The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2004-10-25 2251'1.1' Hi STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELEl;lKlCAL PERMIT APPUCATION City Job Number C.OVIA ZO'oC{' '- 0 (3 ( f Date, ' , (0 - 25" - D ~( r~~vf(~~:!4:.~~'r"'.j~:,;~'Jf<.'~;,~;~~<<;;,i;<0"(~;: 1. ;,/XQCATION;JJFflNST.', ~-';'1~ili".,:..:.-~~q,,~"'~'~>"rr,'~;':I!..,<,;;:-;p-- -~\-S~..' - LEGAL DESCRIPTION /70S 3bt I 3. OZ30~ Service Included $106.00 A. >f-;<L-v lee c. t+A- rJ 6-t!:' 6 1000 sq. ft. orless <91'61 Each additional 50Q9~ ft. portion thereof o'l~e 0'& Each Manufact'd Home or ~., Modular Dwelling Service or <91'"", e Feeder JOB DESCRIPTION . Permits are non-transferable and expire if work is ,1" not started within 180 days of issuance or if work is Suspended for 180 days. 2. B. City / Phone 200 Amps or less NOT~CE: 201 Amps to 400 fflfls , ~ Di=RMIT SHALl4liV<~ M=6W~pQRK UTHORIZED UNDEf601~J;~~Mbb \'S,:,~pT r.nMMENCED OR 1~~I1~~~ ANY 180 DAY PERlOOconnect Only c. Electrical Contractor Address Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Am s or 1000 Volts see "B" above. D. New Alteration or Exte&.w~~~~IU\\X\~ One Circuit . O{e9on \ne Ote9 '" ~e\ \~('\,~.OO E~c{1;:1\iai'tf~fuco~~.'8~~~$J\es :~ 90Z,'OO ~ SeMc~ Oli\Eeeaer ~pO u9n Or t~\et \).vO ';\1\\O'l '~ cen~' \n{O. ~ \t\'" e $ 50.00 $ 69.00 $100.00 OWNER INSTALLATION E.\' \ ,<ou n\et. \)\\X\ :\ ~gi,iJriga.'ti&ce o{e90~ nf).'l,::ltlJt,- $ 50.00 t::.a.\\\\ '';;1 \ne QQO-';)~ Sign/ou~~tgllor& \s \-g $ 50.00 LimitriEnerM~sidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges The installation is being made on property I own which is not intended for sale, lease or rent. ~(}),p 41.1~ t - -.. , 4. ~~~f~:i{iii92~O'%l~i!;; b) Lflfl b>o 737.!- 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03,doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2535 I ST ASSESSOR'S PARCEL NO,: 1703361102303 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01318 ISSUED: 10/25/2004 APPLIED: 10/25/2004 EXPIRES: 04/25/2005 VALUE: Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Service change Owner: AMY WILSON Address: 2535 I ST SPRINGFIELD OR 97477 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type 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 TYPE OF USE: Repair Residential Phone Number: 541-744-7173 I CONTRACTOR INFORMATION. I DEVELOPMENT INFORMATION. Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Expiration Date Phone n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: Contractor License OWNER _r' .. "'1.\ \:. ~9~~ C~:. BUlL N6\),NFO~\fION' \-\O~ ~t.t\~\\ ..r~~ "\\\\ .IDG~t.\) rIJ ' "\\\\-:> \It.\) \.Ht. I ~,\er~\~ ' ,,\~H\Ot\ Ct.\) ~g)it8rStructure ~~t.~ ~ li~\Qmeat: c \ 'Q\) \)~ Water Type: f:>.: Range Type: Energy Path: Sprinkled Building: REQUIRED PARKING Total: Handicapped: Compact: _ ..nil to I PUBLIC IMPROVEMENTS . \a\!'J {eo,UII <;;~o' ~ \jt\\\W -., o{e9 I' ~ rtn o '.r ,--". ~ ,I w~e o...Set ,0 "1"1 t.l-f\ \ \ . \ ~ted '0, Si{!~m"1'y'p.e~OO'\. p.,., UI12L; ac-v I\lOse np.,.? ~~." 'o\\O\N {, '~centet t\l{~~~fWW(O'tift.n~ ~0,\\,\cat\05'2._00'\ _00'\ ~n CO?\es 0 te\e?no~e \n Op.,.? 9 rna'1 o'ot3o ,Note', \ne NO\\t\c3o\\on 0090. :out\le centef. gon \jtWI\'l 44). ra\\~~~. ',:' \ne,Os{~vcr-'>.~2.'2.~ {lU\ 1'- n\61 Valuation JJescri 'on $ Per Sq Ft or multiplier Square Footage, ' or Bid Amount Type of Construction Total Value of Project Paee 1 of 2 Value Date Calculated J Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description ' + 10% Administrative Fee + 7% State Surcharge , Perm Serv/Fdr 200 amlls or less ' Total Amount Paid l Fees Paid I Amount Paid $6.30 $4.41 " $63.00 $73.71 I Plan Reviews I CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01318 ISSUED: . 