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Home My WebLink AboutPermit Electrical 2007-7-16 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COW( 2-007 - 0 IOLr 8" 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only AI ff':nmON: Ore Ort la""J~u,lr~ $~.<,~,.: .''0'' follow rtll~e~ 8€!. . _~E'" dC'rs.tJ, Notification Center:rUli3s l)iffi'"" ...~., In OAR 952-001 eQa~jJ~~fR.\l~JiQ.Mi~~~~.1rocation t'1090. You may cibtirn oopie~_ of the ndes by CSllling the cen~ 1~8ti,f ffi~ telephone number for the me~\J91 ~ibation Center j$C1~32 LPS or 1000 Volts see "B" above. 1. !OZO"N (/ ~+- Li7DJ2b~/ IDJOO JOB DESCRIPTION: 200;AwfJ 'OVl f: ( ChAv--! V / Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. p;~-': -; , ~,~7>r;~:,-~r::~"''''1''::':'---,:''qr}N:--:,~?i''''~,:'~'<\?"'--:::-:':rti'-.~Y?3>;::>-'tT{?:'F7:~::>.<~-':: 'Vi >CONTRACTORiINSTAL1d1TIOi\lONLY 2. ~<.i;'_'>;': :0",":' >'..; ';/-_:~ .,;' ;;;;'/,', . ',:.;0;~6i,~,-"':{::-hj:<;::>\tL :":'-;\<}~Yt+t.k'<:<~.'j&n:"',,<:: ,/ -" Electrical Contractor ) / Address City Phon/ Supervisor License7u 7 Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name ~-;At./;J+e-( I J4-nJ1/ ~ 6. _ Address (6zO {~1 (/ sf-r.-e-e.+ City S'f12I nbiHefd Phone !L12 -I.)~23 OWNER INST ALLA TION The installation is being made on property I own which is not intended for sale, lease or rent. 3. '.",',<. ;,; .~,;<, ,,<' ':~.~-:.:'<< :.::::~,:"j~~(, 0;",-L-,UiA>+ ,;~. A. 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. / $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 '70 $ 55.00 $ 76.00 $110.00 D. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 48.00 . $ 4.00 E. included,) -Each Installation Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited EnergylResidential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges 4. .s:0if~i.ALd~~1R~;V 7C> 8% State Surcharge .5 &<..1 ~re 10% Administrative Fee "7 ~(orlr~\\a[f;: 5% Technolo,gy.JI(~ 1\1 JYL;; THIS PERMIT SHAll IEXPIKE It THE WOR" (/ / 10 AUTHORIZED ~THIS PERMIT IS NOT 6 t> - COMMENCED OR is ~,,~OONEEJ3r@ili\ Forms/Electrical Permit Application 7-07.doc ANY 180 DAY PERIOD. 5I1:,"!t1';:f 6 \ <;11(1(, 1M11/lJh Inspection Request: 726-3769 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01048 ISSUED: 07/16/2007 APPLIED: 07/16/2007 EXPIRES: 01/16/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1020 N ST ASSESSOR'S PARCEL NO.: 1703264110300 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: 200amp panel change out Owner: MICHAEL LANNING Address: 1020 N ST SPRINGFIELD OR 97477 Phone Number: 541-912-0623 I CONTRACTOR INFORMATION I 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: 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: R-3 n/a I DEVELOPMENT INFORMATION. REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: ATTENTION: Oregon law requires yo~.~o tollOW ru'.. aaop1~!li,I. Notification Center. it'fiM"NTS , Street Improvements: In OAR 952-001-0010throug 2-001- 0090, You may obtain copies of the rules by Storm Sewer Available: calling the center. (Note: the telephone Special Instruction: number for the Oregon Utility Notification Center is 1-800-332-2344). Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Sidewalk Type: Downspouts/Drains: Description Type of Construction NOTICE: THIS PERMrr SHAll EXPIRE IF THE WOF K I I AUTHORIZED UNDER THIS PERMI11~ Nl'l Valuation Description COMMENCED OR IS ABANDONED FOR $ Per Sq Ft Square Footage ANY 180 DAY PERIOD. It. I. B.d A t Value Date Calculated or mu Ip ler or I moun Notes: Pal!e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01048 ISSUED: 07/16/2007 APPLIED: 07/16/2007 EXPIRES: 01116/2008 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 $7.00 $3.50 $5.60 $70.00 7/16/07 7/16/07 7/16/07 7/16/07 2200700000000001135 2200700000000001135 2200700000000001135 2200700000000001135 Total Amount Paid $86.10 I Plan Reviews I 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. I Reouired 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 times during construction. /JJl1rtA~ L/m>1/iJr: 7,-/ /,r(J7 Owner or Contractors Signature Date Pal!e 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#: COW\Z-oc 7- O/Ci-tg Address: /020 AI . s> r- . .