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Home My WebLink AboutPermit Building 2004-02-02Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0210212004APPLIED: 0110212004EXPIRES: 10/1912004VALUE: $ 10,000.00 SITE ADDRESS: 527 PARJ( ST Springfield TYPE OF WORI(: Single Family Residence ASSESSOR'SPARCELNO.: 1703353405600 TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Install 200 amp panel; replace 17 circuits; Remove bearing wall & reinforce existing beamsl relocate lavatory sink. Owner: WILSON SMITH Address: 527 PARK ST SPRINGFIELD OR 97477 Phone Number: 541-747-4206 License Expiration Date PhoneContractor Tvpe General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER )NTRACTOR INFORMATION # 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: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 \rN NOTICE:HE WORK AUTHORI SETBACKS c0 MMENC 180 D MIT SHAL ev PEnnoerhy Dist: REQUIRED PARJ(NG Total: Handicapped: Compact: ANY # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: Type: Notes: Page I of3 T I' U ILI-'Il\ (J IT\ T UI(IVTA T TUN J Building/C ombination Permit Status Issued 225 Fifth Street, Spring{ield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0210212004APPLIEDz 0110212004EXPIRES: 10/1912004VALUE: $ 10,000.00 Description Bid Amount Tvpe of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 10,000.00 Total Value of Project Amount Paid Date Paid Value $1o,ooo.0o $lo,ooo.oo Date Calculated 0u26t2004 Fee Description + l0%o Administrative Fee + 7%o State Surcharge Perm Serv/Fdr 200 amps or less + l0Yo Administrative Fee + 7o/o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Plan Review Residential + lOoh Administrative Fee + 7o/o State Surcharge Building Permit Fixture Minimum/Adj ustment Plumbing + l0o/o Administrative Fee + 77o State Surcharge Minimum/Adj ustment Plumbing Total Amount Paid $6.30 $4.41 $63.00 $9.10 $6.37 $43.00 $48.00 $69.81 $1s.24 $10.67 $107.40 $14.00 $31.00 $1.10 $0.77 $1r.00 $441.17 U2t04 u2t04 U2t04 u26t04 U26t04 U26t04 u26t04 u26t04 2t2t04 2t2t04 2tzt04 2t2t04 2t2t04 5t3to4 513104 5t3t04 Receipt Number 1200400000000000001 1200400000000000001 1200400000000000001 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000r0s 1200400000000000148 1200400000000000148 1200400000000000148 1200400000000000148 1200400000000000r48 1200400000000000604 1200400000000000604 1200400000000000604 ['eps Paid Plan Reviews Initial Review Structural Review 0u27t2004 0U2712004 APP LLH 0u27t2004 0u2812004 OK TCM Per Don Moore, only structural review is required - No Planning or Public Works review. To Request an inspection call the24 hour recording at 726-3769. 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. I Electric Service: Approval required prior to utility company energizing service. 2 Rough Electric: Prior to Cover 3 Final Electric: When all electrical work is complete. 4 Footing: After trenches are excavated. Page 2 of 3 Rpnrrired fnsneefions ril I Valuation Descrintion I Building/C ombination Permit Status Issued 225Fitth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0210212004APPLIEDz 0110212004EXPIRES: 10/1912004VALUE: $ 10,000.00 5 6 7 8 9 10 Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing 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. Owner or Contractors Signature Date Pase 3 of3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone nity of Springfield Oflicial Receipt ivelopment Services Department Public Works Department RECEIPT#: 1200400000000000604 Date: 0510312004 8:31:22AM Job/Journal Number coM2004-00006 coM2004-00006 coM2004-00006 Description Minimum/Adj ustment Plumbing + 7Yo State Surcharge + l0% Administrative Fee Amount Due l 1.00 0.77 l. l0 Item Total:$12.87 Payments: Type of Payment Paid By Received By CheckNumber Authorization Batch Number Number How Received Amount Paid Check A WILSON djb 6164 In Person Payment Total: 12.87 $r2.87 s13t2004 Page I of I amf0 't Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-00006ISSUED: 0210212004APPLIED| 0u02t2004EXPIRES: 08/0212004VALUE: $ 10,000.00 SITE ADDRESS: 527 PARK ST Springfield TYPE OF WORI(: Single Family Residence ASSESSOR'S PARCEL NO.: 1703353405600 TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Install 200 amp panel; replace 17 circuits; Remove bearing wall & reinforce existing beamsl relocate lavatory sink. WILSON SMITH 527 PARK ST SPRINGFIELD OR 97477 PhoneNumber: 541-747-4206Owner: Address: Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone CONTRACTOR INFORMATION )RMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: side l SetbaflOTlCE: side 2 Setba"[HtS pERMIT Rearyard setAlbftlO R t ZE D Solar Setbacl€OMMENCED Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 VN Overlay Dist: sHALL ExP r RE rF TH g$fi6-f,[1il]' 'J'|D r;*i J3[ llr/ffrtpJ c overa ge : REQUIRED PARJ(NG Total: Handicapped: Compact: Sidewalk Type: DEVELOPMENT INFORMATION Notes: Page I of3 Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0210212004 APPLIEDT 0110212004EXPIRES: 