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Home My WebLink AboutPermit Electrical 2007-7-30 ZON L DL. INITIALS N t'-'\. DATE '1 - ~ .- '0 7 SOURCE 014J~t"'l.?../. Date '( --80 -0"1 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELEcl KlCAL PERMIT APPLICATION City Job Number (' (""'")fA^ C_O 07 -0 I \ -Z 0 1. LOCATION OF INSTALLATION: ~A~ 1-7:5, .3 h d 5f~ 5;~: LEGAL DESCRIPTION: '703"23>'-1 Ot( goD JOB DESCRIPTION: ( ~c.:> -)S""" 2~E:- ( C1~~5 c 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 Electrical Contractor Address P\~, SUP'M'O' Li,,,,,, Numvd ~ Expiration Date -0 City Constr. Contr. Number Expiration Date Owners Name 17a./e K/f1/w . - J Address 7--- 7 J'..3 ~ ~ fAd '7-1' City~/AIJ"(o" ~/~"l-I&....,.,.Phone 1!f{. -7/ 51l V f' I -z: - OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. ow~re:~~~/ -- /l 7 3. COMPLETE FEE SCHEDULE BELOW 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $117,00 $ 21. 00 $55.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit I 7D $ 70,00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 $ 48.00 $ 4.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50,00 + Surcharges 70 4. SUBTOTAL OFABOVE 8% State Surcharge 10% Administrative Fee 7 t'I'n'T"f\\~. K r ,\:iiJ) ~ ~~,.,. . . 5%.I.e~f~ WOR s' .:> THtS PERMIT SHAlt t~~n1\t. IT ' ,!.. .. T ItJ AUT~C;~\lED UNnrm:nl~_~E~~~iT ~~ NO &6-- .0" "\Ii', .....'N' H"i~D 0.. n !~ I\nA~~Q(f~\ildingForms/Electrical Permit Application 7-07.doc (' ',.\I!";""~i n l~ t\1,;$ J. I \l~,~.. -....'f . \\y "; D,l\Y PEflIJO. j; fiQ~~Y. .~vices or Feeders ~,~ON~ oregon \a: t\'\6 oregon Oti\~ ^-ne fn'''''''''' adopted b"i !l~~<<.ation or Relocation iO'I\~oN - b\Oll .J.i~;o\Il. N~t\'1\~at\o~ ~~f.~~'\o ~jU~ bY ~-n-OAR" 95 - . ;jbtal lttP~mps 0090. ~OU ro~J met. ~~ltps ea\\\nG t~e. ~... oregon rf\bSJlU' ".;.;,1 ..e ps or lOOO Volts see "B" above. Signature of Supervising Electrician "". Genter it 1 Branch Circuits Inspection Request: 726-3769 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01120 ISSUED: 07/27/2007 APPLIED: 07/27/2007 EXPIRES: 01127/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2753 3RD ST ASSESSOR'S PARCEL NO.: 1703233404800 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: 200amp panel changeout TYPE OF USE: Repair Residential Owner: DALE KINLEY Address: 2753 N 3RD ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor OWNER License BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure: Secondary Occupancy Group: ~e of Mrityou to Primary Construction Type ATTENTKZ>>I: Oregon 11rln Utility Secondary Construction Ty#1Jlllow rules adopted bi(~, . set forth # of Bedrooms: Notification Center. Th'ElRele~ft1b52-o01. In OAR 952-001.0010t~..BY: . rHlliJi/riD....~ n/a nnan Vnll maY obtain WI"'I ~~."'" calling the I -.v A TION number for th Center is 1-800-332-2344). Frontyard Setback: Overlay Dist: Side 1 Setback: # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: U\llOrnCE' K Storm Sewer AvailableTHIS PERMIT SHALL EXPIRE tF THE ~~~T Special Instruction: AUTHORIZED UNDER THIS PERMIT I COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, Phone Number: 541-746-3154 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: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pal.!:e 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01120 ISSUED: 07/27/2007 APPLIED: 07/27/2007 EXPIRES: 01127/2008 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--1 Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 $3.50 $5,60 $70.00 7/27/07 7/27/07 7/27/07 7/27/07 2200700000000001202 2200700000000001202 2200700000000001202 2200700000000001202 Total Amount Paid $86,10 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reouired Insoections , Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. .f)~/~$' 7-~7-67 Owner or Contractors Signaturef' Date Pa2e 2 of2 .;, , Permit #: CcM1 z..oo 7 - C> II 2...-0 Z7S3 . <> 'a.-d Address: ~ . , Issued by: ~!f Date: 'S1-: ~/'ZLI 0 L Construction Contractors Board 700 SummerSt NE Suite 300 PO Box 14140 Salem OR. 97309-5052 Phone: 503.;.378-4621 Weh Address: www.cch.state.or.us Statement:, Information Notice to' Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit. elm. 