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Home My WebLink AboutPermit Electrical 2004-7-6 . ~ J \. ,.. , " ; CITY OF S'L:-.:INGFIELD, OREGON . (; . ~PRINOFIELD ' ; ","o"<i(o~~J. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 "'~o-i~~~ _ ~ ELECTRICALPERMITAPPLICATION ""7~ ~ 0",,, }~~i;~~ . CityJobNumberCOW12.00l{-COX-lb Date _1 ~/O'~'\..~'o"-,1,, ..%~:~..~~. 1. tt~~TI6~:t:~;:Q^: '\'\r 3. 1-~()Mtg:1p'FEit'~CIiED~.&~~ " "~::'f~~~:..:"1 . A. ~~;':;1i~ide;;;i~i~'~i~':~.~7MJlti:FJ;;;i"J'~.r-~~1~c~.i~~~~~L LEGAL DESCRIPTION 1'-,. . '... ,.c > c'" -"- .!i1y.:p~,,-,,- _~~I"'.;. 170::S 23. L( L.( 0 Y '3 0 0 Service Included ';;> ";> JOB DESCRIPTION 1000 sq. ft. or less '0 Each additional 500 sq. ft. or / Sl2-vC ~O'^'^<=-C' portion thereof 4 Permits are non-transferable and expire if work is ;.. not started within 180 days of issuance or if work is Suspended for 180 days. [-........ ''-.', ..~,.., ...~,.....' CONTRACTOR'lNSTAiLAiioN'6N!Y.~ ' 2. "'. ~",,,,,,,,'.Yw .,......: :.,',,,.-,..-.,,.' '<, .)'".' ,';.'. <.': ','" ',E,I.,", .. 7....' Electrical Contractor Address ? Phone / / City Supervisor License Number Expiration Date OwnersNam. . .-H ^_liiJ/s Address II Z ') ~(r6 ,>IE )"L City ':::;,'<PG' Phone 6n - C('l:? 0 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~r~ ~~t1 .~ Inspection Request: 726-3769 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. k~~~i~ic~_'~i:Fe~d~f~9)~S!~i_!?f~~'~: '~lt.~r'_~'ti6:~_~: ~~ .-!i~'I~,c'atl~~:~--~:__1 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps :...- . '60 I Amps to 1000 Amps . . . Over 1000 AmpsIVolts Reconnect Only $ (i3.00 $ 75.00 $125.00 $163.00 $375.00 I $ 50.00 s-.::> ~.~,' 'c'.. .c~~"~' ."., "J." .~~,"'''' g;;~ c. :remporarv Ser\.ices~or.F i w;." k' \J~ '!.,- '6 ~~.. "( .t> . .' . ~. . ...... InS!3!IeJi~lr.'{\\!Ylil~:tiat.t' ~l" ~~_~ f(//l..f'I)\- $ 50.00 ~\\(1tf ~ 4 ~ ~ O~e tU\811 \II $ 69.00 ~~~o\ ~8?nO\~~~ $100.00 \l\O~~~R~,.o~~Pi,~~~\,\g~'~b~ve. a~' ftl:tn"'i:1tCii'>l1itSO\~'. '.Z~l".~."'<~" ~\ :;.r(~""~~' ."., . . ~t~fIIII6~ \r Extension Per Panel One CIrcuit Each Additional Circuit or with Service or Feeder Permit I ..J $ 43.00 $ 3.00 E. [i\1:i~~~ird~;~u;'{s;~~e1i~;d;~;;6t h.ti~ded).~E~~h Jns\all~ li~~' j Pump or inigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential ~1M0J.l{\P-1<. Limited E~(ft/~erci~\-\~\.\ f'tJI\?,t ~~~ilC\S ~O\ Minimum Elect'Vf\~.lfiiiIf.'''6\~~~eJ\~~OOrges 4. I SbBTOi.:.W~~~~~W.\'3;:, -, :'., 1 r-O b~',",:~~~;~f>;\p~' ,,,'. :::>. 7% State sur~~~ 10% Administrative Fee 3,J0 5"0 TOTAL r 5''8' ~ Shared Drive(T:YBuilding forms/Electrical Pennit Application 1.Q3.doc -.s~cr;.~ l ' ~~ . -" '. , . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1125 DELROSE DR ASSESSOR'S PARCEL NO.: 1703234404300 PROJECT DESCRIPTION: Service reconnect . U 1 l' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00816 ISSUED: 07/06/2004 APPLIED: 07/06/2004 EXPIRES: 01106/2005 VALUE: Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential Owner: MILLS ND Address: 1125 DELROSE DR SPRINGFIELD OR 97477 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VN Secondary Construction Type: # of Bedrooms: Frontyard Sctback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-689-4830 I CONTRACTOR INFORMATION I Licens~&~9tJurUon Date Phone I~~ n.,*" ~._ ,:.~~nn Utility BUlLdi-NG.lIliR8RM~~ NI89 are set tOI1ll . V! ' I ualti:.i'f)lS8 hOAR 952.001- # .