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Home My WebLink AboutPermit Electrical 2004-04-29Building/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: COM2004-00501ISSUED: 0412912004 APPLIEDT 0412912004 EXPIRESz 1012912004 VALUE: SITE ADDRESS: 2764 33RD ST ASSESSOR'S PARCELNO.: 1702193100309 PROJECT DESCRIPTION: Extend mast head Owner: MCALLISTER DEAN & CAROL J Address: 2764 N 33RD SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work OnIy TYPE OF USE: Alteration Residential Phone Number: 541-746-0090 License Expiration Date PhoneContractor Type Electrical Contractor OWNER CONTRACTOR INFORMATION BUILDING INFO # 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: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: R-3 Vlhr SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: the rules bhroumrD ,ARKTNG teleplrcne Thoso rul€ 8rt of center. (Note: the Surface Area: Total: Handicapped: Compact:Paved %o ofLot Coverage: Street ImprovemlqsTr n tr. storm Sewer """q4ilEiP'itil'4tT SHALL EXPIRE lF THE w0RK Speciar rnstructio,p g T'H'g;i iz?D I rrr o E n i H t S P E R M lT- l-S-N 0 T no"" lly'l5lg'^?ll;|oS:^ND0NED F,R $ Per Sq Ft or multiplier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: Total Value of Project Paee 1 of2 PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated Valuation Descriotion I 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: COM2004-00501ISSUED: 0412912004 APPLIEDT 0412912004 EXPIRESz 1012912004 VALUE: Fees Paid Fee Description + lOoh Administrative Fee + 77o State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.s0 $50.00 $s8.s0 Date Paid 4t29t04 4t29t04 4t29t04 Receipt Number 1200400000000000567 1200400000000000567 1200400000000000567 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. Reouired Insnect 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 Construction Contracto-ts Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ryfu,!41!g4q Permit *' &ltuzo r -ooro I Za6q 3.3ol -.}-Address: Issued by:G Date 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 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 md,2, and either box 3A or 38: Y"x 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. t] 3A. 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 Constnrction Contractors Board. ,o* B 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 conhact with a contractor who is licensed with the CCB and will immediately notiry the office issuing this building permit of the nirme of the contractor. I certify that the above information is correct and that I have read and do understand the Information Property on the reverse side of this form. of permit (lVhite copy to issuing agency perrnitfile, pink copy to applicant.) @ate) Property_owner.doc 03/l l/03 Aetistg e$ Your Owm #*xreral Contractor? I'*FORM&TI*FJ ruSTI$ffi TS PffiSPffiffiTY #WNXR$ ABSUY f; SN$TRt"'*Tt$N mHSp*ruSrffi ;LIT!ffi $ ff#IS: I&is Jnf*n*a$*n ff*frc* f* Fr*g:rrfy Ourn*rs a**ul #*nsfru:*f/*n f?*sp**sr*iiifi*s w*s #*r*i*ped,by f*e S*rsfruc#CIn Cc*fracfcrs fiaarcl rn acesrda*ce wittt Str$ 7Sf "SS5{5J, p*ssed Sy f*e f $SS Oregon legrsfat*r*. If v*u xr* **ling ils .v*$r own contractr:r ts) c$nsffuct a new lr*rn* or make a substarrtial impr*vernent 1* a* existlng stru*{*r*. yoil can pr*-;*nt rcnny pr*b?*ms b3r h*ing ax'*r* {"}f {.h* {lrl}*x.,i*g resp*r:sii:iliti*s anri *<l**er:ns" Hmpl*yer Re$ponsibilities Yau will, in m*st irstances, be ruled to be an "employer" *nd the contractors you cofitract with will be "ernpl*y*es" if ycu usc c*nkact*rs not iiceflsed with the Construction Contr*ctors Eoard to do labor in constructing or to assist in the ctnstru*tion or imprcv*ment af a residential strueture. As the ernployer, you must comply with the following: Oreg*xr's ltr,ithhtldi*g T*tx n aw; As a* employer, you ffiust withh*id income laxes korn er:rpioyee wages at the time empl*y*es *r* paid. Y*l: rryill he iiabie f*r th* tax paymefits *ven if y*u <l*n't actuall,v $rithh*ld the tax fr*m ycr.rr *mpl*yees" Fnr * $tate B*siness XI) nrlrnber, cali the Busiue*s lnfi:matrr:n Center at 5{i3-986-3?