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Home My WebLink AboutPermit Electrical 2007-7-3 (3) ZON \ ri ,of' .,c t", INITIALS t'-l \'V'\. . ~ ',/; DATE'1-03-0 I SOURCE P'18"fY,v ,.".... '''''''W'~-''''''''''F_ir1 ?.,,,,....''^',..y~ "r 3. .COJlfPLETEFEESCHEDULE'BELOW;, "";: .(".~ \ ;,. ,:' b';.~,~.;,.~.\ ....,;..~....:..:J~~n,;j;-6.1\j;,l.",.......,/........:. ~'--....l..;,. ~:;""';"~'.J~:h.i' ':';':.'.l,A~:.J'::':...<'~.~ .1.: ,.l '. 225 FIFTH STREET. SPRINGFIELD. OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 / '> 200 Amps or less ~~ziJO \ 201 Amps 10 400 Amps $ 75.00 -JlYeIyotI~1 Amps to 600 Amps $125.00 ,.rteNT'Ott. o~~~:on!imps 101000 Amps $163.00 ~'1cI!!rilltDllcl1dlJtl...= areee\ {r 1000 AmpsNolIs $375.00 NotlfiC8110n Cett'....'O..' OAR 95Z . eel Only $ 50.00 \nOAR~952 ~oI=~_:.,;=..=...._=.".r' .,...,-'~._--~,.. Supervisor License NtS~r YOU n.Iftt8: theN ~mporary)ScrYices:or~Feedcrs ...'(~:;?J:~t'~f't, {r~;'; .':,' J, ~~.? ' .:(i.:( oaIl1n eOt~~~-- ._-- . .,rt_'"''''~_''''''''"'~'''~_'''''''~'_~''''~ l\um~7 ef IS ,:eoo--2344)' Installation, Alteration or Relocation 200 Amps or less $ 50.00 Constr. Contr. Number 201 Amps to 400 Amps $ 69.00 ,40 I Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volls see "B" above, D. ~~}~fh,~~~:~il;~!'i:2~-1~~~~?~-;S:L~;: ',:;~;~~,(~~~. Pump or irrigation $ 50.00 Sign/Outline Lighting . $'50,00 . ) OWNER INST ALLA nON . Limiled EnergylResidential $ 25.00 The mSlllllation is being made on property I own ~mtCE: Lillit' ~'\V11~tarHOR~ $ 45.00 IS nol mtended for sale, lease or rent. 1""5 ~~ ~~~~~:~,~~ .~;4~~~?_~~UrCharg~ ' Owners Signature: ~~=. ls~~~.~'!.i~.--:\-, ~~.' ' , .z ;X }/)~~{t7 -J;;I;;;-/'" ""180I\N~harge ~ bfb A." "'lb% Administrative Fee ~ Zo:. 5% Technology Fee ~ /60 ~ ELECTRICAL PERMIT APPliCATION City Job Number CovV' 2..00 7 ~..... -'16 ". "~.' ,'"" - ~.', ,,~.. '") .. '."~ ......'_~_.. .. ",,"'.' '-'''' "':"'''l:''~.'':-,:\... L : LOCATION OEINSTALIATION:,Zih;,'J'i'i : \: ".~'\..:_I"~.l' .'.....;:.::t'.,._........... ...'"",:. j.,...' .......;,~...- .,_.,;t,.;;..'i..-:J:.~j.4 (0 7 <:) ~A-{LU:lI t-'"" LEGAL DESCRIPTION: 1703 l-72-7... 005C>C JOB DESCRIPTION: SlAv) PirN~L .I Lf/',-,^-dr Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ' '\...-...."'.- t ( .:t(..............~......- ...,."""........."'-~~~'_~ --.--{(J.'--"'" 2. ~C.'qNTRA9r(XR'iNsj4~TIQI;1i?~d'j .'..1" . ~_ t. ..' "~"4."IfQo_">.J>jl.;~",,,"'''L '~'..,_,..._l___. ._1:. _1 Electrical Contractor Address City Expiration Date Expiration Date Signature of Supervising Electrician Owners Name <dCoRop C-<,T,d" <~ ..... ..J Address ) Cl '7" J) (:f-a. I c' '" (=_ . . \ City ..5" o::;.~D . ( 7 4- H 'T f'f=, Phone Inspection Request: 726-3769 SCANNED Date f,~':'" ~~.,'. >t:'f~;; :<0: :..._....J".'r;.-~1~~..;~rr"";!':"...:::-:;'"':""j_~r:-'.:.'_.;-:-.~."F;~:J-.r.::- ",,,. A. ~)1.~w ~esid.ential ~ Single or ~1ul!i-F~nlily 'pcr dwclli'!g unit. . ": .~,.~_:..e;l.,......",-~ . ._~ ,. .... ._ c.-.,................. ....,.,,~._.t __..o'_~._ -- _..~. 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 $106.00 $ 19.00 $50.00 ~':~".!."'T-r.-\ .. .. ~..~:..' ,."~~,~..,. ,.,' ._"",-...-~..__--;-~. - ....t. Tr ~ ":-."'\", ..,...._"1 B. fSe-r"ices~;.:j;\~eders~~'Iii'staU'atioil,.AIt'~r~tion's 'or~Reiocnti~n: t 't lJ.~~4":~~ '_';:,:~.'';;',':,!f.;.!:;'s.:!.:~",.,~:t ..__3~"".s.. ..;-1.,......"./. : . 70)' New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Penn it $ 43,00 $ 1:(,00 \/2-' . -,,- '3 ~?1 -~ ~';;~<(1:z.~ ~;~: 4,-'-'{-:-:"~~'~''''. --:r:.",,-'_!'-,'':~:-J'- ~..:~.r;-,' \': t~ ",G't\ E. ' Miscellari.eous..(Ser.vice/feede'r not illcluded)~EachIilstallatioll'" ;.~.;.t$}.~ ':;'It.4JQ~''',~~~''\;,W-':''''!.';' ,\~.,~, .....".x......... :., ',. .... u.:_...:..~1:..:..-=_!..."'..,.;,.' TOTAL Shared Drive{T:)/Building Fonns/Electrical Pcnnit Application S-Q6,doc -l;..;.~. ..i WI;:. .. O' , . . . 1 , -:. ~ "-'._- ,. .. &. ' . . