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Home My WebLink AboutPermit Electrical 2005-9-30 i:j?:p\": ".". 'c' TT.::'iOF't"~UN'GFIELD':O' 'RE' G'O~(" ',f}'~ ''ii'':1, j,.i, ,,,!,~ J..Ji,~,_ ~.,j ., '1 ~'v ~ -'I 1::- 'r " ,.'. ..,.", . L .,. ~ I '--" ' j. . ," ~.,- ,,{ 'C '< I', SPAINOPIELD :-- -'--., llv:l~- ~ ---..;.c~\ ~i~ ----"'-~ ~jfI 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726,3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CCIN1 Z-OOr- C) 1"340 r----:--"""-' --:---..-,._.. ----..-.. .-._-- --- I. rl?!.<ji\?:ION ()F'iN.S!.Af0,!!ON Sb 7 ~ v(:-fL 1+,11" ~(1 LEGAL DESCRIPTION /7033<-//2. II soo JOB DESCRIPTION A j) \~ fYTEAf'\ Z Clrc.,-,,-;-/~ . Permits are non-transferable and expire if work is I'c not started within 180 days ofissuance or if work is Suspended for 180 days. ,-- ---,-- - - - . . ----, 2. I CQNTRACTORINSTALIATION ONLY I Electrical Contractor D f// N ~ Address r City Phone Supervisor License Number Expiration Date Expiration Dale Signature of Supervising Electrician Owners Name \2oL.,~f J.lo"^-'5. ~ YL, 11'(-;'( 1+. If s. D I[ Phone '1~~~ 1/60 Address g6cr <sf> t=h City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. -;;;;;i7~ Inspection Request: 726-3769 ,. cco;~~'."""","";'.";;;..;~.~i L_ ^-' ~ iOmrig.-aria':'does-norrequlre'speclfic-larid.'~~"';;--'" approval. I ~ 0 I. :-.:...,..., "-""oj""'1':':"'"" cc,.-c_-:-.'O. --O-:"":~~,l+" "-~"'''"'-'',,<:::1')!,;)f~"~-';- .",'- A. l~New Re~iden\ial.,- Si~@:I!~'-'l~f~':tfS'~~:~'::!"b.~;,it. . j . Date ' Service Included cr\w 1 000 ft I Authorized Signature ,. sq. . or ess .1 UCl.OU Each additional 500 sq. ft. or portion thereof $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder B. LServic~' or Feeders'.,-Jl!stallatio;: Alterat:'-;;s or iel~;~iio"n: -' $50.00 n1?A-f Btl'l5llon law requires vnlJ to $ 63.00 All 2UI i mps'to.~'R AmD~he Oregon Utility $ 75.00 fo 0 u es aao u uy . Notifi~[i6~!\\ p'O'J"HRJl'll rules are set forth $125.00 In OA?\l9~IDtpO!WUlmptlgh OAR 952-001- $163.00 009<p'yW~sii\101lSpieS of the rUles uy $375.00 ca!Mfg''!l\tcl;@Ab!r. (Note: the telepnu"" $ 50.00 rm'lo- .ho_Qreaon Util.itv NotlTlCallOll nu . ~.""'=. -- c. T~P!lr,ms~<Mfes"!ar;F~li~. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. ! Br3n~h-<;ircui~. " "---- --.. -- -- ~~] $ 50.00 $ 69.00 $100.00 New Alteration or Extension Per Panel ( One Circuit Each Additional Circuit or with Service or Feeder Pennit $ 43.00 $ 3.00 tt3 .3 ( E. ! .MiSceU3!leous (S~r.vi~eJfeeder notbl~l~ded) ~Ei(ch Insl~Uatio~ Pump or inigation $ 50.00 Signi'Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Iil\Q.U~:Enytgifll\~ O'Wa <;;iijRft45.00 M_ri~J~If~~&~+surChargeS 4.~CltMJ~~.ua~ON~tUfl.l l( b AN'ttBg-MymlQ~. . - "-.-'- -.' 7% State Surcharge '3 zZ 10% Administrative Fee l/ 6 C ~~8~ TOTAL Shared Drive(T:)lBuilding FonnslElectrical Pennit Application I..oJ.doc . Status: Issued 225 Flftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line . CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2005-01340 ISSUED: 09/30/2005 APPLIED: 09/30/2005 EXPIRES: 03/30/2006 VALUE: SITE ADDRESS: 869 RIVER HILLS DR , ASSESSOR'S PARCEL NO.: 1703341211500 Springfield TYPE OF Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: . Add 1 circuit and extend 1 circuit '7 Owner: ROBERT HOUSTON Address: 869 RIVER HILLS DR SPRINGFIELD OR 97477 I I' -, Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Yrlmary Construction Type Secondary Construction # of Bedrooms: ~ f' Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction Phone Number: 541-988-1160 I CONTRACTOR INFORMATION I License Expiration Date Phone R-3 "00\0 , BUILDING INFORMA TlONln\li(es, .