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Home My WebLink AboutPermit Electrical 2007-7-19 ZON l;\7Z- INITIALS N jVl DATE .,' Vi - t;- i SOURCE mNt~/2-- I .. -r j 225, FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COMZG07 - 0/67</ , f 1. LOCATION OF INST.ALLATION: 3. /~.'~).2. J~; (''fIAI'kA1f1 ia rR/ vr). LFGAL DESCRIPTION: B · i7D32bLt3 -JOB rlESCRIPl'fON:' I ZC>c>~ :>~vL C)C>9cx:::::> Lt+M~ e Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR'INSTALLATION ONLY Date A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. Services or Feeders - Installation, Alterations or Relocation:. Electrical Contractor /200 Amps or less I 20 I Amps to 400 Amps Address 40 I Amps to 600 Amps 601 Amps to 1000 Amps City Phone 0JllD'ftmpsNolts d'\ ~ ~ \e.'Il teat. ~\\~ Jt~o~~ C?lfe(~d b'l ~I as ate set ~,\. . Supervisor License Numbt:r ~ ~C,,~n aOOV" 1'hosa~ o~~a~rvlces or Feeders J,o\\e'~ . "vifil'to. Q\~tO\1g r;et\.i\e ~O'i."\C~t\~., QO'\-OO'\ CO~\eS 0 ic\On8. . Expiration Date V ~ n!)..~ 9t)2-~.." O'o\a.\t\ rte~ tn kt_ratIon or Relocation \7\ "{oy \\ ~ t ~~O ooSO. the ce\,\\8 · s or less Constr. Contr. Number ci.\\~~i tnt \n9.O '\_ Am;s to 400 Amps ,'UOll<<' ce'C\\Qt \S" 40 I Amps to 600 Amps Expiration Date Signature of Supervising Electrician Owners Name (~~ \:.. C vA. 5 Address 2j 3 2 C~ k--I'-- \. City S~\) Phone Y37-?Ycf OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" aboye. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Miscellaneous (Service/feeder not included)-Each Installation ,- Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ownV2gign~ /'." 4. SUBTOTAL OF ABOVE 70 ~ tlllu'1j,1..'-./ r 4~1 '. __ NQTiC1i~o State Surcha!]l?-....... It! "rUE WORK ;:eo -- '1<':JI5 PEfW~tl$MAt.LIOO~ If" I n ~ (, ~f ~;'HOR~rn~ fftWlS PERM~T IS NOT "3 To COMM~R IS ABANDONED fOR Q6 ~ Inspection Request: 726-3769 !:Qlnn 0 ANY 18 A stnM:tl'1:5'fi'{.'e(T:)/Building Fonns/Electncal Pennit Application 8-06,doc ~ CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-01074 ISSUED: 07/19/2007 APPLIED: 07/19/2007 EXPIRES: 01/19/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line. SITE ADDRESS: 832 CENTENNIAL BLVD 1 ASSESSOR'S PARCEL NO.: 1703264300900 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: 200amp panel change TYPE OF USE: Repair Residential Owner: CATHERINE CRAIG Address: 832 CENTENNIAL BLVD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: A,,1:NT10tt. Oregon 'awr~ Wh~tO. . f 'I w rules adopted by tha'9ftQAPdll ~ing: n/a o 0 _ .,.....~i ~I'IAR ArA I\ftt oitti :~~~2.oo;~1~~~~RMATlON I 0090. You may obtain e. the telephone calling the center. (NO~t'm'f~M_tion number fortthe,~~~g~-33t_~).Trees Rqd: Cen er Paved Drive Rqd: % of Lot Coverage: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone Number: 541-337-9408 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: NOTICE: E IF THE WORK l~~:O~::O ~~~~~ ~ PERMIT 15:0T COMMENCED OR IS ABANDONED FO ANV 180 DAY PERIOD. Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pal!e 1 of 2 Value Date Calculated r- Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01074 ISSUED: '07/19/2007 APPLIED: 07/19/2007 EXPIRES: 01/19/2008 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 $7.00 $3.50 $5.60 $70.00 7/19/07 7/19/07 7/19/07 7/19/07 Receipt Number 3200700000000000486 3200700000000000486 3200700000000000486 3200700000000000486 Total Amount Paid $86.10 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. I Reouired Insoections . 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 ~;;;;;~ 6/2ar~- O1n<<., Cont'~cto" Sign at"" (:l 7/JQ/07 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 #: C OWf2:o6 7 -0 I 07,'-/ Address: <6.5 Z. Cbv~V\L~ I CD Issued by: ~ Date: -"7;; 7' ~ 7 / I Statemel1t: Information Notice to Property Owners About' Construction' Responsibilities . Note.: Oregon Law, ORS 701.055(4) requires residential construction permit applicants wh,oare not licensed with the Construction Contractors Board to sign the following statement before a building permit can.beissued.