08/0212004VALUE: $ 10,000.00 Description Bid Amount Tvpe of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 10,000.00 Total Value of Project Amount Paid Date Paid VaIue $10,000.00 $10,000.00 Date Calculated 0|26t2004 Fee Description + l0oh Administrative Fee + 7Vo State Surcharge Perm Serv/Fdr 200 amps or less + l0o Administrative Fee + 7o/o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add PIan Review Residential + l$Yo Administrative Fee + 1oh State Surcharge Building Permit Fixture Minimum/Adj ustment PIu mbin g Total Amount Paid $6.30 $4.4r $63.00 $9.10 $6.37 $43.00 $48.00 $69.81 $15.24 $10.67 $107.40 $14.00 $3r.00 $428.30 u2t04 u2t04 u2t04 u26t04 u26t04 u26t04 u26t04 u26t04 2t2t04 212104 2t2t04 2t2t04 2t2t04 Receipt Number 1200400000000000001 r200400000000000001 1200400000000000001 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000105 1200400000000000r48 1200400000000000148 1200400000000000148 1200400000000000148 1200400000000000148 Fees Paid Plan Reviews Initial Review Structural Review 0u27t2004 0U27t2004 APP LLH 0u27t2004 01128t2004 OK TCM Per Don Moore, only structural review is required - No Planning or Public Works review. 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 Electric Service: Approval required prior to utility company energizing service.2 Rough Electric: Prior to Cover 3 Final Electric: When all electrical work is complete. 4 Footing: After trenches are excavated. 5 Foundation: After forms are erected but prior to concrete placement. 6 Post and Beam: Prior to floor insulation or decking. 7 Framing Inspection: Prior to cover and after all rough in inspections have been approved. Paee 2 of3 rTL I Valuation Descrintion I Keourred Insnections Status Issued 225 Fifth Stree{ Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00006ISSUED: 0210212004APPLIEDz 0110212004EXPIRES: 08/0212004VALUE: $ 10,000.00 8 9 10 Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing 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 70f .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. ( .Z -2-o4 Owner or Contractors Signature Date Page 3 of3 Construction Contractors Board Permit #: (DrlrtZO<- , -gOaO 6 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: llwly.ccb.state.or.N Address: 5Z-7 ?P,aU :S Issued by:b6 Date: Z-Z_ULI jB & 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 be filed with the permit. 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3.A.. 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 38. I will be my own general contactor. If I hire subcontractors, I will hire only subcontactors 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 notiff 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 Responsibilities on the reverse side of this form. -o permit applicant)@ate) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/1 l/03 Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: tr ( Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Constructian Contractors Board in accardance wtth ARS 7A1.A55(5J, passed by the 1989 Aregon Legislafure. If you are acting as your owa contractor to construet a new hsrne or make a substantial improvement to an existing structure, you can prevent many problerns by being aware of the following responsibilities and concerns, Employer Responsibilities You will, in most instances. be ruied to be an o'employer" and the contractors you contract with will be "employees" if you use contractors not iioensed 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 following: Oregon's Withholding Tax Larv: As an employer, you must wrthhold 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 a State Business ID number, call the Business Information Center at 503-986-2200. IJnemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpo$es on the wages of al1employees. For more information, call the Oregon Employment Departmentat5AS-947-1488. Workers'Compensation Insurance: As an ernployer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain rrorkers' compensation insurance, you co,uld be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Service$ at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from ernployees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, cal.l the IRS at 866-816-2065 or fax them at 801-620-7i 15. Other Responsibilities and Areas of Concerns Code Compliance: As the'permit holder for this pmject, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to $ee if you have adequate insurance coverage for accidents and omissions such as falling tools, paint ov€r spray, water damage from prpe punctu"s, fire or Time: Make sure you have sufficient time to supervise your employees' Expertise: Make sure you have the skills to act as you, own general contractor, to coordinate the work of rough-in and finish hades, and to noti$ building officials as the appropriate times so they can perform the required rnspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Properfy_owner.doc 03/l I 103 225 Fffth Street