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Home My WebLink AboutPermit Electrical 2007-8-20 225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CO vVl C:uO '7 ~ () 12- z.,,(( 1. LOCATION OF INSTALLATION: cll~5 .' b J s+ LEGAL DESCRIPTION: t7D:S1bt Z. ~t4t-t; ,')<2.. \t J '-1/1 07,)DO JOB DESCRIPTION: A ~ 0 ) R.vvv-lth.: -S- c \, .-- Lv__:- J\.. Permit/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 Supervisor License Number \ ~ ~ i\J' Expiration Date CIJ Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name -:::::r~W-lA'<KJQ' Address ~ J.d..~ "r;;' Date 3. (...-\)":...- [oJ tv' \ . r J .'~ i....-( 1\''- '"'-"1L; c A. New Residential- Single or Multi-Family per dwelling unit. Service Included 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 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps AI I c.~f)~tMa~ requires y.ot' !':" fol~OW~lIDf:l1~~d by the Oregon lltility NotificatIon Center.. Those rules are set forth In O~ ~arO~Qctft.lmugh-~Mll952-o01. 0090. You may obtain copies of the rules by caflinittMlmcmef\I~@n ~lilfafl6jj)e numb!lOi J1!~ 9~~f10n Utility Nctiflcat10n ~ii 1~O-332-2344) 201 Amps to 400 Amps ' . 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit ;' Each Additional Circuit or with Service or Feeder Permit $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 $ 55.00 $ 76.00 $110.00 if $ 48.00 $ 4.00 L(6 Ib E. Miscellaneous (Service/feeder not included) -Each Installation City C.Pi<L14,X:EV".l Phone '/ l...j\f-':SJi Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 OWNER INSTALLATION Limited EnergylResidential $ 28.00 The installation is being made on property I own ~.h Limited Ener~~~ $ 50.00 is not intended for sale, lease or rent. N 01\ . ,.~WJl.ttnaml~ "elAW f!Sf\6'(ion Fee is $50.00 + Surcharges . ".ll\~ PERM\ ~~\,~6M) ~~ b L/ Owners~~~re: ~\\\'THOR\2tO \.1N 'P.M,\OO~VE- ~~'_~--... ':~..l'I\I\[NCE.D OR~~ ~~{e"Surcharge ;5'L-_. - l~~ :'f\I~'Ba DP-.'{ PEa~dministrative Fee Yt~ - Id'i , 5% Technology Fee '3(;:..'-". Inspection Request: 726-3769 TOTAL _7~ 7 t Shared Drive(T:)/Building Forms/Electrical Permit Application 7.07.doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01228 ISSUED: 08/20/2007 APPLIED: 08/20/2007 EXPIRES: 02/20/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2225 G ST ASSESSOR'S PARCEL NO,: 1703361209500 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Rewire/add 5 circuits TYPE OF USE: Repair Residential Owner: JARED TAYLOR Address: 2225 G ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMA nON, Contractor Type Electrical License Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMA nON I Frontyard Setback: . Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-744-1307 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: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS I :r~:~MIT SHilt~'R~ THE WORK AUTHORIZED UN~R~i'StPDtMlT: IS NOT COMMENCED OR IS ABANDONED FOR , ANY 180 DAY PERIOD. ' 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: COM2007-01228 ISSUED: 08/20/2007 APPLIED: 08/20/2007 EXPIRES: 02/20/2008 VALUE: 225 Fifth 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 + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $6.40 8/20/07 2200700000000001313 $3,20 8/20/07 2200700000000001313 $5,12 8/20/07 2200700000000001313 $48,00 8/20/07 2200700000000001313 $16.00 8/20/07 2200700000000001313 Total Amount Paid $78,72 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. Reouired InsDections 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 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 e!lch 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 dudng ~s\~n~ ,~\\\\ <t\~o I~ODI Owner or Contract\s Signature Date Pa2e 2 of 2 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.oVV\~7-~ I-Z.z% G- St- s/~Io 7 I I . z Zz..- ~ 'b~ Date: Address: 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: )J 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. ~ 3B. I will be my own general contractor, If I hire subcontractors, I will hire only subcontractors licensed 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 ofthe 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'reverseside ofthis form. ~~\\_~ ~20~7 (Signat~fPermit\rPPlicant) / (Dater (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 , '. _\ L \ < ~, \ ;" , \ , . _~cting, '~as:Y'our'Own General Contractor? t -' -_...I .' ~. ~'- - .' " INFORMATION' NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES '. -. ; - .1 ~'" .' ... 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 ownc~mtractor to construct a new home or make a subst~ntial improvement to an existing structure, you can prevent many problems by beirigaware' Of the following responsib,ilities and concerns. Employer Responsibilities '. . Y oU,will, in most instances, be, ruled to be an~'employer" and the contractors youc~mtract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing 'or to.a'ssist in the construction or improvement of a'resid~ntial s~cture. As the employer, you must comply wit~ the fonowing: . .' . . , ' ,~., " '.' ~ . . . . ~ '~ " . Oregon's Withholding Tax Law: 'As an employer, you must wi'thhold income taXes from empio'yee 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...3784988. . ; Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpose~( , I . '> on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488. ., , The Oregon Business Identification Number':cBIN) is'a' co~bi~~d:"~~mb~;f9r'botb: ~~go~ Withhoiding' a0 Unemployment Insurance Tax. To file for a BrN, call 503-945-8091 or. \v\vw.dor.state.or.us/formsoav.htrnll for the apjJl vjJllate forms. WOlrkers' Compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain worker~' cVlUjJen~ation in~urance fo! your employees. If you fail to obtain workers' compensation insurance, you could be subject"to penahies"and be ti~ble for aU claim costs if one of your cfl?plbyees is injured on the . job. For more information, call the Workers' Compensation Division at the Depaitrrient 'ofConslimer'~md Business Services at 503-947-7815. U.S. ][nternaR Revenue Service: As an employer, you must withhold federal income ,_tax. from employees' wag;0 You will be liable for the tax payment even if you didn't actually withhold the tax., For a Federal ErN number, call the IRS'at 1-800-829-4933 or visit their web site at:\\-'\vw.1TIi,gQY. .. - ' . . . . Other ;RespolllsillJiUitiesaIDld Areas of C'OIDlCeIrIDlS Code Compliance: As the permit holder for this project, you are responsible for resolving any faihirc to meet code requir~ments t~at may ?e brought to your attention through inspections. ,.. Liability and Property Damage Insurance: Contact your insurance agent 'to see if you have adequate insurance coverage for acc!dents ah,d omissions such as falling tools, paint over spray, water d~mage fWm pipe punctures, fire or work that nmst be'redone.\ ...... , \ I ,. . _:J \ . , Time: Make sure you 'have sufficient time to supervise your employees. Expertise: Make sure you have' the skills to act as your o~ '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. I' . '.'. If you have additional questions can the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owneLdoc 06~O 1-04 225 Fiftb Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007 -01228 COM2007-01228 COM2007-01228 COM2007-01228 COM2007-01228 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 2200700000000001313 Date: 08/20/2007 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JARED TAYLOR Item Total: Check Number Authorization Received By Batch Number Number How Received djb 05573B In Person Payment Total: Page I of I 9:58:00AM Amount Due 48.00 16.00 3.20 5.12 6.40 $78.72 Amount Paid $78.72 $78.72 8/20/2007