HomeMy WebLinkAboutPermit Electrical 2003-5-21
. ~ CITY OF S()NGFIELD, OREGON .()
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54t)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number El.e,?:OOJ -CC>lzg Date
B. 20::::~0~~;::~~~~::aIl~tio~'vt:~:;:; Reloe~i~I,: ~O
201 Amp~~~P91Rmp's~\ \.0 0'1 $ 75.00
O,'4ofA~P),;ttb 600~~p'~s,,~\j "", $125.00
. ,'" - 0 Vl \}\"'- Y'\"J !:> Y
~\ p~' oo~66\~P~tbr!p60!>Amp.s \}\0\\e $163.00
1>.-(\'(;: ,,}\0"'~e\\\0verriQOO')~~~srV;~~~i\\0 .\0\\ $375.00
~, G "..,\V ,,!"I'C- \1:>' "C'O.'
\0\\0 \\0\\ O\Reconne.ct 0nly\'(\e _\o'i.\\~ $ 50.00
\~\ca. S'l:<J .0-0\'30" i'SAo\6' "\\'l \~ '\ .
~O" ~ 9 \\'lr.-'1\7' -\ \\\\J - -",ri"+'--- ------- -- --
'.<"\ Oil' -{O\} ~1i ceT~O~,g~a~:~er,y~<:.s-O!-!':eede!! ____ _ u._
OO~v' ~\\\\l:JJ (\'(\e __ \ .~CJ
C~ :oe\ \Olnstallation, Alteration or Relocation
v\\\ Ge\ ,,-
\\ 200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
~"er~O.Q.A,!,p~,,-o! 1000_~?!~~e~{~t~~_ ____ _____._,
D. I Brallch Circuits \In\?.t \~ \" ~a\ '
"P~~~.\Io~~~~;~~a-~t~~I'Q?'~ .- ~- ---
. i~i~i!tQ \l~~ \S II.~II.~Q $ 43.00
~~g~:~~~~:"ith IV $ 3.00 l:(l, ()~
~;~dt~' <6~
rll.~ \.- -- -- -. -- - --- -- -.---..... n - --
E. L~~~seellaneous ~erv~~':"-"de.......~o'- i~lclude~~:-:~ch !'IS!~~aH~n i
I.
LOCATION OFINSTALLA'l10N
I 0 '-f4 O-;"'deo,-' "S-t-~'- --
LEGAL DESCRIPTION
I ROZ6b( 3.
JOB DESCRIPTION
S€-I/C u. p~t: c1 12 c..\.(.L",::h;
Permits are non-transferable and (xpire if work is
not started within 180 days of issuance or if work is
Suspendcd for 180 days,
06/00
2. ~C?~Ric:r~#llj~T~~!!O~ (JNLYn!
Electrical Contractor
Address
City
Phone
Expiration Date _
-"IV
J ~v
n"
Supervisor License Number
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
'K'-'-6LJRS
Lov<?M. CQ!
Owners Name
Address I ~ 4-- <f D l1!l d CUi..
CitY~"'v~t~~[d- Phone 1,+1.,. ~~31
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
/~~<~
Inspection Request: 726-3769
~;lYD 3
COMPLETE FEE SCHEDULE BELOW
3.
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r
A. . New Residential- Single or Multi-Family per dwelling uuit.
_.- - .
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
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
--- -~------'---_.~--- ._~-_._- ~--.
'77
{P.43
'7/0
1/ )8::::'
4. SUBTOTAL OF ABOVE
,
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I
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivc(T:)/Building Fonns/Eleclrical p(..'f1nit Application 1-03.doc
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City of Springfield
Electrical Permit Attachment
...
