HomeMy WebLinkAboutPermit Electrical 2003-7-15
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00923
ISSUED: 07/15/2005
APPLIED: 07/15/2005
EXPIRES: 01115/2006
VALUE:
.
Status: Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1177 A ST
ASSESSOR'S PARCEL NO.: 1703354103600
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: Relocate main electrical panel
TYPE OF USE: Repair
Residential
Owner: SCOTT OLSON
Address: 1177 A ST
SPRINGFIELD OR 97477
'CONTRACTOR INFORMATION'
Contractor Type
Electrical
License
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jl.TTEN'f ciopt~b L~ U - re se lorth
'0\\0'14 ru\es~a ffle"to1l\lille rules ~R 952-001-
~tilication ~llf\hrO~gh ~ the rules b,/
\n OAR 952 _!.y.I!l\:J!!i~llll'tPI~S oe telephone
Vtlb90. '(ou II Wt~eT.Yl,lllote. th Notification
calling t\'\lkca'fi3ti{~!llll'l UtilitY 4)
number ltth~r~ f_~_332-234 .
C_'IOed nla
Contractor
OWNER
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
I DEVELOPMENT INFORMATION'
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Phone Number: 541-953-4991
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:
REQUIRED PARKING
Total:
Handicapped:
Compact:
IPUBLIC IMPROVEMENTS' \NOR\<.
N01\l;l::. I" S\-Il\ll E~I'\Rt 1~.r~I~SideW1ilk Type:
S I'ERM \ 1\-11S I'EnlVl I Iv ~.-
1\-11 ORI2EO UNDER NOONEO I'Downspouts/Drains
I\Ul\-1 NeED OR \S I\BI\
COMME Ol\'i I'ERIOO,
I\N'i 1 &0
Street
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descrintion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
I of 2
Value
Date Calculated
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00923
ISSUED: 07/15/2005
APPLIED: 07/15/2005
EXPIRES: 01115/2006
VALUE:
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
l F""s Pairl I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
7/15/05
7/15/05
7115/05
Receipt Number
1200500000000001017
1200500000000001017
1200500000000001017
Total Amount
$73.71
I Plan Reviews ,
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.
~""nn'U
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 SpringfieW 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 ofthe 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 win remain on the site
at all L~2~~c~ ~ 1- I (S- - <Ps;
~ Contractors Signature Date
2 of 2
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Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Pbone: 503-378-4621
Web Address: www.ccb.state.or.us
Pennit #:
CO/lflfW_-60 '7z.3
I{ 77 It- ~t-
"hd'
Date:
7/;; lor
Address:
Issued by:
, ,
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 befiled with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
)g- 1.
~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 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 the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that tbe 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.
L~LI:t!~
~
7 o( S -ct>o;;;:
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner ,doc 06-01-04
" . . .
Adnnnzr1l1l~ \I@1lJJ.Jr OWIill cG<enn<eJr~R C({j)lllltIr~~lcm..?
\
INFORMATION NOTICE TO PROPERTY OWNERS
\
\\ ABOUT ~ONSTRUCTION RESPONSIBILITIES
-~
.."t~
'-
r
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.
lEmp!oyel!' ResjpOlD.snlbmties
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 followiug:
Oregon's Withholdiug 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 information, 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 Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.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 be subject to penalties and be liable for all claim costs if one of your employees is injured 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 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 EINnumber, call the
IRS at 1-800-829-4933 or visit their web site at www.irs,Qov,
Otlh1eIr ReSjpOHD.Snbillities 2IIlld AIre2!> OJ[ COm:eIrIIll!>
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code
requirements that may be brought to your attention through inspections,
Liability and Property Damage Knsurance: Contact your insurance agent to 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 l?e redone.
Time: Make sure you have sufficient time to supervise your employees,
Experiise: Make 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 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
SP91,1gfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2005-00923
COM2005-00923
COM2005-00923
Payments:
Type of Payment
Check
7/15/2005
.
RECEIPT #:
8~:
~
JiJ.ty of Springfield Official Receipt
.velopment Services Department
Public Works Department' ,
1200500000000001017
Date: 07/15/2005
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Penn Serv/Fdr 200 amps or less
Paid By
SCOTT OLSON
Item Total:
Lbeck Number Authorization
Received By Batch Number Number How Received
djb 147 In Person
Payment Total:
I of 1
3:03:S7PM
Amount Due
4.41
6.30
63,00
$73.71
Amount Paid
$73,71
$73.71