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Home My WebLink AboutPermit Electrical 2004-4-19 S:Ff~:';:',;h'Jtp:':laf-_::z, 225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FA.XftW1Jt~d~M-Jglb1ect as submitted has lIowing ELECTRICAL PERMIT APPLICATION u IJ c. t.. u '~~~ir~g~a~.nd does not require SPeeCifiC d use City Job Number ~2.0C)Ll _ c:> 0 l( .3 ~ Date II) 1'/6-, I / zoning.1 T1 3. COMPLEl'E-FE2fSCHEDtr:f.E 111f"LO'lAT 4-8.0 -Of, Authorized Signature C1>) u-:J 1. LOCAl'ION OF INSTALLATION ~~9 J-7 G 81_<)o~"~{'~rf( C~ ,/ , (J LEGAL DESCRIPTION 17023>422 OOyz,.1 JOB DESCRIPTION -A ~ ,j &,e:-/\.( LJ I Permits are non-transferable and expire if work is not started within 180 days of issuance or if worv is Suspended for 180 days. ,. C ( (l.CLA. ~ 1- 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Expiration Date ,~~ ~~/ ,i/ I Supervisor License Number Constr. Contr. Number Expiration Date , Signature of Supervising Electrician L. tJ~W1-eY r;; 51/ 51( I Phone 7l/b tJ /J 7,;;2 Owners Name C ha y 1'I9...s Address S"9 d 7 City ~ #I~ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: /~k ';;f; ~ ~ Inspection Request: 726-3769 A. . New Residential- Single or Multi-Family per dwelling unit. Installation, Alteration or Relocation 200 Amps or less . \~~ \NQ~\~ $ 50.00 2.0...I..Am..ps to 40~~. ~.\\\t. ~y . ~\\ \S ~J $ 69.00 "..... ,,\;401\~g~t~~~\S ?\:?~~o yn\\ $100.00 ,\; · · , .- 'C.s.;..j.{ \ '\ OJ, \ \~.}r\ \ \ \\\ 0. ~'C.\J _\ \\\9\tef..6~\:.~il;.~'\tg<f..~~1~~ee "B" above. P.j\ ~~~@"~~ \\)\). 1'\, .y,\\r.l.'i ,,'>l ~t.~\ \;~~\;v:N,tt~Mn or Extension Per Panel ~l\1 C~cuit I Each Additional Circuit or with Service or Feeder Permit Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 43.00 l() Each Manufact'd Home or Modular Dwelling Ser;-ice or $50.00 Feeder . \1;\.'" ",";l'~ \:t-$\\\ B. Servf~~.,~'~<<ede;',s ~~~stallation, Alterations or Relocation: , \'" .eG." ,.,0\ .~ \!~~( /",: ~\, / .~>~~\~-;) 1/ ~ ~OQ~itips~1e;~c;,~ ~)\,; ~ ,,'\ Yo- ~ '. " \:' ~\ ;;- '\; .'::;;' _, ~\) \;j (r'p. ,,' QO 1 K':"';i tJot'400 ,/I-M?., ~ '(\" < " .,.~,<; J,,";~.-j.>uR~~ ,.\~uP~0;"S'. ~ ,.<V" '~40\1' A'~;,/Vt'~ '~^iO' a~\^'\;'-' fA'-\\) ,,'.~" ..i';~<;' ,\\rt..u~~;,9"o;'",n.mP?-c"\\j" " '\",".' ..,\,' . "\'\".. ".,," ,. ';" .,,,,,\.,\"\ .,.,\W'\;~ ,\~;>}" ~~;S.v.~~~~.:., ~~H~. '~.~~ ~~/,s!t~'.~~\.. ~" .....':...:':,. "")"". ,~pr.'l000 A'm~sN s ~'\;"V""" -ri'.r',"- ,""~ .~\~ , I' \~'~ [1-' r');", ~u"'. "\ p" .<,'>;.',. D'~~~nM.Qi.jo:lnn<TA~)" '" Ir-'t~'" .";::"\~' 't :::,~)t~v,,",,\"'t'&'vl. ~~1] ,'r\~;';;, ~~d ~.\\~) 1P\Ji. 00 \\ l'~\;. ..1 \~:\ '," If ~~\:;} ....,.. :. - ,'1'0.... ,.fl>\\~:':}{ W:. Temporary' Services or Feeders v ,{)'" . '{\ \ 't.~ $ 3.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee (f$45.~ Surcharges 4. SUBTOTAL OF ABOVE 7% State Surcharge 10% Administrative Fee TOTAL 40;- 3// y~= I' sz. ~ Shared Drive(T:)/Building Fonns/Elecllical Pennil Applicalion I-G3.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00438 ISSUED: 04/19/2004 APPLIED: 04/19/2004 EXPIRES: 10/19/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5927 G ST ASSESSOR'S PARCEL NO.: 1702342200421 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Extend 1 circuit TYPE OF USE: Owner: CHARLES HAMMER Address: 5927 G ST SPRINGFIELD OR 97478 Contractor Type Electrical I CONTRACTOR INFORMATION. Contractor OWNER License BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: . Description # of Stories: Height of Structure Type of H~~ \~ VN Wato.\'<Ib'YIteu\~\\'1 (\ < ~~~J!fJ'J:s'O\ \0 0 0(\ \~ ~9~v.~. Srz,Jj O~'O~ -' '0'1 ~\)\0S ",,~.9 . ,\eS \ ....\'. _'O\) ",,'0 Or ~v ~$,\Y" S:-('\\; ~,,:('IW>.r:J:~ nl.r'O . t:.