Springfield, Oregon 97 477 541-726-3759 Phone {0 City of Springfietd Offidial Receipt Development Services Department Public Works Department #:0000148 Date: 0210212004 9:34:08AM coM2004-00006 coM2004-00006 coM2004-00006 coM2004-00006 coM2004-00006 Building Permit Fixture Minimum/Adj ustrnent P lumbing + 7%o State Surcharge + lUYo Administrative Fee 107.40 14.00 31.00 10.67 15.24 Item Total:$178.31 Type ofPayment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check AWILSON SMITH djb 6t04 In Person Payment Total: $ 178.31 $1783r ) 225 FIFTH STREET . SPRINGFIELD, OP.97477 o PII:(54I)726-3753 O FAX: (541)726-3689 E LECTRI CAL P ERM IT AP P LICAT I O N City Job Number Date JOB DESCzuPTION Permits are non-transferable and expire if rvork is not started within 180 days of issuance or if work is Suspended for 180 days. 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 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $106.00 $ 19.00 $50.00 $ 63.00 s 7s.00 $ 125.00 $ 163.00 $37s.00 $ s0.00 $ 69.00 $100.00 1.LOCA:I'ION LEGAL DESCRIPTION 7 Electrical Contractor Address Phone Supervisor License Number Expiration Date Constr ber Expiration Date Signature of Supervising Electrician A. Nerv Residential - Single or.Nlulti-FaInil,v pcr drvelling unit. 3. or. oo City B. D. E. Installation, Alteration or Relocation 200 Amps or less $ 50-00 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel onecircuit / $43'oo Each Additional Circuit or with ! , Service or Feeder Permit i4 s 3'oo $ 50.00 /':'* (/9 o@ a,)7 Owners Name Address o l0% Administrative Fee TOTAL a, /e t /rInspection Request: 726-37 69 Shared Drive(T:/Building Fonns/Electrical Permit Application l-03.doc # Cor&Uz(f< ( ,, .r' C. Temporarl- Services or Feetlers fr, Lil ,' ls o,l *,*f T il City The is not Pump or irrigation is $45.00 * Surcharges may obtain copies of the .,r1gs lMinimum center.the telePhone 4. CITY FIELD Buildin g/Combination Permit Status: Issued 225 Fifth Street, Springfield" OR 541-726-3753 Phone 541-7263676Fax 541:7 26-37 69 Inspection Line PERMITNO: COM2004-00006ISSUED: 0110212004APPLBDz 0110212004E)GIRES: 0712612004VALUE: $ 10,000.00 SITE ADDRESS: 527 PARK ST Springfield TYPE OF Single Family Residence ASSESSOR'S PARCEL NO.: 1703353405600 TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Install200 amp panel; replace 17 circuits; Remove bearing wall & reinforce existing beamsl relocate lavatory sink. Owner: WLSON SMITH Address: 527 PARK ST SPRINGFIELD OR n477 Phone Number: 541-747-4206 Contractor TtDe Electrical Contractor OWNER License Expiration Ddte phone BUILDING INFORM # of Units: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: SETBACKS Frontyard Setback: calling Street number Storm Sewer Available: Special Instruction: Notes: R-3 VN # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: the center. (Note: lortheOregon UU Centeris 1 -800-332-2344). Overlay Dist: S PERMIT SHALLfffitrRU(tFYFHf WORK AUTH 0 R I ZE D U N D E bEH,6&EfiJe$tr"|$sN0T COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, REQUIRED PARKING Total: Handicapped: Compact: $ Per Sq Ft or muhiplier Square Footage or Bid Amount iption Type of Construction lof2 Value Date Calculated E \T LJ Valuation Description I Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 541-726-3676Rax 541 -7 2637 69 Inspe ction Line GFIELD Buildin g/Co mbin ation Permit PERI{IT NO: COM2004-00006ISSUED: 0110212004 APPLIEDz 0110212004 E)(PIRESz 0712612004VALUE: $ 10,000.00 Bid Amount Use Bid Amount Fee Description + l0o/o Administrative Fee + 7%o State Surcharge Perm Serv/Fdr 200 amps or less + l0%o Administrative Fee + 70/o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Plan Review Residential Total Amount $r.00 10,000.00 Total Value of Project Date Paid u2104 u2t04 u2t04 u26t04 il26t04 y26t04 y26t04 u26t04 Receipt Number 1200400000000000001 120040000000000000r r20040000000000000r 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000104 1200400000000000105 $10,000.00 $10,000.00 0u26t2004 Amount Paid $6.30 $4.4r $63.00 $9.10 s6.37 $43.00 $48.00 $69.81 $249.99 Plan 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. I Electric Service: Approval required prior to utility company energizing service.2 Rough Electric: Prior to Cover3 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 certiff 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 certiff 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. Owner or Contractors Signature 2of2 Date \t1- H pes rard I Reouired Insnections I Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 5033784621 Web Address: ryfulqt@q Permit #: Address: Issued by:Date KB Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 70L055(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 and2, and either box 34 or 38: 1. I own, reside in, or will reside in the completed skucture. 2. 