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Home My WebLink AboutPermit Electrical 2004-07-12Building/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: COM2004-00865ISSUED: 0711212004 APPLIEDz 0711212004 EXPIRESz 0111212005 VALUE: SITE ADDRESS: 1372 30TH ST ASSESSOR'SPARCELNO.: 1702303400500 PROJECT DESCRIPTION: Reconnect service Owner: WOJCIK FAMILY TRUST Address: 15538 ANDRAE CRT N NORTH HILLS CA 91343 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential License Expiration Date PhoneContractor Tvpe Electrical Contractor OWNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group:R-3 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: #of r0 I Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: F{ nla \s $ Per Sq Ft or multiplier REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains:\t Square F or Bid PUBLIC IMPROVEMENTS Description Type of Construction Total Value of Project Value Date Calculated L Secondary Construction # of Bedrooms: lruLLl-rll\(, lNIt ruYfAlllrt\ | Status Issued 225 Fifth Street, SPringfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00865ISSUED: 0711212004 APPLIEDz 0711212004 EXPIRESz 0lll2/2005 VALUE: aid Fee Description * l0o/o Administrative Fee + 77o State Surcharge Service Reconnect Total Amount Paid Amount Paid $5.00 $3.50 $50.00 $s8.s0 Date Paid 7n2t04 7n2104 7t12104 Receipt Number 1200400000000001073 1200400000000001073 1200400000000001073 Plan 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. 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 Paee 2 of 2 E -:I J Reouired lnsDectlons I Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us permit #:C-\yvtzo\rq -OO Zbf Address: l3ZZ SO*( Sf Issued by:G Dalr,:7- / Z-t:^\ 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 the following 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: &-l. f 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 E-- (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 M :n. 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 notify 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 InformationNotice to Property Owners about Construction Responsibilities on the reverse side of this form. 7 -,te-o {(Signature of permit applicant)(Date) (White copy to issuing agency permitfile, pink copy to applicant.) Properfy_owner. doc I 2-09-03 INFORMATION i*OTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RE$PONSIBILITIE$ If y*u are acting as )iour$1vn contragtor tr construct arew hcme or m4ke a substantial improt'ement to an existing structure. yclu can preverit marf,prbblerns by beirrg awaretof didfollo*ilg responsibilities and concems. Employer Respansibilities Yoqlxill, in pTost instaqags, h9 ruled to be ar 'lernplcyer:: ard the contractors ye* conp.ast with wiil !q "employees" if you:!se. oostractor$ not licensed rytth,the Consfuction Contractors Board to do labof in constructing or to Sssist in the constn:ction or improvernent of a reside*tial structure. As the employer, you must comply with the following: .: Oregon's Withholrtiirg Tax Law: As an employer, you must *'ithhoid income taxes from ernployee wages at the time employees are paid. Yau rvill bp liabl,e.f'or the tax payments even if you dgp't, actualll' llithhgld lhe t3,r from {.1{ empitiyees. For more informatiorti call ifre Department ofRevenue at 503-3784988, ' :; ) i : -r ttnernplo)'mcnt lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpols ern the wggfs of all ernpiayees. For more information, call the Oregon Emplo;,rnent Departrnent at 503-947-i488. - . .:... .:j r t., .,;:,.,. , ,, ::F The Oregon Business identification Number GSD is a combined number.for both Oregon ltrithbolding and Uneruployment Insurance Tax. To {ile for a BIN. call 503-945-8091 or *+r,-rv.dor.state.or.usiformspay.htmll for thl ...t lappropriale fcrrms ' i'.' Workersr'Compensatign Insurance: As an employer, you are subject to the Oregon Workers' Compeasation L,aw, a*d must otrtain rvorkers' compensatian insurance for your empl-oyees- If- I'ou fail to obtain worker5' compensation i*surance. .vou