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Home My WebLink AboutPermit Electrical 2004-04-30Building/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: COM2004-00506ISSUED: 0413012004APPLIEDz 0413012004EXPIRES: 10/3012004 VALUE: SITE ADDRESS: 170610TH ST ASSESSOR'S PARCEL NO.: 1703264205600 PROJECT DESCRIPTION: Move electrical box Owner: ALEXANDERJASONA Address: 919 NANCY AVE SPRINGFIELD OR 97477 Springlield TYPE OF WORK: Electrical Work Only Residential ln OAR 952-001 -0010 through 0AI1 0090. You maY obtain copies of tir€ the Oregon UtilitY Nc is 1-800-3322344'; License Expiration Date Phone 541-746-0506 Contractor Tvpe Applicant Contractor JASON ALEXANDER BUILDIN( # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: REQUIRED PARKING THhXI,qTI Mll*hJugtrn.u. ED UJHrpact: # 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: $ Per Sq Ft or multiplier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: Total Value of Project Pase I of2 DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated rc Valuation Description I 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: COM2004-00506ISSUED: 0413012004APPLIEDz 0413012004EXPIRES: 10/3012004 VALUE: tr'ees Pa Fee Description + l0oh Administrative Fee + lVo State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Date Paid 4t30t04 4t30t04 4t30t04 Receipt Number 22004000000000004s6 2200400000000000456 2200400000000000456 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 Pase2 of2 -El CT Kequlreo rnspeeuols ] 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Ctty of Springlield Official Receipt relopment Services Department Public Works Department RECEIPT #: 2200400000000000456 Date: 0413012004 12:5e:11PM Job/Journal Number coM2004-00506 coM2004-00506 coM2004-00506 Description Perm Serv/Fdr 200 amps or less + 7%o State Surcharge + l0% Administrative Fee Amount Due 63.00 4.41 6.30 Item Total:$73.71 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check JASON ALEXANDER ddk 36s9 In Person Payment Total: $73.11 -ffir 413012004 Page I of 1 5I I tLi l,;. ::i !i;i;:;:*i fit:".:: 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: ELECTRICAL PERMIT TION DateCiry Job Number 1. LOCAT'ION 3. COMPLETE"FEE 0 Service Included 1000 sq. ft. or less 200 Amps or 201 Amps to 401 Amps to 600 AmPs 601 Amps to 1000 AmPs Over 1000 AmpsAy'olts Reconnect OnlY 201 Amps to 400 AmPS 401 Amps to 600 AmPs Over LDE $ 106.00 -Sd*bo $ 75.00 $163.00 $375.00 $ 50.00 $ 69.00 $100.00 o o approval. Zoning Date LEGAL DESCzuPTION tfl0 I,D JOB DESCRIPTION hrui OL Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 1 B. D. 43.00 {07 City Address Supervisor License Expiration Date Constr. Contr. Expiration of Supervising Electrician Owners Name Address City Phone ^7 OWNER INSTALLATION The installation is being made on properly I own which is not intended for sale, lease or rent. Signature: C. Temporar-v Services or Feetlers Installation, Alteration or Relocation 200 Amps or less $ 50'00 1000 Volts see "B" above, 3.00 E. or irrigation $ s0.00 $ 50.00Sign/Outline Lighting Limited Energy/Residential $ 2s.00 Limited Energy/Commercial $ 45'00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges (Service/feeder not included) -Each Installation 0 7%o State Surcharge l0% Administrative Fee TOTAL lz;llb2 Phone Request: 726-3769 Shared Drive(T:)/Building Forms/Eloctrical Permit Application l -03'doc A. Nen'Residential - Single or lVlulti-Farnily per drvelling Each additional 500 sq. ft. or portion Each ThosE are set tol Modular 4. SUBTOTALOFABOVE Construction Contractors Board Permit *C0Wt74 - 0050k Address: \-1OLN- \0+lA Date Statement: Information 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 and2, and either box 3A or 38: l:.-J'lA l. I own, reside in, or will reside in the completed stnrcture. tr 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 (Name)(ccB #) ( 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 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 N to Property Owners about Responsibilities on the reverse side of this form. permit applicant)@ate) (White copy to issuing agency permitfile, pink copy to applicant.) 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us 0 I will instruct my general contractor that all subcontractors who work on the structure must be licensed with ttre Construction Contractors Board. OR 38. I will be my own general contractor. Property_owner. doc 03/ I I /03 rssued by: VVz!( | ur Own General Contractor? INFORMATION NOTICE TO PROPERTY OT'YNER$ ABOUT CONSTRUCTION RESPONSIBILITIES NOIE: Tttis lnforma$on Nofice to Property Oivners about Canstruction Responslbl/ifres' was developed by the Constructian Contractors Eoard in accordance with ARS 701.055(5j, passed by the 19Bg Oregan Legislature. If you are acting as your own contractor to construct a new home m make a substanfial improvement to an existing skucture, you can prevent many problems by being arvare of the follorving responsibilities and concerns. Employer Responsibi lities You will, in most instances, be ruled to be an "e[rployer" and the eonhactors you oontract with will be "employees" if you use contractors not licensed with the Consffuction Contractors tsoard to do labor in constructing or to assist in the construction or irnprovement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an empioyer, you must withhold income taxes fronr ernpioyee wages at the time employees are paid. You vr.ill 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 Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance plrposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation La1v, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you eould 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 Department of Consumer and Business Services at 503-947-7815. 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 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 801-620-7115. j Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure tr: meet code requirements that may be brought to your attention through inspections. Liability and Property Darnage fnsurance: 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 pdtctures; fire or work that must be redone. Timc: Make sure you have sufficient time to supervise your employees. Hxpertise: 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 noti$/ building officials as the appropriate times so they can perform the requireii inspections. If you have additional questions call the Construction Confractors Board t503-378-4621) or write the agency at pO Box 14140, $alem, OR 97309-5052. X-r'Acting as Yo Properfy*orvner.doc 03ll I /03