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Home My WebLink AboutPermit Electrical 2005-09-13CITY OF SPRIN Buitdin g/Co mbinatio n Permit Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 541-726-3676Fax 541:1 2G37 69 I nspe ction Line PERMIT NO: COM2005-0L254ISSUED: 0911312005APPLED: 09/13/2005E)?IRES: 03/1312006 VALUE: SITE ADDRESS: 3325 MONTEBELLO AyE ASSESSOR'S PARCEL NO.: 1702193101015 PROJECT DESCRIPTION: Replace service panel Springfield TYPE OF TYPE OF USE: Electrical Work Only Repair Residential C)wner: Address: PETER PAKULAK 3325MONTEBELLO SPRINGFIELD OR 97477 PhoneNumber: 541-7414949 Contractor Type Electrical # of Unib: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: " Frontyrrd Setbaclc Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacla: Street Storm Sewer Available: Special Instruction: Notes: ENTTON:Oregon req rules adopted bY thre Oregcn tlllOfnse Expiration Date Phone rules are set fcrtlr in OAR 952 0090. You m calling the centtbf $ielftai he telePhone nukr$e r for the mgtrbDtil ity Notitication center iflY@trxf&€s4'iu\Water Type: Range Type: Energy Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: o/o of Lot Coverage: REQUIRED PARI(NG Total: Handicapped: Compact: nh Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: $ Per Sq Ft or multip[er Sidewalk Type: Downspouts/Drains Square Footage or Bil Amount DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Tvpe of Construction lof2 Value Date Calculated I Valuation Descrintion I Buildin g/Co mbinatio n Permit Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 54l-726-3676Fax 541:7 2G37 69 Inspe ction Line PERMIT NO: COM2005-01254ISSUED: 0911312005APPLIED: 09/1312005E)?IRES: 03/1312006 VALUE: - Fee Description + l0Yo Administrative Fee + 7o/o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Amount Paid $6.30 $4.41 $63.00 $73.71 Total Value of Project Date Paid 9lt3t05 9fi3t05 9n3t05 Receipt Number 1200500000000001344 1200s00000000001344 1200s00000000001344 PIan Reviews To Request an inspection call the24 hour recording at 72G3769. AII inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Electric Service: Approval required prior to utility company energizing service. lnsnecfions By signature,I state and agree, that I have carefully examined the completed apptication and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of SpringlieH and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCT PANCY wilt be made of any structure without permission of the Community Services Division, Building Safety. I further certi$ 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 4 is-of Owner or Contractors Signature 2of2 Date Hees ralo I Construction Contractors Board 700 Sumrrer St NE Suite 300 PO Box 14140 Selem OR 97309-5052 Phone: 503-3784621 WebAddress:www.ccfulg1le.or.us Pemrit #: Cotnzc i- O/ZSY Address: 33Zt lwoil e(L 6 At/ Issued by:><Date:?0 Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom 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 I and 2, ard either box 3A or 38: .[f t. 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. tr 3A. My general contractor is (Name)(ccB #) v { I will instruct my general contractor that all subcontractors who work on the stnrcture must be licensed with the Construction Contractors Board. OR 38. I will be my own 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 notifli 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. ofpermit applicant)@ate) (White copy to issuing agency perrnitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 4 -r 4.o Acting as Your Own General C6ntracton? INFORMATIO}I NOTICE TO PROPERTY OWNERS I\BOUT CONSTRUCTION RESPONSIBILITIES If you are acting as your own confr,.actqr to construct a new home or make a improvement to an existing structure, you can prevent many problems by berns aware of the following responsibilities and concerns. E mployer Responsibilities You will, in most instances, be ruled to be an "employetr" and the confractors you conkact with will be "employees" if you use conffactors not licensed with the Construction Conkactors Board to do labqr in constructing or to assist in the construction or improvement of a residential structure. As the employer, -vou must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are p*id. You will be liable for the tax payments evefl if you don't actually withhold the tax from your employees. For more information, call the Departnlant of Revenue at 503-378-4988. " Unrmployment fnsurance Tax; As an employer, you are requlred to pay a tax for unernploymcnt insurance purposes:^ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identificatjon Number Gf$ is a combined nrxnber for both Oregon. Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formspay.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 instirance for your empioyees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of yow employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consurner and Business Services at 503-947 -7 81 5. : U.S. Internal Revenue Service: As an enrployer, you must withhold federa{ income tax from employees' *"g"S- You will be liabie for the tax payrnent even if you didn't actually withhold the tax. For a Federal EIN number, call the IRSat l-800-829-4933 or visit ttrriir web site at 14q4ry.r1s.gov. Other Responsi.bilities and Areas of Concerns Code Compliance: As the permit hoider for this project, you are responsible for resolrring any failure to meet code requirements that may be brougtrt to your attention fhrough inspectiaas. Liability and Property llanrage Insurance: Contacf your ins{rriids allent t* see if you'have ddeqr:dte insurance covemge for accidenls and omissions such as falling tools, paint over spray, waler darnage from pipe punctures, fire or work that rnust be redcne Time: Make sure y6fi:have sufficient time to sup*rvise your employee$. Expertise: Make sure y*othurr" the skills td'iIito y5u['o*ii'gei,ti*]il''cor:kactb],'ioloorcinaie the work of rough-in and finish trades. and to notify building officials as the appropriate times sc they can perform the required inspections. If you have additional questions call the Constnrction Coatractors Board (503-378{621) or write the agency at PO Box 14140, Salem, OR 97309-5052. . iii{,i,.:.. ,r: ... ... Property_owner. doc 06-0 I -04 A*, NATE: This lnformation Notice to Prapedy Owners about Construction Responsrbr7rt'es was developed by the Construction Contractors Eoard in accardance with ORS 7A1.A55(5J, passed by the 1989 Oregon Logislature- 225 Fifth Street Springfield, Oregon 97 477 541:126-3759 Phone City of Springfield Official Receipt :velopm ent Services Department Public Works Department RECEIPT#: 1200500000000001344 Date: 0911312005 3:04:25PM Job/Journal Number coM2005-01254 coM2005-01254 coM2005-01254 Description + 1Yo State Surcharge + l0Yo Administrative Fee Perm Serv/Fdr 200 amps or less Amount Due 4.41 6.30 63.00 Item Total:$73.71 Tlpe of Payment Paid By Received By Bdch Number Number How Received Amount Paid CreditCard PETER PAKULAK djb 0M724 In Person $73.71 Payment Total: -Sffii- It 9/13/2005 lofl tnxf,I[ \ unecK NumDer Autnonzatron 225 FIFTH STREET . SPRINGFIELD, OR97471 o PH:(541)726-3753 o ELECTRICAL PERMIT APPLICATION Ciry Job Number COv?\Zcef ^O I ZSY Date 1 3. 3Z{O.w Le o r' LEGAL DESCzuPTION t-7DZ t7 3f oto( f Service Included JOB DESCRIPTION 1000 or less A. New Residential - Single or Plulti-Farnity per drvelling unit' 500 sq. ft. or $106.00 . filao& lse $s0.00 ?-?ctlcl- SPrc y'z+xe't- Permits are non-transferable and expire if work is '" not started within 180 days of issuance or if work is Suspended for 180 daYs. C ONT RACT O R IN STALLATI ON O N L'' -1 200 201 401 601 6 ,g 4/^ B., Electrical Contractor Address Phone Supervisor License Number Expiration Date Consff. Contr. Number ExlirariotnDfe Signature of Supervising Electrician Owners Name Address City <pr i rl$ir-(4 Phone ? '{ I' OWNERINSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: C. Temporar.v Services or Feeders Installation, Alteration or Relocation 200 Amps or less $ 50.00 401 Amps to 600 Amps 5100.00 One Circuit $ 43.00 s 3.00 Each Additional Circuit or with Service or Feeder Permit E. Over 600 Amps or 1000 Volts see "B" above. New Alteration or Extension Per Panel to (3 $ 63.00 $ 75.00 $125.00 $ 163.00 $37s.00 $ 50.00 Over 1000 Amps/Volts Reconnect Only 7%o State Surcharge l0% Administrative Fee TOTAL Amps Amps to Amps to 1000 City uL Pump or irrigation $ 50.00 Sigr/Outline Lighting $ 50'00 Limited Energy/Residential $ 25-00 Limited Energy/Commercial S 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SLBTOTAL OF ABOVE 63y(/ 6,so 73/Inspection Request: 726-37 69 Shared Driv{T:/Building Forms/Electrical Permil Application I {3.doc COMPLETE BELOW' uPt f:iil 'pi :e