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 appwpriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1, jp/2. i I . I own, reside in, or will reside in the completed structure, 1 understand that! must become licensed as a construction contractor if the structure is sold or offered for sale before or.on completion, '0 3A. My general contractor is <N:ame) (CCB #) . I will ins~ct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR' y 3R I will be my own general contractor, If! hire subcontractors, I will hire only subcontractorsJicensed 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 and that I have read and do understand the Information Notice to Property.Owners about Construction Responsibilities on the reverse side of this form. !J(~/, . ~/4 1-]./7--07 - - '(Signat&e ofp.:,u;li applicant) _ (Date) (White cqpy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 f , ,- . . _ __ -j-4cti(lg~'~sY'O!ir,r ,. ~ -' .i~rFORMATION'~OTICE TO.PROPERTY OWNERS' \. '\ ';\.,'- ABOUT CONSTRUCTION RESPONSIBILITIES . .;. General Co-ntractor? . .'-. -, J' '\ ," .\. Information Notice to Property Owners about Construction Responsibilities was developed by the Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature. " , < . ~ , If you are acting as . own contractor to construct a new home or make a substantial imp,ovement to an existing structure, you can prevent many problems by being-,a\vare following tesponsibilitiesand'.eoncerns. Employer - i.-- . . contractors you contract with will be "efiJ.ployees" if to do ~abor,..in con~tructing or to <!-ssjst in the you must comply yvith the following: . . '.. . ~. lo-_ . ~ '.'.. .' .; .. You will" in most instance~, .be ru~~d to ~e an"e~ployer" you use contractors not with the, Cons~ction constructiO'n ~r '. 9f aresidentlal stnicture. Oregon's employees are employees, ; -. .".j;, ..' ." Law: As <an 'employer, be liable for tax call the . income taxes from employee wages 'at the time .. you don '!a,ctually withhold the tax from your, . at 503-378-4988: Unemployment As an employer, are ,on the wages of aU employees. For more information, can to pay lttax for 'uriemploymentinsurance pUrP-;;$e-s"-....: Employment Department at 503-947-1488. ~ . ," ~ . ".' -;., :.; ': ;-!- '. ; "'_ . j- 1,':; I .. .., The Oregon Business Identification Number (BIN) is a n~ber for:both: Orei~n' Wjthl1Qlding and....<... . Unemployment Tax, To file for a BIN, can 503-945-8091 or wi:vw.dor.state,or.uslformsnll.v,htmll for the appropriate \Vorke.rs' and must obtain I" . ,;,. insurance, you'to:uld job. For more Services at Insurance: As an you. are subjectto:the Oregon Workers' Compensation Law, pompensa.tion)nsur:a.nc~ fQf you~ _ . If'you. f~il to obtainworkers~ compensation to penaltIes 'll.i1d~1:je liable for cbs.ifdr~:)l1e O'(YOUf einployees-ismjured on the can tbe Workers' Compensation at the Departtrlent of'Consumer'irid Business' irlcome taxfr6fu employees"wages~ the tax, For a FederalEIN number, call the Revenue Service: As an employer, you must for the tax payment even if you oi:wisi f their. web site \;;1t ,;. ~. ~esponsibU.ities Concerns' '- As the permit holder for this project, you are may to you~ att~nt,ic:n for resolving any f~ilure t6: meet code Insurance: omi~sions such as falling agent to 'see if ybi>' have adequate insurance over spray, water damage from pipe punctures, fire or sure time to your - -:,~ ""-;:,...' '- ", , ..... ,"...:-:-_0" and the skil1s to act asyouf building officia'ls as contractor, to coordii1ate the work of rough-in so they can perform the required inspections, call the Construction 97309-5052, (503-378-4621) or write the agency at PO 06-01-04 225 Fifth ~tt'eet Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01120 COM2007-01120 COM2007-01120 COM2007-01120 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001202 Date: 07/27/2007 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By ARLENE ANN KINLEY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 7795 In Person Payment Total: Page I of 1 2:42:18PM Amount Due 70.00 3.50 5.60 7.00 $86.10 Amount Paid $86.10 $86.10 7/27/2007