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Home My WebLink AboutPermit Electrical 2006-8-22 (2) ~ CITY OF SPRIN~,...JELD, OREGON ZON L012- INITIALS D1'- DATE '61 r Lz.../ Vip SOURCE 'VV\~J 225 FIFTIl STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number ~ :)IJ1)~ ~ tJ W_~ WE~ 'D12;Z~J~{P Date 1. LOCA110N OF INSTALLATION: 3. COMPLETE FEE SCHEDULE BELOW 3S'3 0 G-Awtl:.'"' {-:.1a.v'--- rl 7:r LEGAL DESCRIPTION: n D3 IS- 4-0 02:>100 JOB DESCRIPTION: ( Add f Ct rLLA;1-- 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 City Phone Expiration Date Constr. Conlf. Number Expiration Date Signature of Supervising Electrician Owners Name C'h'ldy NDv-1'Yl? '" Address?b?/:) (1'"jJYYl(, ~ 1- 70 City~rO_. fY?""",,- Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~~~~r~ 1&r1M~ / Inspection Request: 726-3769 A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft, or less $106,00 'Each additional 500 sq. ft. or portioRf!l<gfSfION: Oregon law rPnIJires vOL$tot,9.00 EachlMahufatt>a'Ho'me-:bfd by the Oregon Utility MotlillafoO;velling.SeiVite 1i~ose rules are set forth Fee~~rJf..p. 852-001-0010 throu;~~ ,:,w ""2t\9',OO cr;'~. y-n rr:;:y ~t .~:~Il Cf':p:es of H~8 rlJk~s by . B.. Services or Feeders~ Installation,.Alterationsor Relocation: C.:..-, .... ;.' v'" ~. -' ,.. -.. -.<..- "- ~ 1....;... ~.I ' ......~~:,on .., $ 63.00 $ 75,00 $125.00 $163.00 $375.00 $ 50.00 1'"\'''- I, I:,~: :"; \_ 200 Amps or I~ss .', ! L 201 Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only _ .....,. ~ : '; c. . Temporary Sen'ices or Feeders , - Insta!lation, Alteration or Relocation 200 Amps or less $ 50.00 - 201 Amps to 400 Amps $ 69.00 N llQiI~IDPs to 600 Amps $ 100.00 n~eP 66bVA~t5s~M,ll OOO;V"Hlti[see 'jBrla~liY:~-;j K DWrB~'i,~lfaif~~~R THIS PERMITISNOi r.ONlvtMEN-cEQ OR r&ASANIlOpNF'f1 Fn.R-' . ew Alterahon.ori ..x tenSIOn er'Pane / ' 'h;-'lf\Yt'-'tHUll One Circuit' $ 43.00 Each Additional Circuit or with Serv~e or Feeder Permit ';' $ 3.00 1(:3 E. . Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential' $ 25.00 Limited Energy/Commercial . $ 45.00 . Mini",-um Electric Permi.t Inspection F~45~UrChargeS 4. SUBTOTAL OF ABOVE 'f J 8% State Surcharge :3 60 10% Administrative Fee L( j C> 5% Technology Fee Z z,. TOTAL 5;S !f Shared Drivc(T:)/Building Forms/Electrical Permit Application 8-06.doc . .CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01084 ISSUED: 08/22/2006 APPLIED: 08/22/2006 EXPIRES: 02/22/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3530 GAME FARM RD SPACE 73 ASSESSOR'S PARCEL NO.: 1703154003100 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Add one circuit. TYPE OF USE: Addition to Residential I N requires yuu ATTENTION: Oregon ~~\le Oregon Utility '-_~ ........!t"\.....1?d b, _.. ~......th \Il..I I~_n' ,.....- - j\ Or"P rUll;:~~ (.1.,.... - ~ t"":c1;cn C8rlcr. 1 -:, n' Ci\R 9:.,2-001- " . r". ":)10 t~.,. J,,) 'b" ..,r'l'i~'~' ~. '. _ r"1''"\rU.35) If. \.,' .._ cn :~S o~ ~. ,..... r:-r' ",. \,'.~\ r,,~' r-'_ 1'1 q'1' ,r'" '~C:1C Owner: NORMAN CINDY L Address: 3530 GAME FARM RD SPACE 073 SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I L I', IT'. "I,..~~-..,Ull .' .'~~..,-tl' Contractor Type Electrical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: Total: # Street Trees Rqd:'IC~ Handicapped: "'11 . Paved Drive Rqil:' Compact: % of Lot Coverage: PERMIT SHALL EXPIRE If- I He wOKK AUTHORIZED UNDER THIS PERMIT IS NOT .. ._..~~...... nf"'\.n ~r\_~~lr\"~lrn rAn . "..",.." '\U' U v" ,...... "". Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC ll\u"v.EMENTSI "\'~, p:~),1 Sidewalk Type: DownspoutslDrains: ; Notes: I Valuation DescriDtion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of2 . .CITY OF ~n'(,ll"\.Jl' lcLD . Building/Combination Permit PERMIT NO: COM2006-01084 ISSUED: 08/22/2006 APPLIED: 08/22/2006 EXPIRES: 02/22/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees P,'!id I $4.50 $2.25 $3.60 $43.00 $2.00 8/22106 8/22/06 8/22/06 8/22/06 8/22/06 Receipt Number 2200600000000001179 2200600000000001179 2200600000000001179 2200600000000001179 2200600000000001179 Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ MinimumlAdjustment Electrical Amount Paid Date Paid Total Amount Paid $55.35 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. L.Rl'olJirl'rl Tnsn~ 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 , Paee 2 ofl {t)\i .... .... " ," . , . 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 pennit#:CbYvtd ~ O\~ Address: 303u ~C::~ 7'73 Issued by: ~ Date: %' ['2--2-J Dt.. 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 befiled with the permit. Fill in the app,vl,,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ..0'2. 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 M' 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 iDformation 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. ~f,"~1~~ 1A~~) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 Acting as -Aut: Own General C!ntractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT ,C.ONSTRUCTION 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 construcl a new home or make a substantial improvemenl 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 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. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined nllmber for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor_state.or.us/formsDav.htmll for the appropriate forms. Workers' CompeDsatioD Insurance: As an employer, you are subject 10 the Oregon Workers' Cuu.t'~,.sation 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 1-800-829-4933 or visit their web sile at W\vw.irs.l!ov. Other Responsibilities and Areas of Concerns Code Compliance: As the permil 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 InsuraDce: 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 you have sufficient time to supervise your employees. Expertise: Make sure you have Ihe skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the ~t't'wt',;ate limes 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 06-01-04 225 Fifth Street Springfield, Oregon 97477 . 541-726-3759 Phone . :~Q-~;~ wr. CjApf Springfield Official Receipt ~opment Services DepartmeDt Public Works Department Job/Journal Number COM2006-0 I 084 COM2006-01084 COM2006-0 I 084 COM2006-0 I 084 COM2006-0 I 084 Payments: Type of Payment Check cRcceinl] RECEIPT #: 2200600000000001179 Date: 08/22/2006 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By CINDY L. NORMAN Item Total: L'heck Number Authorization Received By Batch Number Number How Received ddk 843 In Person Payment Total: Page I of 1 1:31:33PM Amount Due 43.00 2,00 2.25 3.60 4.50 $55.35 Amount Paid $55.35 $55.35 8/2212006