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Home My WebLink AboutPermit Electrical 2007-8-31 ZON L~~ INITIALS ~ V'"'" . DA TE <6'::' I -- v , SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION '\ City Job Number torYlZCfO 7 -- 0 1 0 I c; 1. LOCATION OF INSTALLATION: ,t-J;~;()' } ?---cfL < /"r:1 /,;\f/';) I '{./ II -' .'"7 () , ..J. j-'tO" L4- / LEGAL DESCRIPTION: ., /. 'J -' ~~ / I ' - I // /),,', /1"-" L.-/-fC rr~(CL' / JOB DESCRIPTION: ),,'/1-(' /r / )1 0 ';;;. 3, '".? II (J 0 ~ 0 I 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. CONTRACTOR INSTALLATION ONLY E~cal Contractor Addres ./ City Expiration Date / Constr. Contr.yumber / Expiration'Date /' / Signature of Supervising Electrician ./ ~ ~ ./ Owners Name . ~ -:;'V1 Cj JtJlh r 1/.- .#c /k015 c-,:/i..... rl /-- <;-<}j Address '7~v ;( ) City c;;Ok.// oK Phone '7t,//-Y7tv{~ 5/7~ 7 57/' I OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~, L9 o ~ign >. ?;~L-/A~ ~----_ <.-. Inspection Request: 726-3769 rYI, r~p ~ Date g' ~~:J J "07 3. COMPLETE FEE SCHEDULE BELO"' A. New Residential - Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additiona1500 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 Over 1000 Amps/V olts Reconnect Only / --JO,UV $ 70.00 r ' $ 83.00 $138.00 $180.00 $413.00 $ 55.00 C. Temporary Services or Feeders '(tf1CZ-Z'~C"009.l Sf J8JUeo Installatio\O!n~YlH!I1h~~!fGIUQtiMD 'etn 10# JeqtUnU lJOyu8le) S4J :GlON) 'J91uao e A 200 AmpQcplSl~J fnH Je} se!doo lJfefyv ,few fS1J~lM~e:J 201 Am~~...,. OO;~..' ~ 4.10nOJ4l 0 ~OO ~6~f..!~~OO. 401 Am~~~~~elfll aS04..L "allJ60 _~ UI Nli'm uop,a~lJl,((] ~ "UvN Over 600 ~^,I$tB Ol'l'S'~eJ>~ ~~lnJ MOIlOl " J Mila uOfieJO 'uO" U:I' " D, Branch CIrCUIts '1.'1 ...'t;;uJ.y New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Servioe or FeeQer Permit $ 48.00 $ 4.00 E. l\1i~i~lrii~fJ~fWJr~~~~tRmfu~tuUlij W:QM:nstallation "I }1"L.lrd~)!!lD lJNDf:R TH!S PERMIT IS NOT . I' . i " . .~ C" ,. 1'1 ,1 ;0. I 1"", t'.~. '; 1 ~~. f'., C ~c Pump~lrtigatbn ic.l 1",bhl\UUi\ltU., \mOO SignlOutldne'Llg1itili.g D. $ 55.00 Limited Energy/Residential $ 28.00 Limited Energy/Commercial $ 50.00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges _ 4. SUBTOTAL OF ABOVE '70 . (fZ) 8% State Surcharge 10% Administrative Fee 5% Technology Fee fl~- iO TOTAL Shared Drive(T:)/Building Forms/Electrical Pennit Application 7-07.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01079 ISSUED: 08/31/2007 APPLIED: 07/20/2007 EXPIRES: 03/01/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 700 58TH ST ASSESSOR'S PARCEL NO.: 1702331100201 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Building Addition without Permit(s) Owner: HANSEN TIM B & ANNETTE J Address: 700 N 58TH ST SPRINGFIELD OR 97478 Phone Number: 541-741-8760 UO""'''I'' ',<f7;"CZ-(;88-009-~ 91 JcL CONTRACTOR INFORMATION' ,~~~ !:II'ON i\WU" uoBe 'a 'a4' JO~'-.I . "1 '0' 'rJ... ,. I · t t Jaqwnu . Contracto~ Type v;e;GQotFft'ftpr.J81UaO a e: License q sEllnl 8tH}0 SBldoo una LlJ &Jum~o -, ^^ ....,~- . .. -' . 100 AP.II' nl'l\ 'e~'" -. ~~vl;.JvUyuIIUJl./lOl' ,l.w,' 4llonas €w:/ saIni as041 '~aO-WO COO-" INFORMATION ^lIl!Jn 1I0BaJO a4lliq peld Juaa . !lON # of Units: Ol noli saJjnbaJ Mel uOBeJoP~ safOJ JI#QIJtlJtories: Primary Occupancy Group: 0 .NOIlN3IlW,ght of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type Water Type: Secondary Construction Type: Range Type: # of Bedrooms: Energy Path: H ,', .. Sprinkled Building: n/a 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: I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overl:w'Dist-:If'''''' Total: "I;"j K I1II .",. # Streetlr.eeSPRqd: Handicapped: pav~ief.~~fRq~':l!T SH Compact: % oito{ fl6fl;;.,a?!J U 'ALL EXPIA Aft~~~ENC~n n~~~A THIS D~'! THE IAInn" I PUBLIC IMPRbVEM~rAPf~~D~BANDON~DVIlI IS NO:;'\ . FOR Sidewalk Type: Downspouts/Drains: . Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2:e 1 of 2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01079 ISSUED: 08/31/2007 APPLIED: 07/20/2007 EXPIRES: 03/01/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid' Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $7.00 $3.50 $5.60 $70.00 8/31/07 8/31/07 8/31/07 8/31/07 3200700000000000591 3200700000000000591 3200700000000000591 3200700000000000591 Total Amount Paid $86.10 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. I Reouired 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. ~;L~/Jt( r3/-0/ ~er or Contractors 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 #: CGiY{7_D7Y7 -- 0) 07CJ Address: t OL:> _ b '(S"4t, :s J Issued by: flJo/Y"t~^' Date' i I s I f 0; G 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 1 and 2, and either box 3A or 3B: ~ 1. I own, reside in, or will reside in the completed structure. D 2. . I understand that! 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. . 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. (2,!-II//7, ~ (Signature ofPermit applicant) 9~ 3/-Q:7 (Date) , (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 ,- I '..l (' )..:. A~!ing -as"you:r :Own'General 'Contra,ctor? )". "'., .-.. . ''') - 'I ,-' . ,. "', "~ . ,'.. 'INFORMATION'NOTICE TO PROPERTY OWNERS . ABOUT C9NSTRUCTION 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 RespolnlsibHities , .. You will" in most instances, be ruled to be an "employer" al1d tl;1e contractors you contract with will be "employees" if you use contractors not licensed with the Copstruction C~ntractors Board to do labor in constrUcting or to assis,t in the , . construction or improvement of a ,residential structure.; As tb~ employer, you. must comply'with ~be fon9wi~g: . . , . Oregon's Withb~lding Tax Law: As an employer, you must withhold iricome taxe~ from e~ploye~ ~ages at the time employees are paid, You will be liable for the tax payment~ even if you don't actually withhold, the tax from your employees. for more information, call the DepartmenfofReveriJe' at 503.J78-4988.' .' Unemployment Insurance Tax: As an employer; you are required.to.paya tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. .....f! . The Oregon Business Identification Number (BIN) is a combined number fort'>oth .QregonWitQholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or Ww\v.dor.slate.or.us/fonnsoav.htmll for the appropriate forms. , . . .:- .; -, Y, Workers' 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' cVlupensation ../ '. . '> ."" . ,", ' '.' - . insurance, you could be subject to penalties and be liable for al1"Claim co'shhf"one of your employeesisinjured 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 inconie,tax.tro'frf'employees' wages,. You win 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 'vi sit their web site at w\vwjrs;gov. ' .," . . .., . Otlhler Re~po'usibiJliitie~ alnld Areas ()If COIDlCCrlnlS ,'. . Code Compliance: As the permit holder for this project, you are responsible for resolving any fai1~re 'to meet code requirements that ~y be brought t~. your ~ttention throllgh ~nspections: . . Liability and Property Damage'Insurance:"Contact yourinsuranCe ~gentto '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 have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as you~ ~wn gerieral contractor, to coordin~te 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 call 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 Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01079 COM2007-0 I 079 COM2007-0 1 079 COM2007-0 I 079 Payments: Type of Payment Check cReceintl RECEIPT #: 3200700000000000591 Date: 08/31/2007 Description Penn Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By ANNETTE 1. HANSEN Item Total: Check Number Authorization Received By Batch Number Number How Received njm 9837 In Person Payment Total: Page 1 of 1 11:23:20AM Amount Due 70.00 3.50 5.60 7.00 $86.10 Amount Paid $86.10 $86.10 8/31/2007