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Home My WebLink AboutPermit Electrical 2004-10-14 '\ ~. 225 Fll' Itl STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-36~ ELECTRlCAJoiPERMIT APPliCATION. ~ ~o"'1)(91J~ City Job Number( ./lrn J(rtJ ij - 0/ d7:i bate \0 \\ ~ D ~ 7"':~?q ~ ( v '" 0.:-<'>"" ::;:'7;m:'~<'fF.A'-;."'fr 1. 3. . \ ;".ls)~~ ~\u~~\\~ ~Ul. l) 30 050; 60 LEGAL DESCRIPTION \ I ('J ~ 3d-. "d.. ~ JOB DESCRIPTION '(tow bT12o~ i~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. Electrical Contractor / /' Aone. /'^' Supervisor o/nse Number ~ / \ / ZXP' on Date onstr. ContI'. Number \ L . Addre~ ~ City Expiration Date Signature of Supervising Electrician S~liulludeay obtain copie~of 100@i!i.i(fI9~ssenter. (Note: the-Jel Ea~fIOdiif5~sq.rftg9lf1 Utility N-Qtifi portion therGffnter is 1-800-332-2344~. Each Manufact'd Home or Modular Dwelling Service or Feeder B. 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only .~ $ 63.00 $ 75.00 $125.00 . $l~?OO .' $17,5.00 ". ,', '.'~' ;10 I . . ',' ,:Ii 50.00 .;r-\l\U'Ji'lLU i UI' c.; Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Am s or 1000 Volts see "B" above. $ 50.00 $ 69.00 $100.00 D. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with \-- ~ ( ~~l" ""_ Service or Feeder Permit OwnersName _ \~~'N'\\~ IJG ~~ Address '-\<.o~<:\ ~\~ \\L ~~\ E. City ~\\L Phone ~~~a?:J0~ , $ 43.00 $ 3.00 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 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. 01:i~: ~A~ ~%~'h . Inspection Request: 726-3769 4. G3 _ au '-(I 7% State Surcharge 10% Administrative Fee TOTAL I r <"'1 . I/O, 60 1//3.7/ , Shared Drive(T:)lBuilding Forms/Electrical Permit Application 1-03.doc Status Issued CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2004-01273 ISSUED: 10/14/2004 APPLIED: 10/14/2004 . EXPIRES: 04/14/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PROJECT DESCRIPTION: Replacing Breaker Box Springfield TY~Fd?lg~9.RK!ei)!;)~~lfi~ab1iRVk Only . ATTENTION. d b'J the Ole?On "t lorth io\\oW ru~PE'ff'i~~l8se ruN€w;\re se2_00~ _Residential , n center. . hOAR 95 Notitica~~2_00~ -OO~ 0 thro~9 t the rules by . in OAR J,-..~;n rnOles 0 I .-~,.., . 0090. '(aU rnGlY~.- (Note: tne le\I;:;~I'-'. - the center. \ " Noti1lcatlon SPRINGFIELD OR 97478 ca\\ing, the Oregon Utility 44) . nl Imber lof . 4 Qnn_332-23 . lierW:;H .... , I CONTRACTOR INFORMATION I SITE ADDRESS: 4629 BLUEBELLE WAY ASSESSOR'S PARCEL NO.: 1702324305900 Owner: TAMMY GATES Address: 4629 BLUEBELLE WAY Contractor Type Electrical Contractor OWNER License." -' Expiration Date Phone # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATION' NuHl.;ir:: # ofSt?fff.~: PERfv1!T SHl-\LL EXPIRE I~O'I~LzW~K Heigh~~f-~m~~tl~rto UNDER THIS PES1J".q~ ,lOW: Type of Heat: ~g ~t i~4 Jor: Water~fiferinENCED OR IS ABANDO~4lFtFBJ:nement: Rangert~~e180 DAY PERIOD. Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: I DEVELOPMEl'll11'l~ORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: 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 Pal!:e 1 of2 Status Issued LITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01273 ISSUED: 10/14/2004 APPLIED: 10/14/2004 EXPIRES: 04/14/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 10/14/04 10/14/04 10/14/04 2200400000000001290 2200400000000001290 2200400000000001290 Total Amount Paid $73.71 I Plan Reviews I 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. 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 ~ du~g strucUou. Q " " ~ Q X) ~ \a~'\~\,-a~\ Owner o~ont~ct~rs Signature Date Paee 2 of 2 ".f. '~ .. . . . . . . . . . .. ... ." . . 