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Home My WebLink AboutPermit Electrical 2004-7-26 .0....0 . BPRfNOFlELD . ....7'1~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX~~~In 6-3as9 ?c ~.. _ ~ ELECTRICAL PERMIT APPLICATION v, ~ City Job Number (Owl ZOO'-t - 00 Z '7)' Date 7/zo10 L( ~?../",~ '- ... ~:'<I.... I " @ ~ ~ ~b.~"'l 3. I COMPLETE FEESCHED~ B~"?O':o/.6,. "'5I5:~A. -.... .~ A. I New Residential- Single or Multi-Fa~~ng unit. "'-" $106.00 2. I CONTRACTOR INSTALLATION ONLY I B. I Services or Feeders - Installation, Alterations or Relocation: ",OU w . . t:id~~I'~\i\'J ~~~tg)l~Il~il.ltQll~~ ~~,~~~--~tu\:%~~~ IS j~~~@~fC~~iRee~Rrr?~s Phone~"~o~ -'-""\fi~fu'dO~61cr,; " ~<a%'.;-.:. ~~'~l;Ob~~S\~\ca.\iO('l ."' ~~~~~~~\~;:"") Supervisor License Number ~.<'1J1.<J\O ':::,\~I:lD7.,"ary Services or Feeders . "~~\;} Expiration Date: '"',- Installation, AlteratioD or Relocation "'-, 200 Amps or less '.).. ", 20 I Amps to 400 Amps '. 40 I Amps to 600 Amps I. I LOCATION OF INSTALLATION j () 3 S? (':;J UI.A.I.flbT C, -t ' LEGAL DESCRIPTION /70'3 Zb L{ I SPl2.lAlhF'fELD I 0(2. CJO~O J08 DESCRIPTION NEi..0 eLeCh.rcllL 'Pr PF TPt'l'lv( .e~ Permits are non-transferable and expire if work Is not started witbln 180 days of issuance or if work is Suspended for 180 days. Electrical Contractor , Address City Constr, Contr. Number Expiration Date Signature of Supervising Electrician OwnersNameGAMES E. U(}r~C;hl Address /.O'i?R n.Uit..lAI.:( :"14-, City S f/FL.D ) De.. Phone 70. 7 -0/57 OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale. lease or rent. Owners Signature: ~A f.#."k'AA-nf*-~ Inspection Request: 726-3769 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 Over 600 Amps or 1000 Volts see "8" above. D. I Branch Circuits $ 19,00 $50,00 $ 63,00 $ 75,00 $125,00 $163.00 $375.00 $ 50.00 ~o $ 50.00 $ 69,00 $100.00 ..,~ New Alteration or Extension Per Panel One Circuit _~ $ 43.00 Each Additional Circuit or ~i'{f ~ 'iJII\l'" ~. 'lTSln:tice or Feeder t~Ip\tl.\:. n~':\ \IS \,\\(1 \0> 3.00 ~~1W~'" ~\" ~I-\I\\. .f\:'t\E o~R~'" -~ ,,1'f.'S I rt,g~~~~l~t"inclUded) -Each Installation I !>-U\ ~Q\,\ I;) CQ~~~ "fi~\QQ. $ 50,00 !>-~~t e Lighting $ 50.00 Limited EnergyfResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45,00 + Surcharges 4,1 SUBTOTAL OF ABOVE 7% State Surcharge 10% Administrative Fee TOTAL <;"0 35'0 I -s-o v 1> 5'8:TO Shared Drive(T:)lBuilding FonnsfElectnca! Permit Application I.03.doc . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00895 ISSUED: 07/20/2004 APPLIED: 07/20/2004 EXPIRES: 0112012005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1088 QUlNALT ST ASSESSOR'S PARCEL NO.: 1703264100500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace mast Owner: LIVINGSTON JAMES & DEBORAH J Address: 261 S 35TH ST SPRINGFIELD OR 97478 ~lolS6~~GfoR INFORMATION. ~oS eQ;G' ~~ \. 'NV contra~~~00~~0 ~~?;(;j '0'\ License O.~_,,-'O" _...~ ('\~'?- _\~\0~ ~ ~;~o~. '\'(\V;\O\ffdWllJJ,I~fflNf,(}RMA TION I ~~_Cfb~sfi,a co~ .\~l, ~o~\, # or Units: ~~ ~ JP' ~-if;,~~.o\0'~~'II.~ries: Primary Occupan' pJit ~ .A~' ~o~ ~~1ght of Structure Secondary Occup . 0 d6 0\0 ~(y Type of Heat: Primary Construct ~~~ ~O\~\'Il '$ Water Type: Secondary Construc;r;n~~e\ Cf6~'S!J Range Type: # of Bedrooms:~' Energy Path: Sprinkled Building: Contractor Type Electrical 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: nla Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION I $'?-~ Overlay Dist: ~'i;. ~ \)\ # Street Trees Rqd: x.. \1( -t; K f:l ~ Paved Drive Rqd: 'i;.i-\l\~ \l'i;.\l-~~ 1(\J\l- % of Lot Covera~\..\.. \~\S ~~'i;.\J '1.f',\~'V;j.~~~ ~'V~~ ~<o~~\J I PUBLI~r'i.! ""\~...' ~ol\lm\)'V' ~~~~~'C.