10/2512004 APPLIED: 10/25/2004 EXPIRES: 04/25/2005 VALUE: Date Paid 10/25/04 10/25/04 10/25/04 Receipt Number 1200400000000001507 1200400000000001507 1200400000000001507 To Request an inspection call the 24 h()ur 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 InsDections I Electric Service: A-pproval 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 atthe 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 Pae:e 2 of2 Date 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 1M Z.C'-v ~.\ - 0) ') I g- Address: ZS"-:>), ..I- sf- .-"c:IX Date: 16 -Z <\ -0 l/ Issued by: 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 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: pI. rr-z, I own, reside in, or will reside in the completed structure. I understand that Imust 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 M" 3B. 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 hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Cons(ruction Responsibilities on the reverse side of this form. ~A (D~ ... D-z)uL{ (S~gnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc o6-oi-04 J , Ac'!ihmg .~~,){ ~tI1ri_OWInl GeIDlera! Conmtract(Q}r?, . . ~NFO[RMAT~ON' NOT~CIE TOPROfPllERTY OWNERS A.~bOl CONSTRUCTION ,.RESPONSIBILlTIES .- 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 toconstruct 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 Responsibilit~es You will, jn 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 c~mply with tbe following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages afthe 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. Unem.ployment 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 '?f.ithholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate fonTIS. Workers' Compensation Insurrance: AB an employer, you are subject to the Oregon Workers' CVUipensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' cVHipensation insurance, you could be subjectto penalties and be liable for all. claim costs if one of your eIl'!-ployees is injured on the job. For more information, call the Workers' Compensation Division at the Department'ofC8nsumer and Business Services at 503-947-7815. . U.S. Internal Revelllue Service: As an employer, you must withhold federal inconie-'taxrrom-ceinploy'ees' 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 \v\vw.irs.l!ov. . . Other Re~po.nsibilftti~~ 2l1l1Hdl AJrea~ ofCoJQlCerIDlS, ': . Code Compliance: As the permit holder for this project, you are responsible for re'solving any failure to meet code requirem~nts that may be brought to your attention through ihsp~ctions. ." ", . -'. . .'" . .' ~ , . LimbUity and Property Damage :D:lIlSUJralllce: 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 mus,t be redone. : Time: Make sure you' have sufficient time to supervise your employees', Expertise: Make sure you have the skills 'to act as y~ur oWn general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. f . ,- 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 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ' r'ity of Springfield Official Receipt , ~velopment Services Department Public Works Department RECEIPT #: 1200400000000001507 Date: 10/25/2004 1 :30:49PM Job/Journal Number COM2004-01318 COM2004-01318 COM2004-0 1318 Description + 7% State Surcharge + 10% Administrative Fee , Perm Serv/Fdr 200 amps'or less Payments: Type of Payment Paid By' CreditCard AMY WILSON It~m Total: Check Number Authorization . Received By Batch Number Number How Received djb 133003 In Person Payment Total: Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 $73.71 rl... .l. "J; 10/25/2004 Page 1 of 1