- This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.01 0(7), need not 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. V ~ - I understand that I must become licensed as a con~truction:contractor if the structure,is sold or e ~. 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 ~R 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 andtliat I have read and do understand-the Information Notice to Property Owners about Construction Responsibiliti~s on the reverse sideofthis form. ~~jJ/~~' . 7/;9~7 V A (Signature of permit applicant) ,I' <pate) I' .' (White copy to issuing a ncy permit file, pink copy to applicant.) Property _ owner. doc 06~0 1-04 \ . "Acting' ,as You. \ f. ',' ".: ' ./ INFORMATlbN TO PROPERTY OWNERS ABOUl? PONSTRUCTION RESPONSIBILITIES General Contractor? ,., \' . , " NOTE: This Information Notice to Property about Construction Responsibilities was developed by the Construction Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature. - - - - If you are acting as your own COl)tractor to constn,lcta new home or make a substantial improv;ement to an existing structure, you can prevent many problems by being aware following responsibilities &nd concerns. You-will, in most instances, be ruled to be an :'employer" you use contractors not licensed with the Construction construction' or improvement of a residential structure. As contractors you contract with will be "employees" if Board to do labor -in constructing or to assist in the employer,.you must comply with the.fon~wing: U nempioyment on of Tax: As an employer, you are For more information, call income taxes from employee wages at the time even you don't actually withhold the tax from your at 503-378,A988. . '", to pay a tax for unemployment iflsJ,mmCe purpose~\, Employment Department at 503-947-1488:, ' .. Oregon's Withholding Tax Law: As an you must employees are win be liable for the tax. employees. more information, call the Department of -, ...., Identification Number (BIN) is a Tax. To file for a BIN, call number foy,both Oregon Withlw1ding and" or www.dor.state.or.us/formsDav.htmll for the Oregon Unemployment : appropriate . .~., -.- Insunince: As an employer, you- an:~ subject to the- Oregon Workers' Compensation Law, worker$' cornpensation ins~ance your insurance, you be subject to penalties be liable for job. For more information, can the Workers' Services at 503-947-7815. If you fail to obtain workers' compensation 'costs if one of your ,employees is'injuied on the at the Department of Consunier and Business U.S. As an you must withhold federal income tax from employees' 'wag~s~ You will liable the tax payment even if you didn't withhold the tax. For a Federal EIN number, call the IRS at 1-800-8294933 or visit their web site at permit holder for may be brought to your attention you are- responsible for resolving any failure' to meet code Code Insnr~mcc: omissions such as fa1hng a:gent to see if you ,have adequate insurance over spray, water damage from pipe punctures, fire or , ':--..... '.. . ", . . ;. . . - \ - \~-. ," --. , . '.... .... -..J \ , _ '_ _." . . _ _ _~'_'~ "_'. ha~e suffH:aent tlmeto supervIse your employees,- , ' " \ '. , \ - '\ ',...J ...J._ \ -'.-\ \ .~\-. ~, \"'-., .~ Slrre the skills to act as your own to notify building officials as to coordinate the work of rough-in so they can perfonn the required inspections, (503-3784621) or write the agency at PO call the 97309-5052. 06-01-04 225 Fifth Street Springfield., Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-0 1 074 COM2007-01074 COM2007-01074 COM2007-01074 Payments: Type of Payment Check cReceint I RECEIPT #: 3200700000000000486 Date: 07/19/2007 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By CATHERINE GRAIG Item Total: Check Number Authorization Received By Batch Number Number How Received djb 696 In Person Payment Total: Page I of 1 9:20:13AM Amount Due 70.00 3.50 5.60 7.00 $86.10 Amount Paid $86.10 $86.10 7/19/2007