HomeMy WebLinkAboutPermit Electrical 2006-9-15
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INITIALS N M..
_ DATE q_ - I '-f .....2_00~
SOURCE(Yla...p~--<- \'5
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CO)}fPLETE FEE SCHEDuLE BELO"!
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
1. LOCATION OF INSTALLATION:
,?-.~~O (( ~ i( S+-- SfY\\,0C ~€.Ib
LEGAL DESCRIPTION: 17D3 ~a( Lf D J Z04.. New Residential- Single or Multi-Family per dwelling unit.
.~.)A.0 4\ u...p j(>A~ 4d^\c:....box ~ Service Included
JOB DESC~IPTION: 1000 sq. ft. or less $106.00
Each additional 500 sq. ft. or
portion thereof
ELECTRICAL PERMIT APPLICATION
City Job Number L""'^ 'Ceo b - c::> I 1....0 D
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
Electrical Contractor
Address
City
Supervisor License Number
. ~~
i
rI
V
/
I
Signature of Supervising Electrician
Expiration Date
Constr. Contr. Number
Expiration Date
Owners Name \?D~1- Woob
Address a3 8- 0 1\ f.. I, 51-
CitY:;~\+" II> Dfphon(fTS) 340 - D'iYf
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
~P4<,J'\A)~
Inspection Request: 726-3769
Date
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
Seryice~\oiFeeders - Installation, Alterations or Relocation:
CL..\,\....t.} \'
y
b~
1
'~ . " \", ~)
}OO Ainps-O); less
_) \.- __ :', .r"'_;
.... ....20'1\ Mips to 400 Amps
\., ,}
. 401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
'U
401 Amps to 600 Amps r<'> ',,\$100.00
....x.....:.-','\'.. ;{\
Over 600 Amps or 1000 Volts see.'~J d,l~~v~."cf:\"
. ,.".,,' .. '\~\""""o" ,.(()', '~~0
D. Branch CirCUIts.. eF,' '()'.)/",'''' .0;'-.:, V;-\
...... '.' .. .... ....................\ "'..... C-"v"'-"'<><:"'r,tv""/c, v
,,~,' _ ,/ 'G- - I...," <.(? ~
New Alteration or Exte~i~'~'l~fr gl6eK~\~'-0 <),"c'?;c~
., c: - '()) to,," \", ~ <. ).:\ '. <r,,~ ~ " .,.....,
One CircUlt 0'." .. '. .' j)~ ,~(::' ('~.$A 3,9-0
Each Additiona~9irc~i~ or Wlth,~<,'" ~. '.:: '."
Service or F!t~f p6rillit:.>'. ,', ..' .: :\$_~ ~,,:QO
/<- ", ;-._.'<, ,-' (,-,' _ ("'-' _ ,\-. '.._i '-. "._ ',"-- \:.J 0
,<,,;V ,.Y '" .,),~'(:\("> 'Z< ,,"\Y ,,: v
E. Mi~c~Ilal~e~us:XSer~ice/I~defnot:'Ji1cliia~d) -Each Installation
1\,CY" ~"<' c5{.,~":~-~t)v, <-::/>.) c ~,..", !:::~,';(.' '-~,Z})
Pump or itrlgatibn: ' '{.J \,' $ 50.00
SignJOutlin~l'{ghti~g': ." $ 50.00
~ G .'
Limited EnergylRes~9.eritial $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
$ 50.00
$ 69.00
4. SUBTOTAL OF ABOVE
b>
50lf
~.,o
3'~
/741
8% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:)!Building Fonns/Electrical Petmit Application 8-06.doc
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2006-01200
ISSUED: 09/15/2006
APPLIED: 09/15/2006
EXPIRES: 03/15/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2380 E ST
ASSESSOR'S PARCEL NO.: 1703361403200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace 200amp service
Owner:
Address:
ROBERT WOOD
PO BOX 657 .' 1\1t. \N0t\'l\
SPRINGFIELD OR 97477 '~~01\C\t~d\\ c.\-\~\,.l t~~,~~~~N\\1 \S \,-\01
-n-\\S t'tlw:::. \ \~l\\F\-\ \ r\l'J,':";:'t..\~D rU\'\
f\\J 1) \-~~Ncr-RWCJ-o'R, INEO RMA:TI 0 N I
Contractor CON\t-J\t~~C-i\~ ~t\\\O\). License
I\~'{ ,<a\J U
OWNER ,....
Phone Number: 775-340-0554
Contractor Type
Electrical
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
R-3 Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
VN Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load: \0
.",,-
5} ~\\\\'1
I DEVELOPMENT INFORMATION I eO"..s.\~~r\00 '0_~ \O~~
\'Q.~ ~ R'IDQUYU?D P~~KING
9>00 '\)-e..... '0 'Q.\ <;!)S'2:v \:i'!
Overlay Dist: '. O~e eO. '0'\ e ~1J~a,lj.\>-~p ~J.e'O
# Street Trees Rqd: ~\O~ 'Q.o.o'9'1!. ",\\'\0'0 o'l:J!J'n'a6~1!Ppedf\0~e ~
Paved Drive Rqd: ~'\(:.';- ~\)\0~ e0\.0'\' \\::/\,'0:\ o~Q:mp~t:~e~\\c'Q.\\O
% of Lot Coverage: \~O\"N \00 C, \,CJ\) \0 c :\.e"\\~ ~O\\
\0 ,\\c'Q.'i; S'2:CJCJ 0'0\-0: ~o 0\\-\\'\ 0.0.).
