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Home My WebLink AboutPermit Electrical 2007-9-4 '~~IA~~. DA TE ~_.{')~ SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT 4fPk~TION City Job Number (' n". V !J'J . - .- 2. : CONTRACTOR INSTALLATION ONL! B. . Services or Feeders - Installation, Alterations or Relocation: Ele 'cal Contractor / 200 Amps or less $ 70.00 201 Amps to 400 Amps $ 83.00 401 Amps to 600 Amps $138.00 601 Amps to 1000 Amps $180.00 $413.00 Reconnect Only \ $ 55.00 --.55.cU ~p-emON: Oregon law requbs_ Numbe Noti::::S adopted by th~OrdglPJIr~ Services or Feeders In OAR 952 ~fder. f nose rules are set f~ffy ??oo You ..Q01-o010through ~~1teration or Relocation CIIi'ng th~:~:~h:NCOtPies oJ<1@~Sl~ss ftUmll., . \' 0 e: t~'A~ 118r .or the Oregon Utility ~. ~ 400 Amps Center'8 1-800-332- t_~l?9600 Amps . C?ver 600 Amps or 1 000 Volts see "B" above. D.. l_I3~~nch Circuits New Alteration or Extension Per Panel One Circuit ~. ~ . Each Additional Circuit or with \n. ("\, ^ \^ i1 ... - {? Service or Feeder Permit $ 4.00 Owners.Nlme uu. \ ..~:.)'-:-, . . s \ fE.S\O..e. a.b 5o~ ~~:Y\a.~~neous (Service/fe_eder not included) -Each Installation Phone q\S4\8) 1. LOCATION OP):NSTALLATION: bS~ ~ \\\fuo..uJY- LEG\ii~D~) - JOB DESCRIPTION: ~ CDl\{\ffX- tled- .~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. City Expiration Date consrr.conrr~ Expiration ate Date 3. COMPLETE FEE SCHEDULE BELOW A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufac( d Home or Modular Dwelling Service or Feeder $117.00 $ 21.00 $55.00 $ 55.00 $ 76.00 $110.00 $ 48.00 Pump or irrigation $ 55.00 Sign/Outline Lighting $ 55.00 Limited EnergyIResidential $ 28.00 The installation is being made on property I own which Limited Energy/Commercial $ 50,00 is not intended for sale, lease or rent. . Minimum Electric Permit Inspection Fee is $50.00 + Surcharges Own"". ,.: a 4. r SUBTQTALOFABOVE ' '(')~~ _ .....~..:> HlmfSffAlL EXPIRE IFi~JiM10iKcharge -. ........ .. ..------ - ~ () p,y / . E& tINDER THIS PERM~liolld\1OiJistrative Fee ~ '5(l '--"" ) ~ COMMENCED OR IS ABANDONE8fOOhnology Fee g-.1 <; ANY 180 DAY PERIOD. -- - Inspection Request: 726-3769 TOTAL \ n\_ t.oS Shared Drive(T:)lBuilding Forms/Electrical Permit Appfication 7-07.doc Ci Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 555 NIGHTHAWK LN ASSESSOR'S PARCEL NO.: 1703274203600 Springfield PROJECT DESCRIPTION: Reconnect electrical service to residence Owner: Address: FRECHETTE BRIAN J 408 PALOMINO DR EUGENE OR 97401 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 CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01329 ISSUED: 08/31/2007 APPLIED: 08/31/2007 EXPIRES: 02/29/2008 VALUE: TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential Phone Number: 541-915-4750 I CONTRACTOR INFORMATION I BUILDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: License Expiration Date Phone n/a 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 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Page 1 of 2 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01329 ISSUED: 08/31/2007 APPLIED: 08/31/2007 EXPIRES: 02/29/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Paid' Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.50 8/31/07 1200700000000001143 $2.75 8/31/07 1200700000000001143 $4.40 8/31/07 1200700000000001143 $55.00 8/31/07 1200700000000001143 Total Amount Paid $67.65 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 InsDect~ 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 Pa2e 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 #: ()t - \2il...Q '\".1.