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Home My WebLink AboutPermit Electrical 2019-10-18OREGON Web Address: www.springfi eld-or. gov Building Permit Residentia! Electrical Permit Number: 811-19-O02356-ELEC IVR Number: 811073410817 City of Springfield Development and Public Works 225 Fifth Streel Springfield, OR 97471 54r-726-3753 Email Address: permitcenter@springfield-or.9o\ SPRINGFIELD ,r, Permit Issued: October 18, 2019 TYPE OF WORK Category of Construction: Single Family Dwelling Submitted Job Value: $0.00 Description of Work: Branch circuit for gas fireplace Type of Work: New JOB SITE INFORMATION Worksite Address 921 55TH ST Springfield, OR 97478 Parce! 1702331200600 Owner: Address: MASON DAREL J & KIM L 921 N 55TH ST SPRINGFIELD , OR 97478 LICENSED PROFESSIONAL IN FORMATION Business Name OWNER - Primary License ccB License Number 000000 Phone PENDING INSPECTIONS Inspection 4999 Final Electrical 4999 Final Electrical 4250 Branch Circuits Inspection Group Elec Res Elec Res Elec Res Inspection Status Pending Pending Pending SCHEDULING INSPECTIONS Various inspections are minimally required on each project and often dependent on the scope of work. Contact the issuing jurisdiction indicated on the permit to determine required inspections for this project. Schedule or track inspections at www.buildingpermits.oregon. gov Call or text the word "schedule" to 1-888-299-2821 use IVR number: 8LLO734LO817 Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store Permits expire if work is not started within 18O Days of issuance or if work as suspended for 18O Days or longer depending on the issuing agency's policy. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not, Granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or Iocal law regulating construction or the performance of construction, ATTENTION: Oregon law requares you to fottow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-OO10 through OAR 952-OO1-OO9O. You may obtain copaes of the rules by catling the Center at (5O3) 232-1987, All persons or entities performing work under this permit are required to be lacensed unless exempted by ORS 701,O10 (Structural/Mechanical), ORS 479.54O (Electrical), and ORS 693.OrO-O2O (Plumbing). t Permit Number: al 1-19-0O2366-ELEC Page 2 of 2 Fee Description Balance of minimum permit fees - electrical Branch circuits without service or feeder Technology Fee State of Oregon Surcharge - Elec (120lo of applicable fees) Quantity Total Fees: Fee Amount $ 13.00 $89.00 $s.10 $t2.24 $119.34 1 Printed on: l0lLS/19 Page 2 ot 2 C: \myReports/reports//production/01 STANDARE PERMIT FEES SPRINGFIELD ti Transaction Receipt 81 1-19-002366-ELEC Receipt Number: 472722 Receipt Date: 10/18/19 City of Springfield Development and Public Works 225 Fifth Street Springfield, OR97477 547-726-3753 permitcenter@springfield-or.gov OREGON www. sp ri n g fie ld -or. gov Worksite address: 921 55TH ST, Springfield, OR 97478 Parcel: 1 702331 200600 Fees Paid lransaction date 1 0/1 8/1 I 10118119 10t18t19 10t18t19 Units 1.00 Qty 1.00 Automatic 1.00 Ea 1.00 Automatic Technology Fee Description Branch circuits without service or feeder Balance of minimum permit fees - electrical State of Oregon Surcharge - Elec (12o/o oI applicable fees) Account code 224-000004261 02-1 033 224-000004261 02-1 033 821 -00000-2 1 5004-0000 204-00000425605-0000 Fee amount $89.00 $13.00 $12.24 $5.1 0 Paid amount $89.00 $13.00 $12.24 $5.1 0 )ayment Method: Credit card authorization 051 14b Payer: MASON DAREL J & KIM L Payment Amount:$1 19.34 lashier: Katrina Anderson Receipt Total:$119.34 rrinted: 10/18/19 8:46 am Page 1 of 1 Fl N_Tra nsaction Receipt_pr Ir ( CITY OF SPRINGFIELD, OREGON Electrical Permit lication 225 Fifth Streeto Springfield, OR 97477oPH(541)726-3753. FAX(541)726-36t9 LOCAL GOVERNMENT APPROVAL Zoningapproval verified? E Yes E No CATEGORY OF CONSTRUCTION ! Residential ! Government E Commercial JOB SITE INFORMATION AND LOCATION Jobsiteaddress: 7Zt 5*h S{- city: g 'D€ )l SlrrtetC-F,,ZTP:I 7,{TB Reference: DESCRIPTION OF WORK {I PROPERTY OWNER Name: \)q,$e,(J. l/lkxan. Address: City:StatS2?nP97q\E Phone -7%-5Vt Fax: E-mail This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(l\ and 479.560(1). " Signature: D,q/z,tr {l- 1,4/b,(A CONTRACTdR INSTIILATION Business name: Address: City:State:ZIP: Phone Fax E-mail CCB license no.BCD license no.: Signing supervisor's license no. Print name of sigring supervisor: Signature of signing supervisor: DEPARTMENT USE ONLY Permitno.: ln-AX//g Date: \ 0 t rg (q FEE SCHEDULE Number of inspections per item ( )Qty Cost ea, Total cost Residential, per unit, service included: 1,000 sq. ft. orless (4)$1E6.00 $ Each additional 