~o\\ "Q... ~ ,(\\'Q.'\ ^\e~' ~(\0 r,0'cz,'?J
I PUBLIC IMPROVEMENTS', ~~\).:o; \,<;\e 0';e ?\~;CJCJ';)~
~ '2:\~\0 \~:\ , :\ \'0
, C Sidewa k.,'IIy''''p' e:
0\)\\" '<J'
Downspouts/Drains:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
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
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2006-01200
ISSUED: 09/15/2006
APPLIED: 09/15/2006
EXPIRES: 03/15/2007
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
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$3.15
$5.04
$63.00
9/15/06
9/15/06
9/15/06
9/15/06
2200600000000001300
2200600000000001300
2200600000000001300
2200600000000001300
Total Amount Paid
$77.49
I Plan Reviews,
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 Reouired 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
tim'\:;:p:=~n~ .Jmf)
Owner or Contractors Signature
1 / IS /0 b
I /
Date
Paee 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 #: COWl e:<-- ~ b- C> I ZOO ,
e~ St--
9 /t ;r'~ '-
I /
23$0
Address:
Issued by:
D~
Date:
Statement: Information Notice to Property Owners-
About Construction Responsibilities
Note: Or~gon Law, ORS 701.055(4) requires residential consiructionpermit applicants who are 'not '
licensed with the Constructio.n ContraCtors Board to sign the following statement before a building
permit can be issued. This, statement is required for residential bu'ilding, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from licensing under
ORS 701.010(7), need not submit t~is statement. This statement will be filed with the permit,
" '
" '
Fill in the appropriate blanks and initial boxes 1 ~~ 2" and either box 3A or 3B:.
~ I. I own, reside in, or will reside in the completed structure. . .
"-
~
2.1 understand that I must become licensed as a construction contractor ifthe 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 Construction Contractors Board.
OR
.4 .3B. I will be my own general contractor.
If I hire subcontractors, J 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 of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Informath)D ,
Notice to Property Owners a.bout Construction Responsibilities on the reverse side of this form; .'
o /l--,;~ 'J-- .J 60 cR . .... cr It S- /06
Y -----. (Signature of permit applicant)' '/ (Datf)
(White copy to issuing agency permit fi!e, pink copy to applicant.) ,
PropertLowner,doc 06-01-04
, ~ctin:g as l,our wn General Contractor?'
INFORMATiON NOTICE'TO PROPERTY OWNERS
ABOUl CONSTRUCTION RESPONSIBILITIES
'#.,. .
,~ ,
\
NOTE: This Information Notice to Property Owners about Construction Responsibiiitfes 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 contractor to construct a new home or make a substantial iUlplovement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and concerns.
Employer Responsibilities
. "
You will, in most instanc.es, be ruled to be an "employer" 'anp the contractors you contract with will be "employees" if
you use cQntractors, not 1icen~ed with the Construction Gontractors Board to do labor in constructing or to assist in the
construction ~r improv<;ment of aresidenti~l structure. ~s (be employer, you must comply witb the following:
. .~ .:" .
Oregon's Withholding Tax Law: As an employer, you must withhold income tax~s 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 infonnation, call the Departri1ent ofRevenue'ut 503-378-4988.
'.
Unemployment 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 compined number for both Oregon Withholding and
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or wVi/w,dor.state,or.us/fonnsnav.htmll for the
appropriate forms, ,
Workers' Compensation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' cvwpensation 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 RevenneService: 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 at 1-800-829-4933 or Visit their web site at www.irs.l!ov.
Other Responsibilities and Areas of C'onc~rns '
Code Compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code
requirements that may' b~b~ought to. your attention through inspections.,
. ~ . '... .
Liability and Property Damage Insnran'ce:~ Contact your insurance agent to 'see if you have adeqilate insurance'
coverage for accidents and omissions such as falling tools, paint over spray, water damage (rom pipe punctures, fire or
work that must be redone, .
Time: Make sure you have sufficient time to supervise your employees."
. _"f. - . - '. "'. .
Expertise: Make sure you have tne skills to act as your own general c011tractor, to~coordiriatethe 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
C:'-' of Springfield Official Receipt
~ dopment Services Department
Public Works Department
Job/Journal Number
COM2006-01200
COM2006-0 1200
COM2006-0 1200
COM2006-0 1200
Payments:
Type of Payment
Cash
Change
Job/Journal Number
CO M2006-0 1200
COM2006-0 1200
COM2006-0 1200
COM2006-0 1200
Payments:
Type of Payment
Cash
Change
c Receint I
RECEIPT #:
2200600000000001300
Date: 09/15/2006
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
ROBERT WOOD
ROBERT WOOD
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
djb
In Person
In Person
Payment Total:
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
ROBERT WOOD
ROBERT WOOD
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
djb
In Person
In Person
Payment Total:
Page 1 of 1
1:22:2IPM
Amount Due
63.00
3.15
5.04
6.30
$77.49
Amount Paid
$100.00
($22.51 )
$77.49
Amount Due
63.00
3.15
5.04
6.30
$77.49
Amount Paid
$100,00
($22.51)
$77.49
9/]5/2006