--' 6 Address: ~~ \J \~ ~\ Wo_} ! Issued by: \ 1 ~f\ Date: C?? ~ (- 0 ( '-' St~tement: .Info. mation 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 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 9RS 701.010(7), need not submit this statement. This statement will be filed with the permit. the appropriate blanks and initial boxes 1 and 2, and either box 3A or,3B: 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 -ct-e :fn'~ 3B. I will be my own~ontractor, . If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCBand 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. \ . (Y, \~ --, /~ ~A) r (Si~~ofperffiit applicant) " (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 . . - '-'._ .f ,. - , A-cting as{Yo'llt Own General Contractor?,' " '- _ ~ I. ~',' ,I t, " " ,fJ-:; - ; ~ 1 .. ; " . J _, ',,: , '.! 'I~FORMATION\NOTICE TO :PROPERTY OWNERS . ,~. I' ,,",,, J:'-- .-'\~ ABOUT CO~NSTRUCTION'RESPONSIBILlTIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 70'1.055(5), passed by the 1989 Oregon Legislature. . . , . If you are acting as your own c01!tractor to construct a new'h<?me or make a substantial iUlplovement to an existing structure, you can prevent many problems by being aware of the following responsibilities and:concems. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and.the.cQntractors you contr.a(.(t,withwill1;le "employees" if you use c~mtractors not licensed with the Construction Contractors Board' to do labor.in co:nstructing'or to assist in the construction or ~~Uplov,e.nient ofa resi~ential struct~e. As the employer, you ~ust comply with thefonowin~: Oregon's Withholding Tax Law:"As an employer, you must withhold'in~'ome taxe; 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 information; call the Department of Revenue' at 503~3 78-4988. . " Unemployment XnsurallD.ce 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. ~ I ~"- , . '" ~ ~. ,_. -;. .<. . ". ~'.' _. ':. . - ....~ . - d.. " . ~ ~... . .~ .', ok ," The Oregon Business Identification Number (BIN) is a combined number for both. Qregol1 Wi~hholding and Unemployment Insurance Tax. To file for a BIN, can 503-945-8091 or \vww.doLstate,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' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could oe subject to pehalties and he' liable fora:l(ciaim'costs irone ofyour'empl'oyees';is injured on the' job. For more information, call the Workers' Compensation Division at the Department of Consumer-arid BUsiness Services at 503-947-7815. , ,l.,' '- -' .) j \ ..it' . 1 J J' ) i J -. U.S. lIlIllterllD.al Revenue Servnce: 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 1-80():.829-4933 or Visit theirweb site,at\v\vw.irs.lwv.,' ' "',1 ' 1 . '.:" _., t- ..... , , .-- . , " .OtllneJr JRespilJr[jl~j1b>iU1l:iie~ ,21ml.(dlAJrea~ of C([J)JIll~eJrri~', ; " .. Code Compliance: As the permit holder for this project, you are responsible for resofving' any 'failrtre tb meet code requireme~ts that may be bro.ught to YOll! ~~e~tior, t,hrough i~~pecti?ns. . _, ,. Liability and Property Damage 1II1lsluance:'."Contact yo~r insurance'ageilft'o see if you have adequate 'insurance , coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe I::mctures, 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; ovm general' contractor, to coofdinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. Tfyou 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 Spril!gfield', Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01329 COM2007-01329 COM2007-01329 COM2007-0 1329 Payments: Type of Payment CreditCard c Receint 1 RECEIPT #: Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By BRIAN FRECHETTE City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000001143 Date: 08/31/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received llh 709520 In Person Payment Total: Page 1 of 1 2:03:39PM Amount Due 55.00 2.75 4.40 5.50 $67.65 Amount Paid $67.65 $67.65 8/31/2007