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Home My WebLink AboutPermit Electrical 2006-10-4 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541 )726-3753 . FAX: (541 )726-3689 . ELECTRICAL PERMIT APPLICATION City lob Number CO&;V\ z..o 0 b - 0 I Z6 , 1~;:~tJ::;7:t:y LEGAL DESCRIPTION: -C70") Z71( 02:200 JOB DESCRIPTION: AltiAI wi.. "riA/At h,ilC~ . I Permits are non-transferable an/d expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. ,,,.,"<:< CONTRACTOR INSTALLATIONONLY ;?1<,'-,.~ Electrical Contractor Address City Phone Supervisor License Number /r' t' :' Jf/ OV/" j / / Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name QLJ )4 JL / L Address ;:) ~/, ~ ~ /~ <2- /f) 1/1/ .- L/ City ?)j',CIr! ZON INITIALS DATE SOURCE Date /b-l{-oG 3. COMPLETE FEE SCHEDULE BELOW A. New Residential - Singl~orMuJti-FamiJy pcr dwclling unit. Service Included 1000 sq. ft. or less C'"'..;(' Each additional 500 sq. ft. or ~,!.) portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder B. "vJC' "t_,;.&"'T' or Feeders- ~nstanation, Alterations or Rclocation: IZb Pi~G"i ". .. -;r' ~" ,.'. fCt200 Amps or less ~ J I~/S PERMJIP~rpfA/9 400 Amps . .ztUTHORJ~l!J tJIDBsilrfJ@PiLRP8/F THE WOfl . .,' vOMMENGf@l!J N8Pt1 t~ ld1jffl~flJlIT IS NO t\ ANY 180 D~epvJ.'Q.d.~ ~f\j.J}g)~fD fOfRj r 'it~co~DI1ly , /' t~_"N' --.--}>,., :,,"," (-"" _ "--',""';':':,,"'--'--, _ ,,~- c. ;le!llPorary Sc;r~ices .'~,r" Feeders ",_, '., *'L'. , .<..v- '-.-" $106.00 $ 19.00 $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 InstaHation, Alteration or Relocation 200 Amps or less $ 50.00 ATTENTIG~:~Oi'l1~o.AmDs. $ 69.00 tc~?W rUI~@p~t6()~l~gUlres you to $100.00 !'lot8~IC8Jftoon C~'" i'D, ~~~ :r.h~~trn'~~fagoU'D UW,itK, :r. OA~ ~~2~)eroUO A'mf1~diYIl '~H;: above. OO~C>>. ,VroaA 1h k ~~ O@ ,,' ,', O()1}:L. C81UUU'D@ ~ifl~ lS~Wt_~.~ilt~ll:uftgy~ 1I1}lnel number VOl' ~~t'n1;J.ft ' @ 1{~{@(9V1JOf1@ $ 43.00 C "'W""'i1 um~ lNJo~'~' . ent'lm~Nm~~i2 ~At j~oon $ 3.00 ServIce or Feeder 8m1\;. Phone ':J. 4- G ' 0 ) () tp. OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~JJt Inspection Request: 726-3769 E. : Miscellalleous Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. g:SlJBTi?TAL I Z~ 10 o~ I'Z ~ co b70 / SC{ !B 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Dnve(T:)/Building Fonns/Electrical Pennit Application 8-06,doc :ITY OF SPRINGFIELD' Building/Combination Permit 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: cOM2006-01269 ISSUED: 10/04/2006 APPLIED: 10/04/2006 EXPIRES: 04/04/2007 VALUE: Status Issued SITE ADDRESS: 2463 CLEAR VUE LN ASSESSOR'S PARCEL NO.: 1703271202200 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: New meter main and wire to sub panel TYPE OF USE: Repair Residential # of Stories: Height of Structure Type o~~~: Wate?l{1~J1.'" Ran~e~A: ~I!:~ Ener~tjf.t9M ~~~~!A:~~ItAI n/a j, . '~ "." I DEVELOP~ I Y A ~~... Q- REQUIRED PARKINC . '/:,0 48. u Pro ,.~ Overlay Dlst: '(/00. ~4'a <.19~ 't" 111 Total: # Street Trees Rqd: . V4'tb r;/'/8 V~,f"Handicapped: Paved Drive Rqd: POP 4'0,. Compact: .<J~ % of Lot Coverage: ". IV, 10#0 ~4'h . Olff es.... In1 ' 0; OAt.R1r~~-r~ftJ~MENTS I ~O 4. l~ le M 'I. "...,' '0,1. ""00 ~/$I" ~.o 'i!i/tf, /; Sidewalk Type: I'J -q'/~1). ., ~ 1..~ .)'~ '.Y II). 69ll' "",0. P I~ ~ 00. -UIO ~e 90,. 1'1"6tS Downspouts/Drains: 6)1"101" ~" ~~I) ~~"/e6' 6.90" YO" 10 Ce"t. ~e 0,....1: (~S~ OA~e ~ ~~~ 61"1" I.. ~ Of"'/~ O/IA lIT 1}~8I1o~} 8,,_ " ~.f" 'l1 eo. ... IB.. on,.. ~~ ~ '. I Valuation Df~ ....0) ~ n $ Per Sq Ft Square Fo{)fage or multiplier or Bid Amount Owner: ROBERT LAVELLE Address: 2463 CLEARVUE LN SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION' Contractor Type Electrical License Contractor OWNER BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 VN Front yard Setback: Side 1 Setback: Side 2 Setback: , Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Page 1 of2 Phone Number: 541-746-0106 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: Value Date Calculated Status Issued 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 + tOo!., Administrative Fee + 5% Technology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $12.60 $6.30 $10.08 $126.00 10/4/06 10/4/06 10/4/06 10/4/06 Total Amount Paid $154.98 I Plan Reviews I =ITY OF SPRINGFIELD- Building/Combination Permit PERMIT NO: cOM2006-0t269 ISSUED: 10/04/2006 APPLIED: 10/04/2006 EXPIRES: 04/04/2007 VALUE: Receipt Number 2200600000000001388 2200600000000001388 2200600000000001388 2200600000000001388 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 ReQuired Insoections I 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 ';m~~o, ",,'",,; I,~ ) 17 J Cd~, (/Ju ,rCJcP ()~, ::2-t2!