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 (Nane) (CCB #) I will instruct my general contractor that all subcontractors who work on the stnrcfure must be licensed with the Construction Contractors Board. OR fue. I will be my own fficonfrator. If I hire subcontractors, I will hire only subcontractors licensed with the Constnrction Contractors Board. If I change my mind and hire a general contractor, I vdll contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contactor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Responsibilities on the reverse side of this form. / ^ Ae- s-o? (Signature of permit applicant) (Date) (White copy to issuing agency pennitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 Ce i^ ?-noo'6 /,+ / --.i '''_... , l _ t \J Acting lQ Yaur Own General Contractor? INFORMATION NOTICE TO PROPERTY OT'\'NER$ ABOUT CON$TRUGTION RE$PON$'BILITIES NOfgj This lnformatrbn Notice to Property Oi'yners about Canstruction Responsibilitr'es was developed by the Conslructian Contractara Board in accardance with ARS 701.055(5j, passed by the 1989 Oregon legrslalure. If you are acting as your own contractor to conskuct a new home or rnake a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concems. Employer Responsibilities You will, in most instances, be ruled tc be an "empioyer" and the contractors you contract with will be "employees" if you use conkactors 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 wlth the'following: Oregon,s Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time "*pioy*.r are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ID number, call the Business Information Center at 503-986-2200. \\, Unemployment Insurauce Tax: As an employer, you are required to pay a tax for unemployment insurance purposg-s -- on the wages of all employees. For more information, call the Oregon Employment Departmentat50S-947-1488. Workers, Compensation lnsurance: 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, cail the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78 I 5. U,S. Internal Revenue Service: As an ernployer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment et'en if you didn't actually withhold the tqq. for a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. i = '.. ' '.', Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to mset code requirements that may be brought to your attention through inspections. Liability and Property Damage fnsurance: Contact your insurance agent to see if you have adequate insurance cov€rage for acridents and omissions such as falling tools, paint oyer spray, water darnage ftomprpe ptmctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general conkactor, to coordinate the work of rough-in and finish kades, and to notifu building of{icials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Confractors Board (503-378-4621) or write the agency at P0 Box 14140, Salem, OR 97309-5052. Properfy_owner.doc 03/l I /03 225 Fifth Street -+ Springfield, Oregon 97 477 541-726-3759 Phone City of Springlield Official Receipt ''r Development Services Department Public Works Department #: 1200400000000000104 Date: 0112612004 10:42:16AM coM2004-00006 coM2004-00006 coM2004-00006 coM2004-00006 Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 1Yo State Surcharge + l0o/o Administrative Fee Item Total:$106.47 43.00 48.00 6.37 9.10 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check AWILSON SMITH dlm 6096 In Person Payment Total: $ 106.47 $106.47 as submitted has the lollowing 22s FIFTH STREET . SPRINGFIELD, Op.97477 o PH:(541)726-3753 I FAX: (541)726'3685i s not require sPecific land use E LECTRI CAL P ERM IT AP P LICATI A N City Job Number CU/I:ZDO,! -16'q>C)Cs L> Dare Lb/- ta-d -o3 1.')eti.)t;al |-Z ag_ lcnrn'c' I LOCA?],ON'OF IATS'IH-I,IA'I'ION 3. COII(.PLET'E P'EE SCHEDULE I )ne) LEGAL DESCzuPTIONlf csses7 s-&oa) A. Nerv Residential - Single or h'lulti-trtarnily per drvelling unit. 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 $s0.00 JOB DESCRIPTION fr\"r( 7-. l*a -&d $ 106.00 $ 19.00 t Permits are non-transferable and elpire if work is not started within 180 days of issuance or if work is Suspended for 180 days. CO^T'RACTAR INST:ALIAION ANLY B. Services nr Feeders - Installation, Alterations or Relocation:) Electrical Contractor Address Phone Supervisor License Number Expiration Date J Constr. Contr. Number Expiration Date 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only Pump or inigation Sigr/Outline Lighting Limited Energy/Residential Limited Minimum Electric Temporar.v Sen,ices or Feeders Installation, Alteration or Relocation 200 Amps or less \aw r' 201 Amps It $ 63.00 $ 75.00 $125.00 $ 163.00 $375.00 $ 50.00 e2J City C D. I v 43.00 $ 3.00t hlOwners Name Address Y E. N'Iiscellaneous (Service/feeder trot included) -Each Installafion City I'hone -)tl OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature $ 50.00 $ s0.00 $ 25.00 V,J-0FK bS(-t 7o/o State surcffi l0% Adminisffative Fee TOTAL 180 D 630 7sLInspection Request: 726-37 69 4 4. Shared Drive(T:)/Building Fonns/Electrical Pennit Application l-03.doc e- One Each ( Signature of Supervising Electrician I v'// CITY