~~ Date: jill, Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities . . Note: Oregon Law, ORS 701.055(4) requires residentia/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 requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under .ORS 70/.010(7), need 1J,ot submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ I own; reside in, or will reside in the completed structure: ~., I 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 instrU(~t my general contractor that all subcontractors who work on the structure must-be licensed with the Construction Contractors Board. OR ~B. I wi Ii be my own general contractor. , ' If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. In-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 thave read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~~~4~ .. (SIgnature of petrmt applIcant) 7r-16~tJ 7 . I (Date) (White copy to issuing agency permitfile, pink copy to applicant.) '.;J Property _ owner. doc 06-01-04 ~. ' c ; .. Jf'l \- "'-",r- - .,- Acting'as - I -o'ur . - \ ~j ," . ~- / \ INfORMATioN' NOTICE PROPERTY OWNERS AaOl,JT CONSTRUCTION'RESPONSIBILlTIES . Gene.raIContractor?: " \. \ -, . ., NOTE: This Information Notice to prOP~rl;~:~~r; about~on~ruction Respo~sibilitjes was d~veloped by t~~l 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 structure, you can prevent many problems by being awa.re or make a substantial improvement to an existing followingresponsibilities and concerns.- Employer You wi11,'in rriost.insJa~ces, ber~led to, be an "employer" you use contractQrs not licensed with theCons!:f.l:l.ction construction.or~mp~qyerU~t of a residentialstructl.JTe: the COP.tr,l19tors Y\?U contract with. will be "employees" if to do .labor in constr,ucting or to assist in the . .... .. :. ' .. y~u must comply witb th.e following: . ,.. ._.'/' (.:.... .:'0 _ _, ,'. _ ," Oregon's Withholding Tax Law: As an employer, employees are You will be liable for the employees. For more information, call the Depa.rtri{ent ..'.. " income' taxes {i vW employee wages at the time even if you dan't actually wit.hhold the tax from your 503-378-4988~' . +'- Unemployment Tax: As an employer, you are an the of all employees. For more information, can the ta.pay a taxtfor unemployment insurance pur:P~ses -\..,~ . Emplayment Department at 503-947-1488. , : ~ ~ -.' The OregQn Identification Number (BIN) is a . Qumber fQf Qoth: _ qregon.: V;lith1}Qlding and Unemployment Insurance Tax. Ta file far a BIN, call 503-945-8091 or 'W'\v-.,v,dar.state.aLus/formsDav.htmll far the - appropriate fQrms. ..Ti........ . . Insurance: As an emplQyer, YQU are subject to the Oregon Workers' CompensatiQn Law, and. must. .obtain w.orkers' cQmpensation insurance fQr. your JfYQU fail tQ .obtain workers ~ compensatiQn insurante, YQU could be subjecfto'p-enalHes arid'be liabli{fof . costs if one ofyour'emplQye~s'is injured on the job. more infQrmatiQn, call the Workers' c.Qmpensationat the Depaitment 6fCQnsumer'and Business Services at 503-947-7815. ":_i "- Service: As an employer, you must withhold:federaHncome hix';fiom 'cmployees'.wages.. ...:~ the tax payment even if you didn't the tax. Far a Federal EIN number, call the .or visitth~,irweb site at www:i1:s; l!OV';! :..'+ ~ .- " ; . ," ,'.f ,-.'. ... ',. - Ilespon~ibiliti~s . '- ." . of- tonCer!llS Code requirements As the permit holder fQr this be brought to your attention ~. ,: .~. . you are responsible for resolVing any faihire.to meet code ~ , .. ~ - - ;; .. . - Liability and Insurance: - coverage for and omissions such as falling work that must be :t;:edo]1e. . \ .', --+\ '. \ 1 ",j, agent to' see' if you ~dequate insurance over spray, water damage fro{TI pipe punctures:, fire or , , I . \.. \' , " . \ ".) :, ~ '''..l....,,~L ....1 '. \. \:,\ \~~:J~t.... I \ \, l.\ "\. _~ . J ~ 4 - .\ Time: Make sure sufficient time to supervise your Expertise: and finish sure you have the skills to aetas to notify building officials as 'contractor, to coordinate the wQrk .of rough-in times so they can perform the required inspections. questions can the Construction 97309-5052. 06.01-04 Board (503-378-4621) .or write the agency at PO 225 "fifth. Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-0I048 COM2007-0 I 048 COM2007-01048 COM2007-01048 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001135 Date: 07/16/2007 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By MICHAEL LANNING Item Total: Check Number Authorization Received By Batch Number Number How Received djb 3503 In Person Payment Total: Page I of I 12:01:57PM Amount Due 70.00 3.50 5.60 7.00 $86.10 Amount Paid $86.10 $86.10 7/16/2007