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Home My WebLink AboutPermit Electrical 2006-4-20 Date ZON~ INITIALS tJ M. ~ DATE \t'-)O~ ~'I SOURCE HHS"rz.'j L((~o/~oD(o . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (54])726-3689 ELECTRICAInPERMIT APPLICATION.. ' City Job Number ('OYY)';? f\[j,tJ - 00 %~ 1.' LOS~T!qIJ rYFiIJ~T4ATI0~' ". .. L/L/JrJ ~6+~R>"6+:S\?~:~~(~ (J\~, LEGAL DESCRIPTION ~e?~StJ '~\QG-,j\\ ~ll~t~( &~ JOB DESCRIPTION \~10?-3~ 31 OSKoD 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. .':'<~,>'-'t:~, '.;:::./.... . .' ~..:", :.:^..,.,~, ,:,,'" .~'>. .'._.', ," <,'. ." CONTRACTORIN8TALIATION ONLi- " , . "...:~;. .,' .,^, Electrical Contractor Ad~ / City ~ Phone / Supem'", L;'en~ /..// ;/~ ~ "'-, '" Expiration Date // Constr. Contr. Number EXP~ Signature of Supervising Electrician " Owners Name G.), \ \.AvV\ M. \Jf\U(~~f\JI' Address 441D kfeZ -51-- City ~fl.'^-b-\~.Q.\~ Phone 71f( - fa 77~ OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, 'lease or rent. Owners Signature: ~)~h:~~ 'Yt-7. JJLJL v G:;~:::ques::~ 726'-3;6~ ~----'\ ---------- / 3. COMPLETE FEE 8CHEDULEBELOHr':: , ..' ,,~, ..Y. 1000 sq, ft. or less Each additional 500 sq. ft, or portion thereof $106.00 $ 19.00 ,/' Each Manufact'd Home or Modular Dwelling Service or . t.,?\ F d . "",':''11\\' Oreaon 1rl.\N requIres ~t,j,~tJ e~er ;":': ;"If:',l;~ ;qCp;'~? by tbe 9r~gon~~:~ ItYth"""; B. ,. Servifes: Orl~f$fI,e!:~2.T4!l,~tanation,r1tlrr€r~[fons-!or1{elocation: _ ,.' <, o~-:)_()O(Ob10 through OAR 952~001-, 200 Ad;ps.'o,r,'i~;~~-rnay obtain cop~ of tr$88Y.OOs by IJI,,,,J, IU t..' I h.anb 201 AmpsC2.':1i9~J1:mp~enter. (Nott!: tile te~f5.Uo. 401 Amp~ltg>:RQJbAmpshe, Oregon ,~t,I\t:YI~j;tI~5~~orl 601 Amps to 1000CAIRifsr IS 1-800<:~0Z-<::.j }163.00 Over 1000 Amps/Volts $375.00 Reconnect Only $ 50,00 c. 21' emp()r;ary'Se~j,~es' ~~F,eed,e~s Installation, Alteration or Relocation .~, ~ J ,: . 200Aim~s' or less ~ $..~O 201 \f.fm~HbMbO ~~~~.L E.XPIRE _I: I.~...E ~r 0 '40\llXMp'ltb?gOO I~JAg~R THIS Ptti~~ I_~ ~ ~OO rn~r,l"~l=~cr:n q~\~ ARANOOOtLJ ruh over .600 ~m. '.p.~. '..'.6 rp...c.O.,.. 0.,..J::v.O~. .ff,t. s see "B" above. li..t\IV 1 Sf: LJ}\Y. '1.'.11:).' ' .' .' D. 'BrancH,.ClrcUIts . ..... "'" ., ' New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. MisceHane?us. (S~l:vice/ieeder notiI~ciudedf---Each Iu'statlation v~-!;"._~...,. ",v,," ~.:;...~ _. Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges -;-,,' 'j' '''~ . ":, :-K~n-'-~- . ~ ~ 03, .5. () (/ 0, (5 iJ '-1.c.; \ ci? ~' I . ,!:~ i 8% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fanus/Electrical Pelmit Application I-06,doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00466 ISSUED: 04/20/2006 APPLIED: 04/20/2006 EXPIRES: 10/20/2006 VALUE: SITE ADDRESS: 4410 ASTER ST ASSESSOR'S PARCEL NO.: 1702323105800 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Replace 200amp service Owner: WILLIAM M VAUGHN Address: 4548 DAISY STREET SPRINGFIELD OR 97478 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-741-6772 I CONTRACTOR INFORMATION I License Expiration Date Phone R-3 BUILDING INFORMATION I # f St . ATTENTION: Oregon law rfiC!lt'is"r;>c; 'IOU to o ones: '1.:;0 lze: Height r,T~J1:~~JvJes adopted by thesi{FV1>ft 'FWSv: Type Of\~Ut~catlon Center. Those rUSq'3IW2ln'03F(06t.~ Water T9~l\R 952-001-001? thro~gISqJFtFBa~ehf'e'iH:. Range ~~~p'. You may obtain cople$qfF.:tl,c;atlfge/.~arport Energy paih::!lInQ the center. (Note: tlSq '1ttk~Jhl,}ne SprinkledlBU1ilaiifgor the OrE~a>n Utjli~qc;l!p.~)!t~!!l,lP: r"...........I-__:_ ~ ,....,,^ ,...,,.,ro. .............. ..\ - _r".._f ...... , _..,..., .....v_ t..