\.t', \".. ,"I 0 UtI \., _ 0le900 OlegO Inrtll .~fl"T)'tiM: ted '0,/ \lIe \eS ale Se~?h~ii'e: f\H~I~~tl/fs adoP 1110Se 1\1 O{>.'" 9'.)Sq)F~ 1st Floor: \~~a~Weat:"te~~o tll(O\lgll 01 tile (\Si'{FJ 2nd Floor: t-I'W\i!~. \!l)~-O taiO copIes te\e?Sq(Ft Basement: irRil ~. ,~:~'/ 0'0 ,t-Iote-- \lIe t-Io\\I,SqIFl('Garage/Carport \Jfu'1l IlY. oaftlJ ceote(- gOO UtilI\,! A') Sq Ft Other: ,'--0\ -, Ore r :2.3"" Speinkleil \01 \lIe \\00-3;n/a Occupant Load: ,..,,~((\be\ . _~~c. "\,. . , -,..- I DEVELOPMENTlNFORMATlON I VN REQUIRED PARKING Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: IPUBLIC IMPROVEMENTS I Sidewalk Type: ~. Downsl[}~VfID~~ ~01'~':. ~I\l~ ~ ~ ~ ~()"{ 11'\\S tl~p.?J\\'{ ~NO~t\ ~\~ ~~~ail ~~ f>.UiI'\O~~~~ft <.}f\ \~ !ll~I\~t)Q .,- ._.___~l~,_ FU'" I "....,.. ~'i ,."'~. V aluation .Dft'ic~fil'ii \ SPerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 . ~ ~ CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01340 ISSUED: 09/30/2005 APPLIED: 09/30/2005 EXPIRES: 03/30/2006 VALUE: 'Status: Issued 225 F1fth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax .. 541-726-3769 Inspection Line Total Value of Project L.Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Aller, Extend Clrc Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $4.60 9/30/05 1200500000000001431 $3.22 9/30/05 1200500000000001431 $43.00 9/30/05 1200500000000001431 $3.00 9/30/05 1200500000000001431 Total Amount $53.82 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. Ueoui~~~nsnections I 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 certii)' that any and all work performed shall be done bl accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertabling to the work described herebl, and that NO OCCUPANCY wiD be made of any structure without permission of the Community Services Division, Building Safety. I further certii)' that only contractors and employees who are In compliance with ORS 701.005 will be used: on tbis 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 wiD remain on the site , at all times duri}!: constru~tion. ~j.~-L d~~~ OJn; or Contractors Signature . Date 2 of 2 I .. A___ _ __ I .. A\~~~'illfii m\~lc<d'WIf'~\vmr-<Gell1leIr~n c((])~rrIr,~te1t((])Ir? . sf l\~'\iN?OR\I\IIATIO~~OTICE-TOPROPERTYOWNERS'~" i . .. ~ _,~:,,: ;':,,\ _, ABO,l!T c.ONSTR~CTION~RESPONSIBILlTIES,~'~ :',~ ~_ ; ;~,,(!:' NOTE: This Information Notice to Property Owners about Construction Responsibiliiies' was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. .'" , ,> . i . ,,' ." I " If you are acting as your own contractor to construct a new home or make a substant'iiil improvement to an existing - . ~ - . - . I structure, you can prevent many problems by being aware of the following responsibilities and concerns, JEmjpnoyelt" ReSjpOlIllsilbinitnes . , I,. '. . ~~ ." '.' " f J\ . ,:c, -,:"'.. . ., You will, in most instances, be ruled to !>e an "empl'?Yer:' and the contractor~ you contract ~tJi will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor ip. constructing or to assist in the .. construction or improvement of a residential struc~e" As th~ employer, you must comply with the followi~g: .. '. . '4 '-: t ~. .-.. !.l , ' " .. 