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Home My WebLink AboutPermit Electrical 2003-7-28 225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAXr~S4dl)(7J~pMect as submitted has the following ELECTRICAL PERMIT APPLICA. TION ~ 0 zoning, and does not require specific land use ,I approval, City Job Number cu:-z-003 -00 17 '1' Date 7 2 '3: 0:3 Zoning JT)(L If. '-''7- 3. COMPLETE FEiSt1:11:'-LJUL1:'-1j1:'-LUW . Authorized Signature L{L/30 LOCATION OF INSTALLATION k,k s t ~c;-6 ~ 7)1^ J 1. LEGAL DESCRIPTION /70Z 323/ A. New Residential- Single or Multi-Family per dwelling unit. '0"5700 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 $106,00 JOB DESCRIPTION s;;..c-rLV I ~t: / i'.t:--COcA--rtC" ;MC"Tl:'f2-. Permits are non-tansferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $ 19.00 $50.00 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: City Phone 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over I OB~~t.~~ss/V oils Rec~I!ljl~~\O<, ~~ o~ 0' C'\O 0~ li) ()~ ~ ~'V"'l!.le.~~!S~i>~ces or Feeders ~ ,'0- -S-0 ~0fb ~~ ~.s ~0 '!..0~O b'Q~ ~\i~q~'(\~~~~~r Relocation ~9 O~,0 -<.,'(\0 ~~A&.f1 (U'~ ~\CJ (!..,O ~?:J 04... (:) ~ OV'. ~~~ ~ ,'Z.fb 0~ ~c::;'" .~ ~aP~~~ .ps $ 69,00 ~ ..\ ...::>" ~ Q s::,'" ~\.~"4~R~~ Amps $100.00 l"- ~O"'" ~O >S ...\ 0 ~..~. 0 ~ . -~ -9'" f-tt .-l\.'b-' ~Cl, 'Amps or 1000 Volts see "B" above "'" .~'v ~'" \' Cj0 0 . . ~d~O't-~ 4,.0'::> ~0 ., .,~lll1ch Circuits .~ ~. '.J:'~ 'O~ 0<- ~ O'\JOJ ~ 0~ c;0~New Alteration or Extension Per Panel o 6t\.'Q e)~' One Circuit Each Additional Circuit or with Service or Feeder Pelmit $ 3.00 .. ~Q\\~ E. Miscellaneous (Service/feeder Jl~{~\s~~l Installation 'i:.'j..~\~ ~~\\ ~ Pump or4\~{!.pn ~CO\\~\..\. \\\\c;,. ~~~~~O Sign!~I}d~~\i \J~O'i:.\\ ~~~~OIJ $ 50.00 Limitell~1Jt ij~ \~ ~. $ 25.00 , Limited~~~~~~~\\\\) $ 45,00 Minimum Ele~~~~it Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OF ABOVE $ 63.00 $ 75,00 $125.00 $163.00 $375.00 $ 50.00 ~ Electrical Contractor Address / Supervisor License Number \~b~ v- a $ 50.00 Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician $ 43.00 . Owners Name IL 0.....1) ~~n..~ Lu..k-e Address l1,4~ 6 A<...+-t:r City ~nj~"e-I cL Phone 7 Lf (,9 - S '3")~ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: r?f cJf)A ~~ ct ~ 7% State Surcharge 10% Administrative Fee ~'--" 3S'o s-c-o S8~ Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03,doc ~B.!'}~55,~I~J?;"",,,,~,,,,, I I 5 I City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 54'1-726-3759 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00179 7/28/2003 7/28/2003 1/28/2004 SITE ADDRESS: 4430 ASTER ST ASSESSOR'S PARCEL NO.: 1702323105900 Springfield TYPE OF WORK: Alteration TYPE OF USE: Residential PROJECT DESCRIPTION: Relocate meter and disconnect OWNER! APPLICANT: ELECTRICAL CONTRACTOR: OWNER LUKE BRAD & LA DEANNA 4430 ASTER ST SPRINGFIELD OR 97478 \0 ~ ,\~on Date: J<0 . \ '\ . r:-(:.. 01 0" ~Y' , Date l&ft~ Ot0~ ~e '00 nJ::JO" Receiot Number ~~(F;'e ~ ~ ~(ij'" !I"" . + 10% Administrative Fee 5.00 'f.0~~ J.1~UCfu\0 ~~ t~e 0200200000000001833 + 7% State Surcharge 3.50 ~9 :<.,Iai WJa6'3-~~O ~..'~0 ~0~.~0200000000001833 Service Reconnect 50.00 ~\ \ ,0 0-00~0R112 I.S.~~ ).,0'0 0 \0\e~~~(j0-\}'100200000000001833 . 0.',<.:'- J,'?Cb #\ ~".". \;a<'? ...~R ~:.