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Home My WebLink AboutPermit Electrical 2006-3-17 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number r'AJYn9-t)[)(p - 00 ~~l 1. LOCATION OF INSTALLATION 3. /"l3;L r/lILL sr. ZON INITIALS DATE SOURCE l-01Z- ~ :b~ Yh'~ Date3! ltf-oh COJUPLETE FEE SCHEDULE BELOW LEGAL DESCRIPTION ~E.PlM.f.. r/tlh ~ JOB DESCRIPTION I, 03 d-I 44- 07t.iOfi New Residential- Single or Multi-Family per dwel\ing unit. C,Rt.UtT ~tL fA-NfL Service Included 1000 sq. ft, or less $106.00 Each additional 500 sq. ft. or portion thereof $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Susp'en~ed for 180 days. :1"t::~~OR lNSTALLATIOlV/ , \" ,/ City \\. ne SUP"";'"' been,e Numbe:'" \ \ \ Address Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name JOEL Address 1'13"2. """ L-L. . S ""1J T J.J City ..5 PR.l N(yf- I f'..L.J) sr. Phone (~ql)?~,-~7~$' OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. owneC11m~ lI~j \ Inspection Request: 726-3769 Each Manufact'd Home or Modular Dwelling Service or Feeder B. serSr~~J~f~~WsH1\\!~I@~~~~;b\1~n'tJ~~location: T II IZED UNDER 1HIS PERMI1IS N01 200 A~b~Q~\~JP OR IS ABANnt)NE{)RO~o 6.'.00 201 Ar&,9M~W 1J'AIY' PERIOD. $ 75,00 401 ArdP~fu ~W Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375,00 Reconnect Only $ 50.00 $50.00 C. Temporary ServiCes or J<'eeders Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 40^0 6.t,gR~TI 1\1' 0 1",., .' i :., " .~$,6~.9,~ 401 Amps to 60l'lTAmps' :01.. , r ~:~",' .$100:00, fo':o\V rUls::; 8.GO:~.,~ ..2, Over 600 Ai11gbmi.~:~~R.J;Y~~:~\l.tj:r"B.'>i!99'ye. D., Branch Ci~i.gvs,R 952.I)Oi.00 1 C)n.:r.q:.',c' i .nr'}0 \In I I r::?': obi;-,,'::. .~. ~ . New A1teratIoo"or'Extensum Per Panel' O c,, C21lingtl"8 cen~8r. ('.:' '$'~4' ".-0"0 ' ". ." ne Ircmt f . '. ,..,.. ~ - . .). " Each AdditionaPerrillll ~PMtW v ' ~~. 0,' - .: . " , .. .' Service or Feeder Permi~en'~8r IS -1.8~0"';,.J-$c -3.00' E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50.00 $ 25,00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OFABOVE 63,00 5.olf 1..'30 7~ 8% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fanus/Electrical Permit Application I-06.doc Status Issued ~! 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax ; 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2006-00321 ISSUED: 03/17/2006 APPLIED: 03/17/2006 EXPIRES: 09/1712006 VALUE: SITE ADDRESS: 1432 MILL ST ASSESSOR'S PARCEL NO.: 1703274407400 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace main circuit breaker panel. . Owner: . Address: JOEL SMITH 1432 MILL SPRINGFIELD OR 97477 . ...,.... "l:r Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: . ~'.. Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-953-4745 NU 11\;[. CONTRACT llQ.M. EXPIRE IF THE WORK AUTHORIZED THIS PERMIT IS NOT COM MEN C~~ffi A S.lf.!tI)OtaliOn()Jhte lIt1IV 1 p,n nAY PFRlno. I BUILDING INFORMATION I Phone # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I REQUI.RED lE>ARKING NTION' Oregon law reyu, -- } - .' Overlay Dist: ATTE 'd ted by the'F()tal~on Utility # S dlollow rules a op _ ,.-" ..oaf forth treet ~rees Rq : " . Center. Those nWan~l~agped: , _ Paved DrIve Rqd~ot\t1catlon _ 01-001 0 throu~€omp~lct:'J2-0(j_1 % of Lot Coverage: OAR 952 0 obtain copies ot the rules by 0090. You may Note: t\le te\aphone _~II;n(1 thp. center. ( .. ,_,:~. ~..,til'ln I PUBLIC IMPROVEMENiSlllb~r tor theOre8g000n_~;;~~3~~)'. . Center IS 1- 0 Sidewalk Type: Downspouts/Drains: I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00321 ISSUED: 03/17/2006 APPLIED: 03/1712006 EXPIRES: 09/17/2006 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 + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $5.04 $63.00 3/17/06 3/17/06 3/17/06 Receipt Number 3200600000000000136 3200600000000000136 3200600000000000136 ',~ Total Amount Paid $74.34 I Plan Reviews I 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 Insnections I Electric Service: Approval required prior to utility company energizing service. "j;; 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. , Owner or Contractors Signature Date ;m Paee 2 of2 . . Construction Contractors Board 700 Summer St NE Suite 301) PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us .Permit #:CD m ~O()~ -003~1 Address: /4-3;;) . /V1, '-'- S"T. Issued by' .