i'ould be subject to penalties and be liable for all claim costs if sne of yow em$oyees is injured on the j*b" Iror rn*re iniormation. cail the lVorkers' Compensation Diriision at'the Departme*t of Consumer and Business Services at 503-92.7-781 5. [j.S. lnternal Regenuc Sen'ice: As an employer. you must withhold federal income tax from'iJmployees'*'age\s' you rvill be liabie for the tax paymenr ev-en if you didn't actually withhotd the tax. Fcr a Federal EIN number. cail the IRS at 866-816-2065 or fax them at 801-620-71 l5' l., Other Responsibilities and Areas of Concerns' Code Compliance: As the permit holder for this project. you are responsible for resohrklg any failure to meet code requirements that may be brought to Ygur,3ttention througlh inspections. Liabilit""* and property Damage fnsurance: Contact your insurance agerrt to see'if you have adequate inru*rri" ,orrrrg" for accidints and omissions such as falling tools, paint oYer spray, *-ater damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise yor-n employees. xpertise: i!{ake sure you have'the skills to act as your orrm general ioniractor, to coordinate the rt'ork of rough-in and finish kades, and to;odfy building officials as the appropriate times so they can perform the required inspections' If yo* have aclditianal questions call the Construction Contractors Board (503-3?s-4621) or write the agency at Po Box 14140, $alem, OR 97309-5052. PropertY-orvner.doc I 2-09-03 ,&*ting as Your Own General Contractor? fu*tr6: This lnfarmatian Notice to Propeiy Owners abaut Coasfruciion Responsrbilrfies was developed by the C*nsfrucfion Cantractors Board in accardance wilfi ORS 7A1.A55{5J, passed by the ?989 Oregon Legislature. CITY OF SPRINGFIELD, OREGONt 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541 7-lz-cL(Oore I t31z = LEGAL DESCRIPTION l7CL30s1 oo_'oo 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 JOB DESCRIPTION 7 Electrical Contractor or less 400 Amps Address to 600 Amps 1000 Amps AmpsAy'olts ft C.Supervisor License 3. sp&trll(}rtlg.Lr, $ 106.00 $ 19.00 $ s0.00 $ s0.00 : City Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Expiration Date Constr Number Date of Supervising Electrician $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00I $ so.oo Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit $ Each Additional or with Service or F DAY Sigr/Outline Owners Name Address Pho"" fib -8 +{L Pump or OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. 'd..r ., < Fnon,.,tG.r{sT Limited Energy/Residential $ 2s.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 50 3so OO 7%o State Surcharge l0% Administrative Fee TOTAL sa tq)Inspection Request: 726-37 69 4. Shared Drive(T:)/Building Forms/Electrical Permit Applicarion l-03.doc I E LE CTRI CAL PE RM IT APPLI CATION City Job Number[or.'L1Zac)Ll -(D X6f our" OPINSTALLATION COITIURAC?OR INSTALI-ATION ON LY ttrc l3tt 70 +L 3r Owners Signature: 4ot COfuIPLETEFSE A.New Residential - Single or or Feeders - lnstrllation, Alterations or Relocation: :>c) d tne Services or Feeders D.Branch Circuits E.Installation ",r, Sli,y{,rJL SUBTOTAL OFABOVE 225Fifth Street Springfielti, Oregon 97 477 541-726-3759 Phone -'f of Springfield Official Receipt -cvelopment Services Department Public Works Department RECEIPT #: 1200400000000001073 Date: 0711212004 2:57:58PM Job/Journal Number coM2004-00865 coM2004-00865 coM2004-00865 Description + 7%o State Surcharge + l0% Administrative Fee Service Reconnect Amount Due 3.50 5.00 50.00 Item Total: Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Cash Change THERESE COLLINS THERESE COLLINS djb djb In Person In Person Payment Total: $70.00 ($ I l.so) $58.50 Job/Journal Number coM2004-00865 coM2004-00865 coM2004-00865 Description + 7Yo State Surcharge + l0% Administrative Fee Service Reconnect Amount Due 3.50 5.00 50.00 Item Total:$58.50 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Cash Change THERESE COLLINS THERESE COLLINS djb djb In Person In Person Payment Total: $70.00 ($ l l.50) $s8.s0 7/12/2004 Page 1 of 1 sPEING'ItrLD -sffi'