of C~IffiCeIrIffi~ Code Compliance: As the permit holder for this project, you are responsible for resolving any' failure to meet code requirements that may be brought ~~ your attention thro~gh inspections. , . Liability amll PropeJrty 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, waterd~mage from-pipe punctures, fire or work that must be redonp._. , . .__~,~ ~,.:5' - \ ~ ;' 1 ~\ . -.. 1 '\~~ J \ ,\ I \. 4, ..'. 1...J"~. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure yo~ have the skills .to act as y~:tlr own general contractor, toc~ordi:i1dte 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 Job/Journal Number COM2007-01019 COM2007-01019 COM2007-01019 COM2007-01019 Payments: Type of Payment Check cReceintl RECEIPT #: Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DAVID NOWAK City of Springfield Official Receipt Development Services Department Public Works Department 2200700000000001109 Date: 07/10/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 546 In Person Payment Total: Page 1 of 1 2:37:03PM Amount Due 55.00 2.75 4.40 5.50 $67,65 Amount Paid $67.65 $67.65 7/10/2007