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Home My WebLink AboutPermit Electrical 2006-5-10 ,...._ ~ w, LJ'"j2., :.- INITIALS r'\ .....- ~, DATE ,1.Ol.? =-a... l;iiIF SOURCE ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541}726-3689 ELECTRICAL PERMIT APPLICATION CiIy Job Number CO VIA [..00 b - D 0 ~S(:) . "':>'. -::; " '''''Co "i" ,,' ;n " ',~'''' Po ::. " .. .;....':..'::r.'.'''''. ~.j.: <~~::;.;:I'::. L :;LOC4HQNO. FJl'{STAP4TIONI,;.y;3~::>': ... '. .....' ....."'"4.:""...,...-"'.,'"...~"",.~'".'!..i,'-,.... _n', ..........". _..I:....;d7;~'-~A~.-:....'l'_."' 53 b 1~l-AMflv'6-D TtV LEGAL DESCRIPTION 170:3 -ZZ/ 3 /6 ZaD JOB DESCRIPTION ~ <; b'll.l LC. E i2e:-c-. 6/.1 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. . ..;.. ~.'" '~ '~"'" ..' -'~f b,' _-n ~' -A""" ....--. "-:-:--r'''''' ''''~''o'_:-,.'':~ .~. ~ 2. :,CO'fiftA!:TOJ'(rN~iAfLA1Iq!\;./)J\fi.Y/ ',.. .....~.,'___.'>-..;;:.l_._,.._..~.._____.._...,....._...._......-...... Electrical Contractor Address CiIy Phone ~ '"_=U_'N=J~ Expiration Date 'n Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name (~ (J Al~ Address /6 ref l~ 61-<- Av' ciIy!:.v-c-L~ fA,., Phone 951.( - 8:;-66 - . IT OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~~ t' IA/' 4/.., //v~F.." - Inspection Request: 726-3769 Date '-;-)6~b , i''';!-~ 'I>"'~' " .~ ":'~~''''':--<,~;''~ ".7''". ~'.....,."'.:"lI"":' ...._~.-'7"<;:_. " ... ''',('d~,:,: 7' -:.:~ ;',.~',:; t::. - ..-- 3, ;{COMPLETEFEESCHEDULEBELOW<":"/;;": '?"'.:,c::>'" l;';.;!;.~'.. .itl~.,." ..:,;;,t.%."~;;.,,~~ ,'~:", -1'. .:u... _~.: ,.:. __ .;.",;,,~,-.t,'-;',':i.:oc'.:.:'::>,,;.'L...~::";..~:::"::.r_:...."..;,;;::,:,' ,--(" .\t."","l,t;7. ",':'1' -::-~~ ;1":7~:.. ';. '~"'I "0 -.'~')' :.. '''',- , ';'~:,.' ; ;'7', !-~:\~, ....4.:'.i:r-~l~ r ......(,'_Y,. A. l Nt"" Re~ide~tia!7':~ingle;,r Mult\-Family.per-jhyeHing miit,\ . : ......__. --._ ._.., _.~_ _._ 'f.,.' __.~ _......._..........".~.-.-...._.~~____._._\ 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 ,'Y"..r,~T..rp.lt:i:>c~..---~ ....~ ..~ , ...~"".,'V~~- ".",s:;,-~..,,_..,..., 1.:',f '>:Y'1{;>,u;.-;;t..t... ~. ~".~ ,,- ~ .~.~,~. '\' '.... , B. f: ~ervice~~orfFeeders_~[!~stallation! Al,ter:ati~ns,?r Re!ocatio~n::, :,": .........N- f-......r_UJ#!t!t.lt;"4_~1Jn-1CtW .....'..~__._4__..~.t-.,_1_~.... .......... - --, . U,'f:cation JOPled b reqUires " 200'lAmps oJ:}ess Center Th Y the Oro~_ $'63.00 20{JAfrip~;~8Jil{PRri,Pl;J'10 thOse rUles ,,~;:ni75'[60 .... " mal{ r.t_ rOUgh 0 - SAt f,.... . 401 Amp'slto,600 Arilps'am Co AI'l06$125!00 n'Jrnh" lie ce'1to. Pies Of . ~-n(), 601 A:mps:totIOOO Amps (Note.t' the ,,/$163.00 ...... U}R Or - . 1/"'" t I 1",::,$ hIt. Over 1000 ~p.~gltsegOn Uti/it ~ e eOhC~?J5:uO Reconnect Only 1-800-332 y IVotJ;/('~I$ 50,00 ''''''44), 'un t:~''''':'''>-':::'''''''7''i:7W';:''f':::t,:.~,~-:-;J";':'':"~~:::);}::'~\:;<::'':':~;:J'7~~''l''ltC>l'~~t!'JRE''i' c. ~~Tc'l!1pora.ry.Ser.yic~s or ,F:e~4.ers>~":} d:t,;'l(^~~~~,~:"';'::; ,;S;'?>..)~:t:'i'(;;1,:!J. t..., .J,:". _~~ _'--1~.""j"~,.t...:.,.:.iI;. _..........__.__;;,.,.;..._... ~.- --,->,' ;~..~ .......-;..$ $50,00 ' <:;0 . Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps . 40 I Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above, '--:.5'.,.,..... :'~-'~"-'1.V':I1":;':':?,~'"l' D. ~.::Branch,Girc'liits:v '/i,},;'::- ,J.:, r L.;..'4:......:~ -.-. '....:.i..'"';"C,I.~~~......::.::-~~.'...: ,-,,',,;_,..':' New Ait'eratlon-or Extension Per Panel - -.n.,'&:; One CiI'~,i!~ PER 'I $ 43.00 Each Additional ~irlufi\jAwi!hCXPIRE IF T 'Iv ~l!UHI/r,., ,,- H'" 0100 Servit,eG'Wfieeder'Permi\IDER THI <!! "'dill' '-c AN~~~~C~Q,ORISABg~;~R~,ITJ$,{ljOT '.... '.,7. E. ~~~!s:5~1~~~~~~~~r~ffI6e6~~r_ 11~~~~~l~B~~:~F~I1~~~I~.~~_~, 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 ..<l ..~-~...--..~-. .~~'f"~~.T;~1 .,,~.-. .'. ,.-'-'~:'~"':'-. 4. (SUBTOTALOFABOVE" . c.. ." , . __;...t ,~ \_i.:..:-_lt..';;'';:,,,--,-.;'' _. '. ' _':_~_: .~". so t-f > ':!;"''7~ 8% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fanus/Electrical Permit Application 1-06.