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00985 ISSUED: 07/03/2007 APPLIED: 07/03/2007 EXPIRES: 01103/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1070 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272200900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Sub panel and 3 circuits in garage Owner: GEORGE ESTRADA Address: 1070 DARLENE SPRINGFIELD OR 97477 Phone Number: 541-741-6996 , CONTRACTOR INFORMATION 1 Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: U # 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: VB n/a I DEVELOPMENT INFORMATION 'I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: Street Improvements: ~iFfE' Storm Sewer a iI'i . . Special Instru . ~RMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 1110 nAY PEl!IDn Notes: I PUBLIC IMPROVEMENlKIT'ENTlON: Oregon raw =: fJ/~w ~w.tIlP_... yau 10 Notlf/catlori-e8nter. on U1lJ1ty In OAR 95U~ 1/'8 let fortfl 0090. You may obtain OAR II6NOt. calling the center. ~~S.br number for the Oregon ~ Center fa 1-800..<l!a!)'llA ~l ., Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of2 . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2007-00985 ISSUED: 07/03/2007 APPLIED: 07/03/2007 EXPIRES: 01103/2008 VALUE:, 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project F.....~ Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid S8.20 S4.lO S6.56 SI2.00 $70.00 7/3/07 7/3/07 7/3/07 7/3/07 7/3/07 Receipt Numher 3200700000000000448 3200700000000000448 3200700000000000448 3200700000000000448 3200700000000000448 Total Amount Paid S100.86 I Plan Reviews , 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. IR..nlJ~ 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 herehy 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 he 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 he 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. ---. bfL_ . _.11.. --:!~ Owner or Contr:'ctors Signature .... --/0>1 .J' Page 2 'of 2 , . . Permit #:C'OM Z'-,- 0 <:I '7IJ r u~A!~ /D70 '06 AI .' . -. , . , , . . ". ," ", ," . . 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.u,! Address: Issued by: Date: 7/J /c" I 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 will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~l. rr-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! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ./1~o /~ 7A/o7 - v (Signature of permit applicant) f I (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 06-01-04 A '0' , \\~. . ((;t-, f1"1 TI tr' · (l\ ,hi.dnlIl!-~r ~~ II 01llllf vwnn \UlenneJl"~Jl \L.Onn~Jl"~(c~@Jl" .; INFORMATION NOTICE TO PROPERTY OWNERS ABOUJ,CONSTRUCTION RESPONSIBILITIES , .. .. NOTE: This Information Notice to Properly 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 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. EmlPnoyer lResjI)ollllsilbinWes 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 structure. As 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 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/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain 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 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. <(J)~llneJr ReSIl101lll!.iIbJinmes ~nHll A.ll"e~s of COlllliCell"llllS Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought 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 s'ufficient time to supervise your employees, Expertise: Make sure you have the skills to act as your own 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 Fjfth Street " - Springfield;Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00985 COM2007-00985 COM2007-00985 COM2007-00985 COM2007-00985 Payments: Type of Payment Check cReceintl RECEIPT #: Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By LINDA ESTRADA ~. . of Springfield Official Receipt .~elopment Services Department Public Works Department 3200700000000000448 Date: 07/03/2007 Item Total: <':heck Number Authorization Received By Batch Number Number How Received djb 2190 In Person Payment Total: Page I of I 8:13:56AM Amount Due 70,00 12,00 4.10 6.56 8,20 $100.86 Amount Paid S100,86 $100.86 7/312007