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. pennit#~I?1'~(jl) ~ -01 ~7g Address:~d1 i5{Jh~bfl~ fJ~J/- Issuedb;)1. ~..hadoDate: IO//~~' Statement: Info. mation 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: 'K11. o 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. 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 myown 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 ofthe 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. ~lb~PliC~ \(j- \~\ .. O~ (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 J '. : A~tingas Y Ollt Qwn General Contractor?' . I . ,-, '< INFORMATiON NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION' RESPONSIBILITIES " . - ~ .: ...., "'1 '. 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 imp' ~)Vement to an existing structure, you can preventinany problems by being aware of the following responsibilities arid concerns. Employer Responsibilities You will, in most instances, be ruled to be an "empl~yer" and the cohtractors you contract with will be "employees" if you u~e contractors not licensed with the Construction Contractors Boarq to do labor in constructing or to assist in the construction or iU1.l:',ovement o.f ~ residential structure. As the empl~yer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withholcfihcome 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 information, call the Depw. ~Hent of Revenue at 503-378-4988. . Unemployment Insurance Tax: As an employer, you ate 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 Insurance Tax. To file for a BIN, call 503-945-8091 or \vww.dor.state.or.us/fonnsnav,html1 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 be subject to penalties and be liable for all' claim costs if one of your emplOyees is injured on the job. For more information, can the Workers' CVlHpensation Division at the Department of Cdrisumer and Business Services at 503-947-7815. U.s. Internal Revenue Service: 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 1-800-829-4933 or visit their web site at www.irs.IWv. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to'1"neet 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 accidents and omissions such as falling tools, paint o-yer spray, water damage from pipe punc4Ires, fire or work that must:l?e redone. ' ).' r'" ( ," Time: Make sure you hive sufficient time to supervise your employees. " Make sure you have the skills to act as your ~\\'ll g~eral contractor, to'b60rdinate the work of rough-in and fInish trades, and to notify building officials as the appropriate times so they can perform the required inspections. have additional questions can the Construction 14140, Salem, OR 97309-5052. Board (503-378-4621) or write the agency at PO Property- o\vneLdoc 06-01-04 22~ Fifth Street .. - . 'I. Sprmgfield, Oregon 97477 541-726-3759 Phone Ji,ty of Springfield Official Receipt ~velopment Services Department Public Works Department Job/Journal Number COM2004-01273 COM2004-01273 COM2004-01273 Payments: Type of Payment Cash Change Job/Journal Number COM2004-01273 COM2004-01273 COM2004-01273 Payments: Type of Payment Cash Change 10/14/2004 RECEIPT #: 2200400000000001290 Date: 10/14/2004 Description Perm ServIFdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Paid By JEFF GATES JEFF GATES Item Total: Check Number Authorization Received By Batch Number Number How Received nJm In Person nJm In Person Payment Total: Description Perm ServIFdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Paid By JEFF GATES JEFF GATES Item Total: Check Number Authorization Received By Batch Number Number How Received nJm In Person nJm In Person Payment Total: Page 1 of 1 2: 12:47PM Amount Due 63.00 4.41 6.30 $73.71 Amount Paid $80.00 ($6.29) $73.71 Amount Due 63.00 4.41 6.30 $73.71 Amount Paid $80.00 ($6.29) $73.71