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 536 FLAMINGO AVE ASSESSOR'S PARCEL NO.: 1703221316200 . . CITY OF SPRINGFIELD - Building/Combina.tion Permit PERMIT NO: COM2006-00550 ISSUED: 05/10/2006 APPLIED: 05/10/2006 EXPIRES: 11/10/2006 VALUE: Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Service reconnect TYPE OF USE: Repair Residential Owner: COREY WALKER Address: 1694 W 6TH AVE JUNCTION CITY OR 97448 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 Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction Phone Number: 541-954-8588 , . ,," \..... .. ''...111 IClVV \ ......""j,...,' "'- } -~. .- I CONTRACTOR INFORM~TlON~I)Y the Oragon Utility _ -CJ: vC::l~r. ",ose rules are set forth 1..'- . __." h ~t-."""'^~Q5"""()n1w in l:;" I C;,,2.(ljlcense t rOExplratJon -Date Phone OG" '). 'leu may obtain copies of the rules by ,,- ... - -~. ~"1r. \1\lUlt::. 1llO;:; LI;;;""'t-" ....... ,..... BUILDING 1~~u~,~~~~.~I~NJ)regon Utility Notification # of Stories: Center is 1-800-33:?dr~iVe: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: . I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: M01ICE'. l EiP\RE'tOilil~E WO~I<. # Street Trees Rq~flS PERM\I S\-I!\~R 1\-11S Pl!ilitiiiEJ~p~\1: 1 Paved Drive Rqdi\U1\-10RIIED UND B!\ND6~!Nla~i1R % of Lot CoverateOMMENCto OR IS !\ flN'l 180 D!\Y PERIOD. I PUBLIC IMPROVEMENTS I , Sidewalk Type: DownspoutslDrains: I Valuation DescriDtion , $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee J of2 . . CITY OF ~n'(.ll'\il..1' IJ!..LD Status Issued Building/Combination Permit PERMIT NO: COM2006-00550 ISSUED: 05/10/2006 APPLIED: 05/10/2006 EXPIRES: 11/10/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project F'Pp< P.'lilLl Fee Description + 10% Administrative Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid $5,00 $4.00 $50.00 5/10/06 5/10/06 5/10/06 Receipt Number 2200600000000000580 2200600000000000580 2200600000000000580 Total Amount Paid $59.00 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~i'li\~uired tnsoections 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. Owner or Contractors Signature Date Paee 2 of2 -. , . . . . , " " " " . .' . C~nstt:uction 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 #: COWl ZcJt -00 S"S"C Issued by: S~ b Rfi-w'IN'-~ A ,j -:P.0 Date: ~j,1()C- 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 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 <01'1',vl'.;ate blanks and initial boxes 1 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. 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 g 38. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I 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 bereby certify tbat tbe above information is correct and tbat I bave read and do understand tbe Information Notice to Property Owners about Construction Responsibilities on tbe reverse side of tbis form. ~ ~ V~ ~ 1tJ, ZC>O~ ~gnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Lvy.u,_owner.doc 06-01-04 AdnIIll~ till~ -IllllJr ((])WIIll GteIIllteJrtilln C!~Jrtilld([J)Jr? 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. IEmjpllloyer Re!)jploIlll!)nlbnllnne!) You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contracIors 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, you must comply with the following: Oregon's Withholdiug '[ax 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 unemployment 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.doLstate.or.us/fonnsnav.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 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. V,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 1-800-829-4933 or visit their web site at www.irs."o~. Otllnell" Res/PIoImsilbiJIll.tnes amll All"eas OJ[ COImCenllS 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, 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 a"".~". :ate 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. Properly _ owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726~37S9 Phone .~- Caof Springfield Official Receipt ~Iopment Services Department Public Works Department Job/Journal Number COM2006-00550 COM2006-00550 COM2006-00550 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description + 8% State Surcharge + 10% Administrative Fee Service Reconnect Paid By COREY WALKER 2200600000000000580 Date: 05/10/2006 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 707290 In Person Payment Total: Page I of I 1:35:22PM Amount Due 4.00 5.00 50.00 $59.0U Amount Paid $59.00 $59.00 5/1 0/2006