\~'V~ t Sidewalk Type: ~ 1\ \~ ~~ REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: DownspoutsfDrains: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pal1e I of2 . . U 1 1: OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00895 ISSUED: 07/20/2004 APPLIED: 07/20/2004 EXPIRES: 0112012005 VALUE: 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 Service Reconnect Amount Paid Date Paid Receipt Number S5.00 $3.50 S50,OO 7/20/04 7/20/04 7/20/04 1200400000000001108 1200400000000001108 1200400000000001108 Total Amount Paid S58.50 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 Relluired T~ections I Electric Service: Approval 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 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 Pal1e 2 ofl . . 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-OWI z.,o_ - 00 g"9 ) /0 <:g <g o.u-.; ""A-\ .\- D~ Date: '/rl.f Address: Issued by: 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 be filed with the permit, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. ft2' 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 Y3B' (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 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 con1ractor 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 oftbis form. ~ r --PI/-n-""'T':ib..- l TUL '/ Zb J () ~~re of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Z6Dt.!- Property _ owner.doc 12-09-03 I. I' ~~~n@~ m~ '((j)UIlrr -(())w@ Ge@errmll C~@~I!"m~lt@I!"? II INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Constructiofl Contractors Board in accordance with ORS 701,055(5), passed by the 1989 Oregon Legislature, " 'I If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you canlprevent many problems by being aware of the following responsibilities and concerns, JEmjplloyelr Re!ijporrn!inllJnllntnes You will, in mostlinstances, 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 WithbJIding 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 ~ore information, call the Department of Revenue at 503-378-4988. Unemployment I,nsurance 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" 11 The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and , Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms!' , I Workers' Comp~nsation 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 co~ld be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more inlbrmation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. II I U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will be liable lor the tax payment even if you didn't actually withhold the tax. For a Federal EIN number. call the , - IRS at 866-816-2065 odax them at 801-620-711). I ii Otllnelr Resjporrnsi.Ibi.HW.es aIrndl Areas of COrrnCeIrIrnS Code CompIianc~: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. I: 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 I work that must be redone. , Time: Make sure :you have sufficient time to supervise your employees, i Expertise: Make,sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, ~d to notify building officials as the appropriate 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, Sa]em~ OR 97309-5052. Propeny_ owner.doclI 12-09-03 I 225 Fifth ~treet springfield, Oregon 97477 541-726-3759 Phone Job/Journal Numher COM2004-00895 COM2004-00895 COM2004-00895 . RECEIPT #: Description + 7% State Surcharge + 10% Administrative Fee Service Reconnect Payments: Type of Payment Paid By Check 7/20/2004 DEBORAH LIVINGSTON .r~"'I"!"~'!":-D. -. --- '. ~._" , . , j -.- -;,> ..' Jiiiily of Springfield Official Receipt -"elopment Services Department Public Works Department 1200400000000001108 Date: 07/20/2004 Item Total: Check Number Authorization Received By Batch Numher Number How Received djb 409 In Person Payment Total: Page 1 of 1 10:44:27AM Amount Due 3,50 5.00 50.00 $58.50 Amount Paid $58.50 $58,50