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Home My WebLink AboutPermit Electrical 2003-9-24 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CO~"2.ro'3 .OO~h\ Date DC) - 1..- 4:' ~O~ 1. LOCATION OF INSTALLA110N /q 1'1 :r- ~\- SrJ.'JC~tP. LEGAL DESCRIPTION \ \ O~ ~ 0 l L-- 6 '"Z- l 0 (:) JOB DESCRIPTION ~e.c>IC\.~~ li\tL.k ~1 ,,;".A.' P'llS \- "'(o~ LvI (,U~ UCAA 1l...J... ~ h. 1.w&J~ 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 INSTALLATION ONLY 2. ElectIical Contractor ,)<2.. ~~J-..e." <S. 61L~ _ { J Address 10;1'1 ""-\~ h City 5r r~ (2.~Ji- Phone q '(;<{, -CJ-..~J ~<.,'.~ - ~\:) \ ~'\~~~~ Supervisor License Number '~~0\ <r...\S \,. <<",~ ~S" - R'J~"v" Expiration Date ~\,.~~~~<V !V~. # 1:J~~~ ~v Constr. ~~1T~~~'V ... QT)~'V' EXPiratiOl~'\~~<<'~~ A~' 1 ~ \)~' ,-oV ' Signature of S~~~ing Electrician tb-?fi. ,:;< At> _ ~ /' f'fj- V Owners Name ~~~ rfL\./ S_ 6erJ Address i Cf P7 . ~ IS-\- City ~fr-~~~e,l~ Phone 9~~7~L OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: tlPr A G'-l Inspection Request: 726-3769 3. CO~MPLEl'E FEE SCHEDULE Bb"'LOl-V A. New Residential- Single or Multi-:Family per dwelling unit. Serviee 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 B.Services or Feeders - Installation, Alterations or Relocation: \/ / I ").!2. 200 Amps or less }.. $ 63,00 ~ 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 Amps/Volts ,,-0 $375,00 Reconnect Only c.:, ,\ov ,;f~'i (. $ 50,00 ~\e ~..J :\.\0 C. Temporary servic~~t!te~~~011b~'l/~~ '\ ~\'l:f. ~0 0lb~ ~q ...~0 ~0 Installation, ~\~~&~ ~~~~ott'0 ~~o ~o~ 200 Am~6~~~'0 ,\~O~...O\}~0lb ~r. ,~0j~,ct50.00 201 ~s G~~~ co~ e~ \~ ~",\$69,00 ~<<ANl~E Q~~~~(' ~o"\ \~~ dJ:> $100.00 ~ ~~ . O"",sjJ ijJ.~. 2~ $(.- D.~~J~j>!~~~ .bov' u (\. ~~ ~~ i..,<b ' Ne$' ~'y-?b.~ ~x~ion Per Panel One Circu~~~'Q \P $ 43,00 Each Addit\bnal Circuit or with Service or Feeder Permit $ 3.00 E.Miscellaneous (Service/feeder not included) -Each Installation Pump or in'igation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45.00 4. SUBTOTAL OFABOVE Minimum Electric Permit Inspection Fee is $45.00 + Surcharges f 7% State Surcharge \.. 10% Administrative Fee TOTAL (oJ.DD lj.LfI ~J 10 t"J 3 . ry, Shared Drive(T:)/Building Fomls/Electrical Penn it Application 1-03,doc LII y Ut ~l"Kll~lj t It..LU Bu1;~ing/Combination Permit Status: Issued PERMIT NO: COM2003-00961 ISSUED: 09/24/2003 APPLIED: 09/24/2003 EXPIRES: 03/26/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1917 J ST ASSESSOR'S PARCEL NO.: 1703361202100 Springfield TYPE OF Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Electric service Owner: BERG JEFFREY S & TAMERA L Address: 1917 J ST SPRINGFIE LD OR 97477 Phone Number: 541-988-9781 I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION. # of Buildings: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: VN # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 SETBACKS I DEVELOPMENT INFORMATION. Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: IPUBLlC IMPROVEMENTS I Street Sidewalk Type: Downspouts/Drains Storm Sewer Available: Spec ial Instruction: Notes: I Valuation Description t Desc ription Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project 1 ~~ ""t Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid $6.30 $4.41 $63.00 Total Amount Paid $73.71 I ,Plan Reviews I Date Paid CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-00961 ISSUED: 09/24/2003 APPLIED: 09/24/2003 EXPIRES: 03/24/2004 VALUE: 9/24/03 9/24/03 9/24/03 Receipt Number 2200200000000001572 2200200000000001572 2200200000000001572 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 Insoections I 1 Rough Electric: Prior to Cover 2 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. !OY'JA/Y A ~ / Owner ofn~;cto(s;g~.tnrc I. Pa2e 2 of2 qhlf!o'1 ( ( - Date LTl}' UJ1 ~PKl1'\jtjJ111!-LU BUhding/Combination Permit Status: Issued PERMIT NO: COM2003-00961 ISSUED: 09/24/2003 APPLIED: 09/24/2003 EXPIRES: 03/26/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid. Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 9/24/03 9/24/03 9/24/03 2200200000000001572 2200200000000001572 2200200000000001572 Total Amount $73.71 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 Reauired Insoections 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 '"' ....l' ., 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00961 COM2003-00961 COM2003-00961 Payments: Type of Payment Check Receipt #: 2200200000000001572 Description Perm Serv/Fdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Received By Check Number Batch Number Authorization Number Paid By JEFFREY BERG Jrnp 3136 City of Springfield Official Receipt Development Services Department Public Works Department Date: 09/24/2003 3:00:41PM Amount Paid 63.00 4.41 6.30 $73.71 Item Total: How Received In Person Payment Total: Amount Paid $73.71 $73.71 . ' 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#:CCM.... -D"t>'--OO'jb \ Address: l q t l J S, Issued by, ~ Date' (0) -"L4 -03 " 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or3B: ~~S1. FtJb. 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 ,qsfj3B. I will be my own general contractor. If I hire subcontractors, I will 'hire only subcQp.tractors 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 ofthe 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. It ~)~J<~D_I/ qj)'t/03 ~v I(Signa~flermit applicant) I . ((Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/11/03 " 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, 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 from your employees. For a State Business ID number, call the Business Infonnation Center at 503-986-2200. Unemployment Insm:ance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes. on the wages of all employees. For more infonnation, call the Oregon Employment Department'at 503-947-1488. ";', 'Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for ypur employees, If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for an claim costs if one of your employees is injured on the job, For more infonnation, 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' 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 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and .Areas of Concerns Code Compliance: As the pennit 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 yo,u pave sufficient time to supervise your employees. . " Expertise: Make sure you have the skills to act as your own general contractor, to coordit,!ate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perfonnthe 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 03/11/03