1 _ .. . Oregon's Withhoidi~~ Tax L~~: As\m e~ploy~, ~~u ~ust ~ihholdincome'~xe; fr~fu eIllploye~ ~ages at the time employees are paid. You will be liable for the taxpaymen~ even if you d~n't actually withhold the tax from your . . .' r,'- -. . employees. For more information, call the Department of Revenue at 503"378-49S8. .' - ' . . . Unemployment Insurance Tax: As an employer;yilU'are requited to pay a ta>> for unemployment insurance purpose~ : 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 numbe~ for"qatIJ Oregon Withholding and' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or );VWW.dor.state.or.us/formsoav.htmll for the appropriate forms. ,. , - , . . .. -"I , Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must .qbtain workers' cu...t'_us~.ti~n insurance for your employees. If you fail to obtain worker$' .compensation insurance, you could be~subject to penalties'''and be liable for all claim costs if on~ 6fyour empl~yees is injured on the job. For more information, call the Workers' Compensation Division at the Departrlient"<;fConsumerand Business Services at 503-947-7815. ..... -," ......, U.S. Internal Revenue Service: As an employer, you must withhold fCderaliilcome.tax frome'il'Iploy'ees' wag~s:---". 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-I-800-829-4933 or visii'their web site atwww.irs.l!ovJ_ - "( " - ._, . Tl.'"f 1:- ' . J .... "". ''; _ _' ~ . \ . _ .. _ Otllnei'_lReSIP9I1llsibftBit~esJann~ Alf'eas of COlIll-C~rlIllS ;. . , Code Compliance: As the permit holder for this project, you are responsible for resoi~rlg a~y failure -llj'meet code reql!ire~~nts~ that may b~.~rought to y()ur attention through inspections. Liability and Property Damage insurance: Contact y~~t insurance ~gen{ to see if you have:adequate .insuranee : coverage for accidents.a.n<!.~missions such as falling tools, paint over spray, water damage ~om pipe punctures, fir:. or work that must be redone. . ~ \ ' ' ,." '.\ '\ . X. ' ---'-~- -~-' ~ -_._--~---~...... "'~~ .\--) ''".-\-. Time: Make sure you have sufficient time to supervise your employees. . . Expertise: Make sure y~u h~~~\ th~- skills t~ ~c;'~s ~~U;iO~ 'general contractor: t~ coordinate'the work of rough-in and finish trades, and to notify building officials as the apt'.up.:ate times 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. .....~ '. ,:..::~ ~.- _-~. .J ..J"".. J I Property _ owner.doc 06-01-04 2'25 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-01340 I COM2005-01340 COM2005-01340 COM2005,O 1340 Payments: Twe of Payment Cash Change Job/Journal Number COM2005-01340 COM2005-01340 COM2005,01340 COM2005-01340 ~~yments: Tl'Pe of Payment Cash Change :1 , " :~I 'f 'I )' 9/30/2005 . ~~.!!'!!!'!!-'!_. pO'. ~I ~.I ~ty of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT #: 1200500000000001431 Date: 09/30/2005 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Paid By ROBERT HOUSTON ROBERT HOUSTON Item Total: LnecKNUlDoer AuUlonzatlon Received By Balch Number Number How Received djb In Person djb In Person Payment Total: Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Paid By ROBERT HOUSTON ROBERT HOUSTON lIem Total: Check Number Aulbortzallon Balch Number Number How Received In Person In Person Payment Total: Received By djb djb I of I IO:57:27AM Amount Due 3.22 4.60 43.00 3.00 $53.82 Amount Paid $60.00 ($6.18) $53.82 Amount Due 3.22 4.60 43.00 . 3.00 $53.82 Amouot Paid $60.00 ($6.18) $53.82