<'I'O . ~i~~ $WS ~ 'O(\1.eDbY\Ent)~ENr~.~ION . ~\O'ltl ~ \0(\ 0 '\ AI'. i$\ v T ~'O'. \\. \0 .~\e'?J."\ Srz"OO ..\ 0'0"- l~O, \\~~ ~bt~'. \0\\ ~ 9 ~~l ~0~ 'OvQtiay .w$l:- ~(\ O~ '{O\} X\0 e'O'" o~j<g~e'fTrees Rqd: Of::{~O. ~\\(\<0 ~\O~ \'(\'0 '. _ P~ved Drive Rqd: C~ 'O~ .' (\\}~'O.. % of Lot Coverage: R-3 1 IPUBLICIMP~i~1 . 't.'1-.\'H\'C. N\\ " \\01\C~~W\\1 <2>\"\~\.~~ 1\"\\<2> ~t.~t.$ rQ\\ 1\"\\<2> ~ o\l't.G U~D \c. ~'O~~DO ~\\"\Ot"' cD O~ \\,} ~ N\N\'t.~C~ ~t.\\\O\). cO -\ lQ\) D~'{ ~~'{ \ New Residential Phone Number: 541-746-0072 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: . Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Pae:e 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2004-00438 ISSUED: 04/19/2004 APPLIED: 04/19/2004 EXPIRES: 10/19/2004 VALUE: 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 Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $4.50 $3.15 $43.00 $2.00 4/19/04 4/19/04 4/19/04 4/19/04 1200400000000000499 1200400000000000499 1200400000000000499 1200400000000000499 Total Amount Paid $52.65 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 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. Owner or Contractors Signature Date Paee20f2 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 #: C-O~ 2.0'~ --00 Lf 'J l? Address: 57 Z 7 G- s 1- Issued by: ~~ Date: ~/o L(_ Statement: Information Notice to Property Owners About Construction Responsibilities . Note: Oregon Law, ORS 701.055(4) r.equires 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 . DRS 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: .~ 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 Y 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 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. CLJ~ y:::t,~~ . (Signature of permit applicant) :' '-1-19- Olf (Date) (White' copy to issuing agency permjtfile, pink copy to applicant.) Property- owner. doc 03/11/03 \ ' Acting as You~.Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES .. NOTE: This Information Notice to Properly 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 ill number, call the Business Information Center at 503-986-~200. ............ Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpose~. on the wages of all employees. For more information, 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 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. 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 lax them at 801-620-7115. ',,,- Other Responsib~lities and Areas of Concerns. Code Compliance: As the .p~rmit'holder for this project, you are responsible for resolving any failUre tomeet 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: Makesille you have sufficient time to supervise your employees. Expertise: Make s'ure you have the skills to act as your own general c~ntractor, to coordi~ate th~ work of rough-in and finish trades, and to notify building officials as the appropriate times'sothey 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 03/11/03 225 Fifth Street Spriugfield, Oregon 97477 541-726-3759 Phone of Springfield Official Receipt elopment Services Department Public Works Department RECEIPT #: 1200400000000000499 Date: 04/19/2004 lO:11:40AM Job/Journal Number COM2004-00438 COM2004-00438 COM2004-00438 COM2004-00438. Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum! Adjustment Electrical Payments: Type of Payment Paid By CreditCard CHARLES HAMMER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 000359 638453 In Person Payment Total: Amount Due 3.15 4.50 43.00 2.00 $52.65 Amount Paid $52.65 $52.65 4/19/2004. Page I of I