\J'"j. I DEVELOPMENT INFORMATION I VN REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: ~~~'~i~M\T SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT ,-,'-';v',;v~C~:~D ~D \~ fiRANnONED FOR I Valuation DescriPti~.N'1180 DAY PERIOD. $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00466 ISSUED: 04/20/2006 APPLIED: 04/20/2006 EXPIRES: 10/20/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project L Fees Paid I Fee Description + 10% Administrative Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $5.04 $63.00 4/20/06 4/20/06 4/20/06 1200600000000000522 1200600000000000522 1200600000000000522 Total Amount Paid $74.34 I Plan Reviews, 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. LReouired Insoections 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 Pal!:e 2 of2 . .' 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 #: Cb~ Z-O 06,- Q,O 1./6 b Address: L{/,{! 0 'It--r~/L ~.1'" Date: Lj /Z-(f /0' b 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 follo~ing 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: ~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 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 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 form. ~~O L /1--1. lLl~__1f (Signature ofpermir1{pplicant) , LJ-Jo r-oto (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 tJ . " '. \ (- t; \ ':; ~',. ., '. ' \, \.-- Actirlg'(as'. Y~u't'Own General,Contractor? .' I~F6RMATION'NOTICE TO PROPERTY OWNERS ABOUT J~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 construct'~ new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of Jhe following ' responsibilities and concerns. Employer Responsibilities You will, in most instances" be ruled to be an "employer" and the contractors you contract with wiJl be. "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the qonstruction or improvemep;t of a -residential structure. As the employer , you must comply with the following: Oregon's Withholding Ta~ L~nv:'As ~n employer, you must withhold inco"tne.taxes froinemploy~e 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. . . J-...... 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/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensl1:tion insurance for your .e~p10yees: ,If you fail to obtain wo!kers' cVJ1lpensation insurance, you could be subject to penalties and be liable for all 61 aim costs ifone 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 withheld'federal'income tax from'employees' wage~, 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 site at W\....'W.irs.lWV. , Other &esponsibilities and'Are;ls ofConcer~S Code Compliance: As the permit holder for this project, you are responsible for r~solving 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 ~amage from pipe punetures, fire or work that must be redone. ' , . .. , ..) I I , ,", :-~"',:",,, ~-"_. ,.-.-. .' .;,:...-c:;}f',.!.,,:t( Time: Make sure you have sufficient time to superviseYOl.iremployees; . '. " -. ~ .7 '\, . , '. Expertise: Make s~eyou h~v~" the skills t~ ~ct as your own g~ner~l 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. 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- owner.doc 06-01-04 225 Fifth S~reet Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2006-00466 COM2006-00466 COM2006-00466 Payments: Type of Payment CreditCard cReceint I RECEIPT #: r of Springfield Official Receipt .lJ~velopment Services Department Public Works Department 1200600000000000522 Date: 04/20/2006 Description Perm Serv/Fdr 200 amps or less + 8% State Surcharge + 10% Administrative Fee Paid By WILLIAM M VAUGHN II Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 135338 In Person Payment Total: Page 1 of 1 2:00:06PM Amount Due 63,00 5,04 6.30 $74.34 Amount Paid $74.34 $74.34 4/20/2006