()010~~otthB~~ H \W!!1QbUlln ~:. the te8lP~ Floor: Ty e ""Cen\8fo y,O 'i\itVN~iftla'Floor: Wate . tar\h8()f~ ~'2.234~\LFt Basement: Ran . . ~ 1I1~ Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: I DEVELOPMENTINFORMATION , REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I N01\C~idewalk T{t~IRt u: ~ W~~~ IS PtB~ls~~r1WiS PERtAIl \S ~1\-\OR\lEO'1l0R IS ABA~OOtia> fOR COt-t.t-t.E~CEO El\\Ot). A~'i '\ BI) DA'i P I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pa~e 1 of2 . . CITY OF ~r.Kll"jul1mLD Building/Combination Permit PERMIT NO: COM2004-00816 ISSUED: 07/06/2004 APPLIED: 07/06/2004 EXPIRES: 01/06/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I F....s~ Fee Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number S5.00 $3.50 S50.00 7/6/04 7/6/04 7/6/04 1200400000000001034 1200400000000001034 1200400000000001034 Total Amount Paid S58.50 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, Reouir..d TnsDections 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 oflhe 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 Paee 2 of2 . , 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 e' . . . . . . \. .: ", .,' .,' ,,' Permit #: C.OI'Yl ~_ 00 &" I b Do-lrcrs c- \ C<... Date: ~ ~O '-( Issued by: 112~ ':t:,rg Address: Statement: Information Notice to Property Owners About Construction Responsibilities 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 requiredfor 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: ~1. ~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. 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. g;B. OR I will be my own general contractor. If! hire subcontractors, I 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~ ~~/C7 V (Signature of permit applicant) / (~~) '-' / (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 12-09-03 AdnIlll~ ~~~ ([JlunIr ([])WIID GeIIDelr~ll ~IID1Ir2}d([D?,? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT 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. IEmjplloyer lResjpol!Jlsfilbifillfitfies 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 lieensed with the Construction Contractors Board to do labor in constructmg 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 !Tom 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 503-947-14X8. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholdmg aJ1d Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.uslfQrnlillfl.y.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 obtam 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. ;. I' u.s. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wage'S. 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 866-816-2065 or fax them at 801-620-7115. .. Othel!" ReSjpa:)[ll!iubiIHies alllJ.dl Areas of COJ1J.tCeJrIrns 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, tire 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 write the agency at PO Box 14140, Salem, OR 97309,5052. Property_owner.doc 12,09-03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ..!'~I~!~.c::a_Fl~,_,'~' .,.__._ _ " ~' I ' .,--. J Jiiily of Springfield Official Receipt .elopment Services Department Public Works Department RECEIPT #: 1200400000000001034 Date: 07/06/2004 Job/Journal Number Description COM2004-00816 + 7% State Surcharge COM2004-00816 + 10% Administrative Fee ,COM2004-00816 Service Reconnect Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash ND MILLS djb In Person Change ND MILLS djb In Person Payment Total: Job/Journal Number Description COM2004,008I6 + 7% State Surcharge COM2004-00816 + 10% Administrative Fee COM2004,00816 Service Reconnect Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash ND MILLS djb In Person Change ND MILLS djb In Person Payment Total: 7/6/2004 Page I ofl I 10:39:03AM Amount Due 3.50 5.00 50.00 S58.50 Amount Paid $60.00 (SI.50) S58.50 Amount Due 3.50 5.00 50.00 S58.50 Amount Paid S60.00 (SI.50) S58.50