~ Date' . 3/ltj ora Statement: I'nformation Notice to .Property OWners . About: Construction Responsibilities Note: Orego'n 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 stcitement is required for residential building, electrical, mechanical and plumbing permits. Licensed ~rchitect 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 b.oxes I and 2, and either b.ox 3A .or3B: ct/ ~2. o 3A. My general c.ontract.or is I .own, reside in, .or will reside in the c.ompleted structure. . I understand ,that 1 must bec.ome licensed as a c.onstructi.on c.ontract.or if the structure is s.old.or .offered for sale' bef.ore .or .on c.ompleti.on. (Name) (CCB #) I will instruct my general.contract.or that all subc.ontract.ors wh.o.w.ork.on the structure must be .' licensed with the C.onstructi.on C.ontract.ors B.oard. '. . rvf: OR ~B. [will be my own general CQntractor. .~ If! hire subc.ontraCt.ors, I will hire .only subc.ontract.ors licensed with theConstructi.on C.ontract.ors ~ B.oard. If I change my mind and hire a general c.ontract.or, I will c.ontract with a c.ontract.or wh.o is licensed with the.CCB and will immediatelyn.otify the .office issuing this building permit.ofthe name ofthe c.ontract.or. f. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners. a):)out Construction Responsibilities on the !'everse side of this form. 0;1~Jj . - 3-/5-06 ~81gnature .ofpepl11t applIcant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property ~ owner.doc 06-01-04 .~" Acting as Your Own General Contractor? ,'. INFORM'ATlON N'OTICE TO PROPERTY OWNERS ABOU! ~Of"S;rRUCTION RESPONSIBILITIES \. r 1 '\ ,,,.......... \.-: .. \ '.. NOTE: This Information Notice to Property Owners about Construction Res~~~~i~lIffie~ was developed by the ""I 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 ofthe.follo\Vingresponsibilities and concerns. Employer Responsibilities 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, yon 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 Wlculployment 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/formsoav.htmll for the appropriate forms. Workers' Compensation Insnrance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cV1Hpensation 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 Revenne 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 w\vw:irs.l!ov.' Other Responsibilities and Areas of Concerns Code Compliance: As the pennit 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 Harnage 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 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 \\'Tite the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner. doc 06-01-04 225 }'ifth Street Springfield, Oregon 97477 541-726-3759 Phone ~~ Jb/Journal Number C')M2006-00321 C'JM2006-00321 COM2006-00321 Payments: Type of Payment Check .. I Q 'i :C :c I v \! 3/17/2006 RECEIPT #: r.ity of Springfield Official Receipt Jevelopment Services Department Public Works Department 3200600000000000136 Date: 03/17/2006 Description Perm Serv/Fdr 200 amps or less + 8% State Surcharge + 10% Administrative Fee Paid By JOEL SMITH Received By ddk Page 1 of 1 Item Total: Check Number Authorization Batch Number Number How Received 1033 In Person Payment Total: 11:38:45AM Amount Due 63.00 5.04 6.30 $74.34 Amount Paid $74.34 $74.34