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00128
5/16/2003
5/16/2003
11116/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
1044 DONDEA ST
1802061308100
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION:
Service upgrade and add 12 circuits
OWNER/APPLICANT:
KNOWLES LORENCE & SANDRA
1044 DONDEA ST
SPRINGFIELD OR 97478
ELECTRICAL CONTRACTOR:
OWNER . 0~I.II\e'" 'J0\,X\\'l ,
\ \ ,3;/'1' O(e~O\\ e\ \0(1:
0\090 ,,\ne ~\e'" ,,00',
,0,-1. CG:B\W' \\}\eS Expiration Date:
. \ .0.\'0\ \ _ ",601" .,-"o",e ~ 0....' - ..,\e~ ~.
r-' (\l'- \I'''''' .~(ov." ~ \11'" \Ie
Amount Paid~\\O\!'l .' 0\1 Ce DatiPaid (lieS 0 \e9no., .Receint Numher
. '~c'Oo'\ 00'1-- '(1 v,)'" ne\e .' '0.\1'-
9.90 ~O\\I ~9'6?-- 'J 0:s1f6/2003\e'.\, ~O\I\IC 1200200000000001230
6.93 \\1 Of>' iO\} \\\~\05/.r6Iio6j, \)\i\\\1'.3AA)' 1200200000000001230
36.00 0090 ',XI\I!?J \ne ~~!r6t2@~'J.'82>'2.' 1200200000000001230
63.00 C~d\Oe\ '-0\~PJ.{!&12003\ 1200200000000001230
DeserlDtion
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ Ea Add
Perm ServlFdr 200 amps or less
,.~ \...'''''
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 working day.
Reouired InsDections:
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete. WOR~
".tri:' "o\p.~Jf i\-\E ,.
By Signature, I state and agree, that I have earefully exami~dltbt'cmnp~~ed.I'\"J!'iclinon '0 dOJ~~rt!lyiDFtify that all
information hereon is true and correct, and I further certifY1~~.€;iIlf-~i1\alfn:o~ItP'elfc\'r'in~ d.ni",1J ~~l~ne In accordanee with
the Ordinances of the City of Springfield and the laws of the S~t,,\.~~lf~n'jlfr~inj~gr~i>\th~IWoYk aescribed herein. I further
certify that only contractors and employees who are in comp~'nce r.1!\1IORS irOi. i55~i11 be used on this project. I further agree
to ensure that all required inspections are requested at the prbp~,~'time.3l./J(iileli'~ i\i.Jliess is readable from the street, and that
the approved set of plans, If applicable, will remain on the sitelD1'll1l \~mes during construction.
Owner or Contractors Signature
Date
Page I of I
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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
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Permit#: e:.e-zoc,~ COIZ-Z
Address: ;0 Lf Lf 1:0.", ~ e-A
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Issued by:
~+
5/16/03
Date:
, ,
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 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 "p.,.vpriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
~1.
X2.
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.
OR
~ 3B. I will be my own general contractor.
If I 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' rmation i orrect and that I have read and do nnderstand the Information
NotiC~~ ut Constructi Responsibilities on the rever~e;;:forib, j,/}if]
(Signature of permit applicant) -f)-for (I)'ate"f/
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner. doc 03/1 1/03
e., e
Acting ,as. ,Your, Own General Contractor?
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT 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 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.
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 a State Business ill number,-call the Business Information Center at 503-986-2200.
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-]488.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,-
and must obtain workers' compensation insurance for your employees. ]f 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 503-947-78] 5.
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 866-8] 6-2065 or fax them at 80] -620-7] 15. .
Other Responsibilities and Areas of Concerns
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 d3mage from pipe punctures, fire or
work that must be redone. .
Time: Mak" sure you have sufficient time to supervise your employees.
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Expertise: Make sure y~)U have the skills to act as your own general contractor, to coordinate the work of rough-in
and finish trades, and to tiotify building officials as the appropriate times' so they can perform' the required inspections.
If you have additional questions call the Construction Contractors Board (503-378462]) or write the agency at PO
Box ]4]40, Salem, OR 97309-5052.
Property _ owner.doc 03/11103
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00128
ELE2003-00128
ELE2003-00128
ELE2003-00128
Payments:
Type or Payment
CreditCard
5/16/2003
City of Springfield .
Development Services Department .
Public Works Department'
Official Receipt "
Receipt #: 1200200000000001230
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
LARRY KNOWLES
3:01:47PM
Date: 05/16/2003
Amount Paid
Item Total:
63.00
36.00
9.90
6.93
$115.83
How Received
In Person
Payment Total:
Amount Paid
.
Received By (;heck Number (.;onfirm No
djb 000070 024952
115.83
$115.83
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cReceiptrpt