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Home My WebLink AboutPermit Electrical 2007-9-7 ZON 225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION ( City Job Number ColA/\. 7007-- 0 I ~ b L Owners Name S\.~..\.n.... ~......<o::t ~OTlCE: ~::'~I~~~~;~;~:e ~;~~~ it~~::::~r~~ OWNER INST ALLA nON HRrited EnergyIResidential 1. 3. ~~\ \ ~~I....~3.. LEGAL DESCRIPTION: 170"33 L(ZZ JOB DESCRIPTION: 6Dt-.O l' ~l:""'l""""dt::VL ( 3' c \ r c loA. '\ +-s f 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. Electrical Contractor Address City Phone Supervisor License Number Expiration Date - ~ f~/ O~I/ ;1 Constr. Contr. Number Expiration Date Signature of Supervising Electrician The installation is being made on property I own which is not intended for sale, lease or rent. ~s Signature: ~ ~~\ ~"'-~ ~~ "--.) \ Inspection Request: 726-3769 Date , { A. 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 $117.00 $ 21.00 $55.00 B. 4QO Amps or less $ 70.00 :,20 rNrii~lsJ:PJ4~ Amps $ 83.00 , -".....!0; f"l" . regOlJ I .r:'J':Wih~fops~ca~P6 aW reqUirea $138.00 In C6(U1~mP-s908IfOOO _ the Orego,(~~,!O $180.00 G09el u 11i1k11l...n' e rUles "'ty ~~Mo1.PJW~ !'V;J\u'tttOUgh are Set forth $413.00 n Caf{~rtn~bf1~ tam COPies ~AR 952-00-1.. $ 55.00 umber for n er. (Not. 0 the rUI C. - 2-2344). tio" Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 70 $ 55.00 $ 76.00 $110.00 Over 600 Amps or 1000 Volts see "B" above. D. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit "\. ~ $ 48.00 $ 4.00 IL 4. 82 bn.... 8z'O l(tO /00 Bb 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 7-07.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: COM2007-01364 ISSUED: 09/07/2007 APPLIED: 09/07/2007 EXPIRES: 03/07/2008 VALUE: SITE ADDRESS: 1231 JANUS ST ASSESSOR'S PARCEL NO.: 1703342200209 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Add feeder and 3 circuits Owner: SHEILA PAYNE Address: 1231 JANUS ST SPRINGFIELD OR 97477 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: 541-736-0883 I CONTRACTOR INFORMATION I License Expiration Date Phone R-3 BUILDING INFORMATION I . ~ TTENT/ON: . # of Stoi:ie's.:W D'U6es adOregon law reqlHPeiU:6' 'J Heigh~!lf!1Mt:;en~ted by the O~h"1~:~i or: Type UHiAA:952-o01_0;; Those rU/es%tgs~p~o oor: WatePlf%~:You may obt ~ thro~gh O~ . nt: Range ~l.f:Ig the center.81~Ncop'es Of$h'1tJiW~/Carport Energ9~er for the Or~ 'I ote: !he ~9Hi~ Sprinkled Bui1lij"ger Is 1ioOf1(lJtllity Nott~oad: eJ:.f32-~'I\JI. I DEVELOPMENT INFORMATION I VB REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUJiU(JIM~ROVEMENTyP Int\) n:ntvlIT 311A'tt IRE !F THE WORK AUTHORIZED UNDER THIS ~f\WmI~9'Wf COMMENCED OR IS ABANDQ)NiIi\,~/Drains: ANY 180 DAY PERIOD. I Valuation DescriPtion' $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa~e 1 of2 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01364 ISSUED: 09/07/2007 APPLIED: 09/07/2007 EXPIRES: 03/07/2008 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 L Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $8.20 9/7/07 2200700000000001409 $4.10 9/7/07 2200700000000001409 $6.56 9/7/07 2200700000000001409 $12.00 9/7/07 2200700000000001409 $70.00 9/7/07 2200700000000001409 Total Amount Paid $100.86 I Plan Reviews, 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. Reouired Insoections I Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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. q-I-\J~ , Date Pa2e 2 of 2 .' ConstructionCoiltractots 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 Pennit#: CO~'Z..o~7- 01 '"3.64 Address: I ZJ I J,A-IVlA- ~ ""]):1' Issued by: Date: s} 9h~7 /' / ,~tatemeilt: Information, Notice to Property Owners . .About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not . licensed!Vith the Construction Contractors Board to sign the following statement before a building permit'c(ln be iss!