~~ . \./ .-/ Owner or Contract rs Signature Date Pal.!e 2 of2 Construction Contractors Board ~I . 700 Summer St NE Suite 300 . Po. Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: ~ www.ccb.state.or.us P 't # (011\I\ ~<;s, .:,,.- GIZ.~ '7 " erml : Address: -z-<.tf;3 ' C( et1 (LVO-~ LA!' Issued by: ' ~ Date: / d /l{J ~ I Statem;ent: lrifor~ation Notice to Property Owners , ,About Construction Responsibiliti,es Note: Oregon Law, ORS 701.055(4) requires residential constrUction permit applicants who are 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 willbejiled with the permit. , Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: k11. ~ 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. 0, 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 if' 3B. .I will be my own gen,eraFcontractor. . 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 inimediately 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. W,t:z!311l <-(Signature of permit applicant) " (Cl,,2, 04j ~O~ " ' . (Date) , (White copy to issuing agency permit file, pink cf?PY to applicant.) PropertLowner.doc 06-01-04' Actin-g' as "I our Own General Contractor? - . -0 . - iNFORMATION NOTICE- TO PROPERTY OWNERS ABO.tll CONSTRUCTION RESPONSIBILITIES , NOTE: This Information Notice to Property Owners about Construction Responsibilities 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 ~ew home or make'a substantial improvemen:-t to an existing structure, you can prevent many problems-by being aware of the following responsibilities and concerns. Employer Responsibilities You win, 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 tpe Construction Contractors Board to do labor in constrncting or to assist in the construction or improvement of a residential structufe. As th~ e~ploy~r" 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 Depar1:ri1ent of Rcvenueat 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 combined number for both Oregon Withholding, and ' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVlupensation Law, and must ohtain workers' compensation insurance for your e~nployees. If Y01:l fail to obtain workers' compensation ihsurance, you could be subject to penalties and be liable for aU claim costs if one of yoUr employees is injured ,on the job. For more information, can the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U:S. Int~rnal Revenue Service: As an employer, you must withhold federal income tax from employees' wage~~ .... 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 atl-800-829-4933 or visit their web site at w\x;.woirs.goy. - OtherResponsibilith~s and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving' any faihire to meet code requirements that may be: br~ught to 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 be redone. 'Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skil1s'to' act as ybur O\Vn general contractor, to coordinate 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 Springfiel{l, Oregon 97477 541-72().:3759 Phone Citv 'If Springfield Official Receipt DI. Jpment Services Department Public Works Department Job/Journal Number CO M2006-0 1 269 COM2006-0 1269 COM2006-0 1 269 CO M2006-0] 269 Payments: Type of Payment Check cReceint I RECEIPT #: 2200600000000001388 Date: 10/04/2006 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By ROBERT LAVELLE JR Item Total: Check Number Authorization Received By Batch Number Number How Received djb 7776 In Person Payment Total: Page 1 of 1 11:27:19AM Amount Due 126.00 6.30 ]0.08 12.60 $154.98 Amount Paid $154.98 $154.98 10/4/2006