\\.... To Request an inspection call the 24 hour recording~~\~~~~ ~1dSEf..tt~~~~,~b~~'7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m, ~~~~~e f~9~ia~wokI60.t'~~ ~O~~<J?o.. n\) ~ r (j0~ r.~0~('\0'~ \{\- BO. ~~,,\. ~~o.~ V~ Reouired Insoections: OCS (j~ 0~\.O ~\0~'I. 1 Electric Service: Approval required prior to utility C~y e&\-~izing service. CCB# Descriotion Amount Paid 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. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on th~~ject. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable~~~e street, and that the approved set of plans, if applicable, will remain on the site at all times during construction. \'(..~ c.. ~<0 ~ ~\~ ~-!~\~~('\y~~<'. y.\)~ Owner or Contractors Signature Date ~\..\.. "'-\~~ 'SJ<0~"'''' ~. S~ &.~ 'f?.~ ~$U"~~\ ~~\j {o ~~ ~~ S <:(~ ~x.~ $~ ~<0~' \~ ~<0~ ~\;~\J ~~~ ~~\ ~~ \J~ \;(.J~ \'O~ . ~~~ Page 1 of 1 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00179 ELE2003-00179 ELE2003-00179 Payments: Type of Payment Check Paid By BRAD LUKE Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Reccipt#: 1200200000000001833 Received By djb Check Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department" Public Works Department Date: 07/28/2003 1l:58:llAM. Amount Paid 5.00 3.50 50.00 $58.50 Item Total: How Received In Person Payment Total: Amount Paid $58.50 $58.50 .. . ~ .. 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 #: ~l..t: Z:OL_ ~ 00(7 c:; , Address: '-/ Lf 30 A-s-+6t1... ~(t Issued by: st Date: ;/z;)o.J '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, exemptfrom licensing under. ORS 701.010(7); need not submit this statement. This statement will be filed with the permit. Fil~ in the appropriat~ blanks and initial boxes I 'aiui 2, and either box 3A or 3B:' ~1. )s(i. I own, reside in, or will reside in the completed structure. t 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 contra~tor 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 I change my niind 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 nameofthe 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 Jorm. ,.' :x()ffi~cR~ ' \./ . (Signature of permit applicant) 7 -;) ~'03 (Date) (White copy to issuingaglmcy permit file" pink-copy to applicant.) Property _ owner.doc 03/11/03 : .O' ',oj . '. Acting .as'.Your Own ,General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION 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 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!l 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, caU the Business Info~ation Center at 503-986-2200. 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. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CV1l1pensation Law, and mustobtain workers: c~mpensation ins~lrance 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 fax them at 801-620-7115. Other Responsi,bilities ~nd Areas of Concerns Code Compliance:. 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. 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: Make sure you ~~ye suf~cient time to supervise ~our. employe~s. Expertise: Makc< sure you have the skills to act as your own general contractor, to co~rdinate the" work of rough-in and finish trades'; and to notifY building officials ~s the appropriate times so they can'perforrn',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