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Home My WebLink AboutPermit Electrical 2004-8-16 SF" ;1"1t:\~ i:'" F:; 2Z-~_D . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CCfVY1 Zc:C-' Lf - 0 10 C) C1 Date 8 "1(; ~ c;V 3. COMPLETE FEE SCHEDfJl.E BELOlV ~6 6Z "?o ~/" o~o '.()~9t-'.9.,<i;/ to/) A. NewResidential- ~Ele ori\%Ifr-(~IY per dwelling unit. " 6, ~ &<5' 0' Service Included v00" ~0 "0/ <$'0'<5' 1 000 sq. "'t. or less ~~~rv";9" /&0,.~6P1lt:.OO JOB DESCRIP~I9~ " , . ~j v' .Ql(' t~L, j)r:~ v.~ 11 v ,"'" YVlll~~ q) P',',C,,,,^,,,,,- r.l-~ c..."c .0_/ 1..:( , c\ ) 1 Each additional 500 sq. ft. or ~.9",- .1'- ("" '). @ ~ 190'~. /) ) 4- ,I "j " ,1 . <$'1. "u "'.J 19qy.Q'.r (JJf/,-Z;>':"O{.{;'L;""" 14~!,<. ". ,.jJk .,l'<"-<.iJiLL) portIOn thereof v/'"" " 'j.. ~9.~ /, 0",_ / / "" /'0 Ql"",'O~o Permits are non-transferable and expire if work is Each Manufact'd Home or" " ~ .'" ' v.r ~ , not started within 180 days of issuance or if work is Modular Dwelling Service or "-.:. 0 (9 ,( Suspended for 180 days. Feeder . 2. CONTRACTOR INSTALLATION ONLY B. ~;dces or Feed..., - I~;itallation; AIi~~~~e ~cal Contractor 7 200 ~J?1S. or':l~ss $ 63.00 ..., ""L. t.'is)\\l~l~'m~~ ~~OOAmps $ 75.00 Address ~ \~~::\: \!.\'': S\\~'-'-? \\..\\S,(}1'4f~ ~OOO Amps $125.00 "'-/1 '(\\s ~t.\\\lt.\) \J~'i)'\) f\\.)~~ps to 1000 Amps $163.00 City ",Phonep.\\\\'\a~VC~~ \o\). Over 1000 AmpsNolts $375.00 ~/ CGt-4\\flt. .. \)p.,'i ?'C.\\ Reconnect Only $ 50.00 ," ~'( \'O~ Supervisor License Number . p.,\ C. Teni~oraryServi2es6r Feeders 1. LOCATION OF INSTALLATION 5/); eYe' sf ,~o.A.'7Fdd , . LEGAL DESCRIPTION 17C Z 3~'3Z o c, t_,c.., C Expiration Date Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Constr. Contr. Number Expiration Date Signature of Supervising Electrician Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits ~. .,,^,-,\te'S':;i.\ibf New Alteration ~i_ImMO~.raml!I~ 5~tego b'l U\8 Of ate se\ \~,,... $ 43.00 II ). ~" ac M~Rl~~f.\~~~9fit~ 1O\\0~ .1ce~{~~~gn tnc!,\\e~" $ 3.00 I Z \,\O\i\iCa.t\on ..()Q,\.@\ tPP\fPrJ.I~~ \n ~~~~~\Q~~a\.\'~d) -Each Installation oagO . "'fOU e ceO\ef. 00 \J\\\\'l!n A.A \ ~~tiJd'8\l Q-'IfOZ.-...rr'J' $ 50.00 ~:.....~~ .T~ .'\.&0 $ ~wvu ~.~lf1g 50.00 Limited EnergyIResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Name ~ 61' IYIC/ . ' F6p L Address 512 oc.. 51 City ~<;privr7F'i8d Phone 7Ifb'-Q>$Cl/ J ij-/' ,r OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~""e"gna""e: " 17 ( /~(}I/ifhl If I 4. SUBTOTAL OF ABOVE s S- 7% State Surcharge 10% Administrative Fee :3 8; <,,~ ... c Inspection Request: 726-3769 TOTAL {.,y J~ Shared Drive(T:)/Building Fonns/ElectricaI Pennit Application I -03.doc Building/Combination Permit PERMIT NO: COM2004-01009 ISSUED: 08/16/2004 APPLIED: 08/16/2004 EXPIRES: 02/16/2005 VALUE: .' Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD SITE ADDRESS: 5120 C ST ASSESSOR'S PARCEL NO.: 1702333200600 Springfield TYPE OF WORK: Electrical Work Only REQUIRED PARKING Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Co~m~~ % of Lot Coverage: c=. \f ,\'\~ ~v '"\1 C~. t.'i-?\~~ t.A\1 \S ~\J ~\{\1\ _. J;\ c.\-\~\.l ~\ \j~ pE?\w\ iOr. I PUBLIC 1M PR01W1S - JD u~DtY\ ~'O~O~~U \' \ en Q;~~?~~ \ CG~~t.~C~~ ~~ Type: ~~'i ~ ~O C~ Downspouts/Drains: TYPE OF USE: PROJECT DESCRIPTION: Add 5 circuits Owner: POPE WM A & LORNA J Address: 5120 C ST SPRINGFIELD OR 97478 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: nla I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Page 1 of 2 Addition Residential 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: Value Date Calculated CITY OF SPRINGFIELD Status: Issued Building/Combination Permit PERMIT NO: COM2004-01009 ISSUED: 08/16/2004 APPLIED: 08/16/2004 EXPIRES: 02/16/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541- 726-3 769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $5.50 $3.85 $43.00 $12.00 8/16/04 8/16/04 8/16/04 8/16/04 1200400000000001218 1200400000000001218 1200400000000001218 1200400000000001218 Total Amount Paid $64.35 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 Inspections. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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 Page 2 of 2 225 Fifth Street Springf1eld, Oregon 97477 541-726-3759 Phone r'!ty of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 1200400000000001218 Date: 08/16/2004 9:45:15AM Job/Journal Number COM2004-0 1009 COM2004-0 1009 COM2004-0 1009 COM2004-0 1 009 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee : Payments: Type of Payment Paid By Check LORNA POPE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1201 In Person Payment Total: Amount Due 43.00 12.00 3.85 5.50 $64.35 Amount Paid . $64.35 $64.35 8/16/2004 Page 1 of 1 . 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 #: CO""", ?-Dc... -t - 0/00 ~ Address: 51 Z. 0 C s + Issued by: ~ ~ Date: 8/ I ~/o y Statement: Information Notice to Property,Qwners 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: \ . fl,l. ~ 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. '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 I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCBand 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. ~ (1,~ gJ/GJoLJ v (Signature ofgerrnit iPplicant) I (flate) (White copy to issuing agency per'!'it file, pink copy to applicant.) PropertLowner.doc 06-01-04 " .1 ....."" Acting ':ar~'1four Own-General Contractor? . ., ' , ) " ., , . ' INFORMATION 'NOTICE TO 'PROPERTY OWNERS AB~q.uT CONSTRUCTI9NRESPONSIBIlITIES :,' T' , '. ~ -... . t NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the i Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. _ ______.._..._.-5 . . \. .- If you are acting' as your own contractor to construct a new home or make a substantial iUlplovement to an existing structUre, you can prevent-many problems by'being'aware of the following responsibilities aildconcerns. Employer Responsibilities .' ", You \Vill, inmost instances, be ruled to be an "employer" and the contractorsyou contract with will be "employees" if you use contractors not licen~eg with the Construction Contractors Boarcfto do labor In constructing or'to assist in the construction or iJ.upiovement of a re,sidential structure. As the employer, you.mus~ com~ly with theJoliowing: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages~t the time employees are paid. You will be liable f~r 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. Formore info:rn1ation, 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 wW\v.dor.state.or.us/formsuav.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' ~ompensation 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 Revenue Service: As an employer, you must withhold federal income tax from employees' wage';;. 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.IWV. ' ::. Other ~esponsibni.tie~aIQ\d 'Areas of CQn~erns Code Compliance: As t~e permit holder for thispn;>ject, you are responsible for resolving' any failure to meet code requirements that may be brought to your attention through inspections. ~". .'~'l'.". _ . . :~ .:. . f..~ " '_ "~'< '-~ .' Liability and Property' Damage Insurance.: . Contact' your insurance agent to see if you have ade'qtlate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pip.e punctures; fire or work that must be red(,)n~: . " .' ",.~-:-:.. . ~ 1, ...C' .;. , < Time: Make sure you haVesuf:f.icient time to supervise your employees: , . . Expertise: Make sure yoh have the skills' to act as your oWn general contractor, to' c~ordinate the work of rough-in and finish trades, and to notify building officials as the appropriate ti~es 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 06-01-04