-,-ed. This statement is requiredfor 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 thepermit. Fill inthe appropriate blanks and initial boxes 1 and 2, and either box 3Aor 3B: ~ ~. I ()Wll, reside in, or will reside in the completed structure: I understand that I must become licensed asa 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. P 3B. I will be my own general.contractor. If! 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 theCCBarid 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 ofthis form. .. ~ ~,~ .~ ~ '\ <:!.-L. ~ ~e of permit applicant) <1-')-0') (Date) (White copy to issuing agency permit file, pink copy to applicant.) . ' Property _ owner. doc 06-0 1-04 '"\'"' -. ~ - ~ ",">-..:.. \' " V" , ., Acting a~ ' ' OU~. (" ;, INF'ORMA+ION'.,~OTICE 'PROPERTY OWNERS ABOUT"CONSTRUCTION ,RESPONSIBILITIES .... General Co'ntractor? ."" :;""'\"'.1 ,,"-, '\. " '. . -\..... NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction-Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature. If you are acting structure, you can , . your own contractor to, con'struct' a pew , or Ii'substantial improvement to' an existing many problerhsby being aware 'oHhefollowing'responsibilities and concerns. Employer . ..' Tax Law': As'an employer: you must . You be, liable .for the tax more call the ..' -- . \. contractors you ~ontract witl,1,will be "employees" if to d() labor in construc!ing, or to as~ist in the you must co~p~y with t.~e followi}~~: income taxes from employ~e wages at the time you don't actually withhold the tax from your 50J,3784988~ :' . , " . . . You will, in most ip,stances,.be ruled tO,.be an , . you license<;l \yith,the.ConstrucJ;ion of a re~identi;il stru~ture. ,on Tax: As an employer-,-you all employees. For more information, , -.', tax;for unemploymerit,insurance purposes..' . "- Employment Department at 503-947-1488. '. , . Identification Number (BIN) is a Tax. To file for a BIN, can ~ ',.' ;'.: .......... number botl}-; Qregon Withholding and)- or \v'\\-'\v.dor.state.or.us/fonnsoav.htmll for the \~ ';. Insurance:' As an employer, you are subject to c~1J1pensa~io~ insli1:a~ce for your subjecftbpertalties ai1dbe liable can the Workers' Oregon Compensation Law, you fai~ to obtain ~~~kers' cvwpensation if one of YOl}r employees is injured on the 'at the'Departriien't:bfConsurner:and Business and obtain YC)U job. For more at 5, .......... Service: As an employer, you must the tax payment even if you or visit their web site ." : federaf income'rn;\( from' employees~. 'Wages~ withhold the tax. For a EIN number, call the . ~ , ~:: ."' . ,-: . ' Co:q,c.erns' . Code As the pennit holder for this may ~o your attention . you are responsible for resolving any failure' to meet code coverage Insurance: . omissions such as .. see if you have adequate insurand:~" water damage pipe punctures, fire or Time: \ ,) \., .: sure you have time to supervise .' .'~ .,; the skins to as building officials as contractor,' to cool:dinate the, so they can perfonn rough-in inspections. Constnlction (503-378-4621) or 'write the atPO 06-01-04 225 Fifth Str.ee.t Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-0 1364 COM2007-0 1364 COM2007-01364 COM2007-01364 COM2007-01364 Payments: Type of Payment CreditCard cReceint 1 RECEIPT #: 2200700000000001409 Date: 09/07/2007 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By SHEILA PAYNE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 094454 In Person Payment Total: Page 1 of I 1:15:27PM Amount Due 70.00 12.00 4.10 6.56 8.20 $100.86 Amount Paid $100.86 $100.86 9/7/2007