OF SPRINGFIELD Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0110212004APPLIED: 0110212004EXPIRES: 0710212004 VALUE: SITE ADDRESS: 527 PARK ST ASSESSOR'SPARCELNO.: 1703353405600 PROJECT DESCRIPTION: Install200 amp panel Owner: WISON SMITH Address: 527 PARK ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential Phone Number: 541-747-4206 License Expiration Date PhoneContractor Type Electrical Contractor owt[ER CONTRACTOR INFORMATION BUILDING INFORMATION # of Units: Primary Occupancy Group : Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay # Street Paved Drive Yo of Lot R-3 Lot Size: Sq PARKING VN SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: 9${Total: Handicapped: Compact: 're \\t1\t \S t0s ss $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page I of2 PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated EE r,r- \\le ITY OF Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00006ISSUED: 0110212004 APPLIED z 0110212004 EXPIRESz 0710212004 VALUE: F ees Fee Description + l0%o Administrative Fee + 7%o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Date Paid U2t04 u2t04 U2t04 Receipt Number 1200400000000000001 r200400000000000001 1200400000000000001 Plan Reviews To Request an inspection call the24 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. 1 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 times during construction. Owner or Contractors Signature Date Pase 2 of2 Keourreo lnsDectlons Construction Contractors Board 700 Summer St ltlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ry$1!a1!e.or.us Permit #:Loruzia OOoo6 Address: 5Z1 ia o-L- - l- Issued by:\'3 o^t", i -z ''c'{ Statement: lnformation 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 thefollowing statement before a building permit can be issued. This statement is requtredfor 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 and2, and either box 3.{ or 38 -k l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Narne)(ccB #) I will instruct my general contactor that all subcontractors who work on the strucfure 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 hfue a general contractor, I will conhact with a contractor who is licensed with the CCB and will immediately notiff 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. X )('1-2--a+ (Signature of permit app licant) (White copy to issuing agency perrnitfile, pink copy to applicant.) @ate) Property_owner.doc 03/l I /03 -k u Acting as Your Own General Contractor? INFORMATION I'IOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOIE: This lnformation Natice to Properly Awners about Canstruction Responsrbddies vyas developed by the Qanstruction Co&ractars Board in accordance with ORS 701.055(5J, passed by the 1989 Oregan 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 concems. Employer Responsibilities You will, in most instances. be ruIed to be an "employer" and the contractors you contract with will be "employees" if you use conffactors.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 following: Oregon's \Yithholding Tax Law: As an employer, you must withhold income taxes from employee \4/ages 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 a State Business ID number, call the Business lnformation Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposss on the wages of all employees. For more information, call the Oregon Employment Departnient at 503-947-1488. Workers' Compensation lnsurance: As an employer, ysu are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your empioyees. If you fail to obtain workers' compensahon insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on thejob. For more information, call the Workers' Compensation Division at the l)epartment 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 EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7i 15. Other Responsibilities and Areas of Concerns 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 Insurance: Contact your insurance agent to see if you have adequate insurance coveragp fu accidents and omissions such as falling tools, paint over spray, water damage Aom pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. ,, .,. .., .. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish hades, and to notit/ b{rilding officials as the appropriate tirres so they can perform the required inspections. If you have additional questions call the Construction Conrractors Board (503-3784621) or write the agency at pO Box 14140, Salem, OR 97309-5052. Propeffy_owner.doc 03/l I /03 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 phone City of Springfield Official Receipt . Development Services Department Public Works DePartment #:I Date:004 coM2004-00006 coM2004-00006 Perm Serv/Fdr 200 amps or less + 7%o State Surcharge + l0oA Adminishative Fee 63.00 4.41 6.30 Type ofPayment Check Paid By WILSON SMITH Authorization Number How Received In Person Payment Total: $73.7r Amount Paid Item Total: A Received By Batch Number djb I 1 s73.71 -