500 sq. ft. or portion thereof $36.00 $ Limited energy (2)$44.00 $ Each manufactured home or modular dwelling service or feeder (2)$89.00 $ Services or feeders: installation, alteration, relocation 200 amps or less (2)$r 12.00 $ 201 to 400 amps (2)$131.00 $ 401 to 600 amps (2)$221.00 $ 601 to 1,000 amps (2)$285.00 $ Over 1,000 amps or volts (2)$654.00 $ Reconnect only (2)$89.00 s Temporary services or feeders: installotion, alteration, relocation 200 amps or less (2)$89.00 s 201 to 400 amps (2)$122.00 $ 401 to 600 amps (2)$177.00 s Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: netu, alteralion, extension per panel a. Fee for branch circuits with purchase ofa service or feeder fee: Each branch circuit $8.00 $ b. Fee for branch circuits without purchase ofa service or feeder fee: First branch circuit (2)I $89.00 $&q Each additional branch circuit S Miscellaneous fees: service orfeeder not included Each pump or irrigation circle (2)$89.00 $ Each sign or outline lighting (2)s89.00 $ Signal circuit or a limited-cncrgy panel, alteration, or extension (2)$89.00 s Each additional inspection: (l )$102.00 $ DEPARTMENT USE (A) Enter subtotal ofabove fees (Minimum Permit Fee $102.00) $PL (B) Enter l2%o surcharge (.12 x [A])$ (C) Technology Fee (5% of [A])$ L|IKS 0n, This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days ofissuance or ifwork is suspended for 180 days. Last edited 7/l/2019 BJones tta.ec{ Taxlot.: $8.00 TOTAL fees and surcharges (A through D): Propefi Owner Statement Regarding Construction Responsibilities Oregon Law 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. (ORS 701.325 l2ll 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. Please check the aPProPriate box: I own, reside in, or will reside in the completed structure and my general contractor is Name CCB#Expiration Date I will inform my general contractor that all subcontractors who work on the struclure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. lf I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. lf I change my mind and hire a general contractor, I will select a contractor who is licensed with the ccB and will immediately give the name of the contractor to the offlce issuing this Building Permit. I have read and understand the lnformation and I hereby certify that the information on Notice to Homeowners About Construction Responsibilities' this homeowner statement is true and accurate. D cr*( J. [fuIas CIA Print Name of Permit APPlicanl Signature Applicant l0 IB lrt Date Permit #: Address: D >G *- Lo [(6 ( lssued by ?7r Date (1 This Copy for Permit Offices lnformation Notice to Owners About Construction ResPonsi bi I ities (oRS 701.32s (3)) CONSTRUCTION CONTRACTORS BOARD PO Box 14140, Salem, OR 97309'5052 Telephone: 503-378-4621 - Fax: 503-373-2007 Website Address: www.oregon. gov/ccb ./--^^^+, ^..,aar :/nnla.i A-rn1A Homeowners acting as their own genenal contractors to construct a or make a substantial improvement to an existing structure, can prevent by biing aware of the following responsibilities: new home many problems o a a a t o Homeowners who use labor provided by workers not licenqed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: oregon,s withholding Tax Law: Employers must withhold income taxes from employee wages at th'e time employeeslre paid. You will be liable for the tax payments even if you don't actually withhold the tax fiom your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment lnsurance Tax: Employers are required to pay a tax for unemployment insurance purposes bn the wages of all employees. For more information, call the Oregon Employment Department at 503-947 -1 488. Oregon,s Business ldentification Number (BlN): is a combined number for both Oregon Withholding and Unemployment lnsurance Tax. To file for a BlN, go online to the Oregon Business Registry. For questions, call 503-945-8091. Workers Compensation lnsurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation lnsurance for their employees. lf you fail to obtain Workers Compensation lnsurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 800452-0288. Tax Withholding: Employers must withhold Social Security Tax and Federal lncome Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, go online to www.irs.gov. a Other Responsibilities of Homeowners: Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. property Damage and Liability lnsurance: Homeowners acting as their own contraclors should coniact iheir insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability lnsurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation lnsurance. Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. a a This Copy for Permit