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Home My WebLink AboutPermit Electrical 2005-8-19 , rOje@J""'iIU.~. ~t~;;ing Des rot r~qu p.~, ' I i" '-v. . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3~~~ing-';---,~. ~'". ~I ELECTRICAL PERMIT APPLICATION Dato I. '~' City Job N~:b~r. ~~V:.7J:]C> ~~".~!~:!-~ . Da.,~~" .~ .~ -. ~~. i;J:-~~~:.'~ .J~ 1, l:E.OCATION9FINSrALIATlQN:, ""1 3. ::cgM.fy3TEF!,E;SC~~l1J;J}'JJELOW.' .". . 1 IDc;?-?R-~CDTI L~-: - ~-~/)~:~~/)r;--'--'---------' LEGAL DESCRIPTION A. b~;';;;R:esi'4~~!iai~~gl~'0~:Mui~~i.~11~i dW~Il~niuni~" 1 /70334// 0 boo 0 s'~~~;'Include~-~%~~~~%Q -_r"90~i'teO'~ _____.J 6(1 ""'- ~\Sl q.s t. JOB DESCRJPTION S 'IoU \0 1000 sq. fl or less 6'{qI)~ '- ~ $1 o6':ila I. ~e ~'\' ~ ~eqU\le On \.\\111\'1 Each additional 500 sq. ft. or ~vre .......... ~~qqO' v;o"";' I bi/1 [=>Oi<A.&;i-.w'jjIs'CfJ. oreg ",,\ \O(\n portion thereof .......... ......... $ I . 0 6 '9 - ~nt:..~,-- dO\?\tlje ,les'"G-''''' 00\- . ~ . Permits are ~~lIptfJ1lU'fePa~~\~~.dl'J.lliTe IPr;~Jf.,n 9<::,2- 'eN Each Manufact'd Home or .> not started Wh'ti\';'c.t..~Ib~bTm~~e:e~Ww8r~',is l\lles Modular Dwelling Service or $ 0 Suspended t/Wrilb~~.OO\ O\ain CO?\es e \ele?none n Feeder \'~~^'l tm\'l_O_- ~\~~._~ICa\\O ,. -;---- .. '. - ---, 2. I'CqNT~wr-<!.ItW'c'~ ~~A(:))Vl.~, B. L ~~~vices or Feeders'- ]!lstallation, Alterations or R~location: , co\lll'\9-",' I \\'Ie Ole 0 ':) 'l~ Electrical Contra~;ll\'oel...~n\el IS \.aO - 200 Amps orless $ 63.00 -' 201 Amps to 400 Amps $ 75.00 Address 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 City Phone Over 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 Supervisor License Number ~n ~\V J~ D C. r:t;niporai'y SerVic~"';'Feede'rs Expiration Date Installation, Alteration or Relocation 200 Amps or less \ $ 50.00 .. _. 201.Amps to~OO(Amps $ 69.00 \,~I.: \I""f' II S\II\LL t)\P\R40\rA'~Ps\;~600TAmPS $100.00 E . . D "j15 I-'l ,I" '0 '\-I\S Pt\'l\\\I' v'" xplral10n ate ",;'; '.:'"""_,, \ Over 600fAmps or 1000 Volts see "B" above. },\.l\11UIW . \S 1\\:li\Nlf1;"':-":--:-. "" . --.... ---- . Signature of Supervising Electrician \tN\,ll) UK D. , Branch CirCUIts. ' 1,,01'''\\, pt.RIOD. ----- t\\~'< WI" lJl\'< New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit FlO,oD Constr. Contr. Number , I I $ 43.00 OwnersName )JON CAJJAVA-N Address I ",-40 Sb{FF~ON $ 3.00 E. i'J\11sc'~U.aneous (S~rvi~e/feeder notind~d~d) ~E.ch Installati~~j City t::-t Y:f:::=AJ C;;; Phone ?iqq -qgfplf Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. r~~tOi1LOFAB9~~ ~_L._ _~J t;O \ DO ~~, !Sf} r;. 00 C\ S? ' ;:;0 7% State Surcharge 10% Administrative Fee OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. O~~~tur~N-- Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building FonnslElectrical Pennit Application l-Q3.doc . Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1055 PRESCOTT LN ASSESSOR'S PARCEL NO.: 1703341106000 PROJECT DESCRIPTION: Temp power "" Owner: DONALD CANAVAN Address: 1540 JEFFERSON ST EUGENE OR 97402 Contractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Primary Construction Type VN Secondary Construction # of Bedrooms: Front yard Setback: Side 1 Sethack: Side 2 Sethack: Rearyard Sethack: Solar Sethacks: Street Storm Sewer Available: Special Instruction: Notes: Description Type of Construction . CITYOFSrKll'\i"d'lELD Building/Combination Permit PERMIT NO: COM2005-01131 ISSUED: 08/19/2005 APPLIED: 08/19/2005 EXPIRES: 02/19/2006 VALUE: Springfield TYPE OF Electrical Work Only TYPE OF USE: Addition Residential Phone Number: 541-344-4864 I CONTRACn:j\r~i>0RMi\(JWrll.' I ! /I J' "III" · I aw requIres yo t N ,. "'~ aOopted by t~ u 0 ot/ficatlon CEllliw.n!ffi ~fiOD1tDl!te Phone ~~AR .952-001-00'10 t~.~~,_!~Ua?a set forth -;. \,." ':f.~r.= J. _1,,, <JOe 001 I BUILDING lNF(lRM '" I In Copies of the rut - b - nUmber fa -., 1,1,. (Note: the tel h as y # of Stories: r the Oregon Utility~~mep~e Height of Center is 1-800-332_2~ ~'fatFil1or: Type of Heat: Sq t 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled nla Occupant Load: , DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: IPUBLIC IMPROYEMENT.SI .,..v, .., ..."T SH~I L F\lPI~f: It. THE: WORf' AUTHOR'Z"D UNSidewalk Typ.e: ' I C I UtH I HI~ /"tHr-.:IT IS NOT COIVifl1ENCED O:I;'\'~~~~,tS8,~~IesFOR ANY 180 DAY PERIOD. . . . . I I Valuation Descrintion I $ Per Sq Ft or multipUer Square Footage or Bid Amount Value Date Calculated 1 of 2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01131 ISSUED: 08/19/2005 APPLIED: 08/19/2005 EXPIRES: 02/19/2006 VALUE: Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax . 541-726-3769 Inspection Line Total Value of Project Fees tlWU Fee Description + 10%. Administrative Fee + 7% State Surcharge Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 8/19/05 8/19/05 8/19/05 1200500000000001218 1200500000000001218 1200500000000001218 Total Amount $58.50 I Plan Reviews I To Request an inspection caD the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wiD be made the following work day. IRpn~ Temporary Electric: Approval required prior to Utility Company energizing pole. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon Is true and correct, and I further certify that any and all work performed shall be done In accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY wiD be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. , I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans wID remain on the site at all times during construction. Owner or Contractors Signature Date 2 of 2 ... .' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit#: CO",",W.- 01/ 3/ Address: /0.-;-5- Pt<&<:;C..CrTr L-N (fJ. . . \, l ", ." " .' . .' Issued by: "bL$ Date: - ()x -I (p -OS Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constroction permit applicants who are not licensed with the Constrnction 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 befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ I. I own, reside in, or will reside in the completed structure. !8r 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 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. i'Jar rJtfjdPPffi- ,...- n K - liP -OJ (Signature ofpennit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Property_owner. doc 06-01-04 ... .. Adnlffi~ ~~JI ([J)unIr' CC>>W1lll CGteIIDterr~ll C([J)IID~Ir'21tC~([J)Ir'? H\lFORftIlArtON NOTICE TO PROPERTY OWNERS AB9UT 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 cab prevent many problems by being aware of the following responsibilities and concerns. JEmJPIn~yeJr ResJPI~llllsfilb>m~fies 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 a residential structure. As the employer, you must comply with the following: Oregou'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 more infonnation, 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. "- The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment fnsurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.lIr.us/formsnav.htmll for the appropriate forms. 1 Work.ers' Compensation 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 could he subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more ihformation, 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' waget:. You will be liablb 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 www.irs.l!ov. On:llneIr Re~JlDonn~nJ)}nmne!> ann<<ll AIrea!> OJ[ <Colllll\:errllll!> Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code I requirements that may be brought to your attention through inspections. Liahility and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for aCcldents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must ble redone. Time: Make sure you have sufficient time to supervise your employees. IEx,ertise: Mak:e sure you have the skills to act as your own general contractor. to coordinate the work of rough-in and finish trades, and to notifY building officials as the a...." v.... ;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, Sale;m, OR 97309-5052. I Property_owner.doc 06-01-04 : 225 Fifth Street 1 Springfield, Oregon 97477 I ,I 541-726-3759 Phone ~ . ........~"llI'I....~ __ ..;. ~! . '! I j . '"'I~-''' . . JIlty of Springfield Official Receipt .velopment Services Department Public Works Department . . . , RECEIPT #: 1200500000000001218 Date: 08/19/2005 10:57:14AM Job/Journal Number {.' COM2005-0 1131 ~ COM2005-01131 '. COM2005-01131 Deserlption + 7% State Surcharge + 10% Administrative Fee Temp Power 200 amps or less. Payments: T)}le of Payment CreditCard Paid By DON CANAVAN Item Total: Check Number Autllorlzation Receh'Cd By Bateh Number Number How Reeelved djb 054515 In Person Payment Total: Amoo nt Due 3.50 5.00 50.00 $58.50 Amount Paid $58.50 $58,50 . i' .' .. t :1 - 'c ; \ f ~ i " " . , L :' '. - I t . .' >- ,. t.. , , , , 8/1912005 1 of I