*i}. L]*ernploym*nt Xnsuy"ilmc* Txx: As an earpl*yer, yorj are requireel t* pay a tax i*r unen:p1*3r*ent i*surarce pury*$e$ r:n tlie wage$ *f all emi:lny*es" Fcr more infuimation, call the Oreg*n Srnplnyment Bepartment at 503-947-1488. 'lVorkers' Compensation Insur*nter As an ernployer, yoit are subject to the Oregon Workers' Compensation La'wo and must obtain workers' compensation insurance f<r yow employees. If you fail to obtain workers' compensation insurance, you could be subject to penaities and be liable for ali ciaim costs if one of yaur empicyees is injured on the job. For more inforrn*tion, cail the Workers' Compensatiern Oivision at the I)epartrnent of Consurner and Business Services at 503-947-78i 5. U.S. Internal Revenue Service: As an employer, you rnust withhold federal inccme tax from employees' wages. You rvill be liable f*r the tax payrnent even if you didn't actually withhold the tax. For a Federai EIN number, call the IRS at 866-816-2055 or fax them at 801*620-7115" Other Responsibititi*s amd Areps of Ccfficerns Code C*mplian*e: As tile permit ltr:id*r fbr this project" you ar* responsible f,*r resolving any failure to m*ct code requirernents that may be braught to your attention ttrough inspeeti*ns" i.iabili{y *nr{ Frop*rty I}xmaxge fnsxrra:rc*: CErnlact y*ur insxranc* age$t lr} $*e if you have adeqx*te insurance $$verage for accidents and omissions snch as failing t*cls, paint over spray, water darnage frrm pipe punctures- fire or work that xtust ba redone. Time: Make sure you have suttcient time to supervise your ernployees. Expertiser Make sure ycu have the skills tr act as yollr own general conkactor, ta coordinate the w*rk of rough*in "nd fini*h lrades, and to notify huilding officials as the appropriate rimes so they can perform the required inspections. If yau have additional questions cail thr Canstruction Contractors Board (503-3784621) or write the agency at P0 Sox 14140, Salern, CIR 97309-505?. Properfy_owner.doc CI31 1 1 103 225 Fifth Street Springfield, Oregon 97 47 7 541-726-3759 Phone C:ty of Springfield Official Receipt relopment Services Department Public Works Department RECEIPT #: 1200400000000000567 Date:0412912004 9:05:58AM Job/Journal Number coM2004-00501 coM2004-00501 coM2004-0050r Description + lYo State Surcharge + l0oh Administrative Fee Service Reconnect Amount Due 3.50 5.00 50.00 Item Total:$s8.s0 Payments: Type ofPayment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check DEAN MCALLISTER djb 4907 In Person Payment Total: $58.50 -5s8so-- 4/29/2004 Page I of I SPhlt{cFr&D $F$eril&psHL;} 225 FIFTII STREET a SPRINGFIELD, OR 97477 o PH:(541)726-3753 r F ELECTRICAL PERMIT APPLICATION City Job Number COYvI TPoq-ootolout'Z7 d approval Zoning 1.3 B. to\\ow rules A lrd LEGAL DESCRIPTION t?oL (a3l o()3() ? JOB DESCRIPTION C-& r\,r Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 daYs. A. Nerv Residential - Single or Multi-Family per drvelling unit' Authorized Signature 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 $s0.00 1 City Electrical Contractor Address Supervisor License Expiration Date Constr. Contr Expiration Phone ol herulea $ s0.00 = telePhonc-- NotiticdBen-- $ 63.00 $ 7s.00 $125.00 $163.00 $375.00 $ s0.00 -<<_> s 69.00 $100.00 $ 43.00 $ 3.00 in OAB numb tor D. rUFs Supervisin g Electrician see "B" above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit( Owners Address Pump or irrigation l0% Administrative Fee TOTAL E. l,Iiscellaneous (Service/feeder not included) -Each Installation $ 50.00 $ s0.00 q <to ,8s2Inspection Request: 726-3769 Shared Drive(T:)/Building Fonns/Electrical Permit l43.doc dc € prc"" X /b o?YD OWNER INSTALLATION The installation is being made on is not intended for sale, lease or Electric Permit InsPection SLTBTOTAL OFABOI,'E ( 1 DAY