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Home My WebLink AboutPermit Building 2003-05-23Status Issued 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676F.a'x 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2003-00320ISSUED: 0512312003 APPLIEDz 0413012003 EXPIRESz lll23l2003VALUE: $ 2,500.00 SITE ADDRESS: 272 35th St ASSESSORTS PARCEL NO.: 1702313108100 PROJECT DESCRIPTION: MH on private lot Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential ,t,riVlUre Owner: Address: LONI{Y BESSETT 34940 HWY 58 EUGENE OR 97405 ,n oAH s 0090. yr )52-001 ru fioy er.Th -0010 rh 54r-747-0790 es ado in ob UGt,;c{w r squ,,eD I are s,AR et fori Contractor Type General Electrical Manuf Home Inst Owner Plumbing Contractor License OWNER RALPH W BROWN 63137 MICHAEL AWHEELERS MOBILE HOME S 91504 LONNY BESSETT OWNER 02n5t2004 05fi412005 54r-729-1500 541-928-0995 541-747-0790 # of Buildings: Prinr ary Occupancy Group: Secondary Occupancy Group: Pri nr :r ry Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontvard Setback: Sitlc I Setback: Sitlc I Setback: Rearl,ard Setback: Solnr Setbacks: Street Improvements: Storm Sewer Available: SpccirrI Instruction: # ofStories: I Height of Structure Type of Heat: Forced Air Elect Water Type: Electric Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: 1 VN 6,000 1,404R-3 3 Range Type: rn&i$?ffif;: ANY Overlay Electric THIS PERMIT SHALL EXPI Surface Area: PERMIT IS NOI ONED FOR REQUIRED PARI(NG 0 Total: Handicapped: Compact:Yes 24.00 l?g:oAY PEB|0D. 34.00 11.00 21.00 13.00 0.00 Fully Improved Yes # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Sidewalk Type: Downspouts/Drains ) PUBLIC IMPROVEMENTS Notcs: Pase 1 of3 To Storm Sewer h follow fhe t -Cna $ U rL DrN G-[I\ ]!lr<rur!!l!!!l ,9Fel:IHIOFIILA Building/Combination Permit St:rt us Issued 225 l,'ifth Street, Springfield, OR 511-726-3753 Phone 511-726-3676Fax 5 I 1 -1 26-37 69 Inspection Line PERMIT NO: COM2003-00320ISSUED: 0512312003APPLIED: 04/3012003 EXPIRESz 1112312003VALUE: $ 2,500.00 Dcscription Ilitl .r.rnount tr !urr uf Home Fec Description l't:r rr lleview Residential *'.i,',r Administrative Fee + ;'il, State Surcharge r\ ,lri ; rssing Assignment Ilrrilrling Permit I ' rr r, ,' f Home State Issuance I I rr r: u factured Home Connection N I n rr tr factured Home Feeder NI r n ufactured Home Placement ) I rr rr rrfactured Home Service l":r rr 'leview - Planning :: ": ry Sewer - lst 50 Feet S rr'' ry Sewer - Improvement S' "','y Sewer-Reimbursement s li(' \ lwMC Administration S i( 'IWMC Improvement : r( IWMC Reimbursement S' ( :rnitary/Storm Admin S')(. i'ranspo Admin S I ) i-'f ranspo Improvement : ' al 'i'ranspo Reimbursement l . r l)rainage lmpervious Area !" ,r Sewer - lst 50 Feetlrr.,r Line - lst 50 Feet J i ., urlane Manuf Home Private Total Amount Paid Type of Construction Use Bid Amount Manufactured Home $ Per Sq Ft $1.00 $1.00 Square Footage 2,500.00 35,000.00 Value $2,500.00 $35,000.00 $37,500.00 Date Calculated 04t30t2003 0st02t2003 Amount Paid Total Value of Project Date Paid Receipt Number r200200000000001100 1200200000000001319 1200200000000001319 12002000000000013r9 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 r200200000000001319 12002000000000013r9 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 1200200000000001319 12002000000000013r9 $34.32 $49.28 $34.s0 $8.00 $52.80 $30.00 $45.00 $s0.00 $160.00 $50.00 $s9.00 $4s.00 $335.80 $441.80 $10.00 $34.83 $332.86 $8r.72 $50.77 $709.81 $160.87 $623.78 $45.00 $4s.00 $1,ooo.oo 4t30103 5t23103 5123103 5t23t03 5t23t03 5t23t03 5t23t03 5t23t03 st23t03 5t23t03 5t23t03 st23t03 5t23t03 st23t03 st23t03 5t23t03 5t23t03 5t23t03 5t23t03 st23t03 5t23t03 st23t03 st23t03 5t23t03 5t23t03 $4,490.14 Fees Paid Plan Reviews I":'' '' Reyiew | ' 'rg Review l),'r ':/' \Vorks Review S,r;.rciur&lReview 05t01t2003 05t02t2003 0510212003 05t02t2003 0510212003 05/09/2003 0st20t2003 0sn6t2003 APP APP APP APP LLH AJI) DJW RJB Called applicant 5-9-03 to request revised plot plan w/ correct setback info. Paee 2 of3 Valuation Descrintion I rr'lGFlS.n I GFIELD Building/Combination Permit Stltus Issued 215 lrifth Street, Springfield, OR 54t-126-3753 Phone 5,1 I -726-3676 Fax a I t -726-1769 Inspection Line PERMIT NO: COM2003-00320ISSUED: 0512312003APPLIED: 04/3012003 EXPIRESz 1112312003VALUE: $ 2,500.00 ' , ',.erluest an inspection call the24 hour recording at 726-3769, All inspection requested before 7:00 a.m. i, ,)c made the same working day, inspections requested after 7:00 a.m. will be made the following work I nlanuf Home Set Up: When installation of all piers or stands is complete. I Frnal Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting' tt,'cks, venting, street address numbers, trees, driveway, etc. have been installed. I \\'rter Line: Prior to filling trench and including required testing. J S:rnitary Sewer Line: Prior to filling trench and including required testing. 5 Slorm Sewer Line: Prior to lilling trench. 6 Iinal Plumbing: When all plumbing work is complete. 7 Manuf Home Plumbing: After home has been connected to water and sewer. 3 MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. 9 1\lH Service: Approval required prior to utility company energizing service. It, l ,i'r Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or I'o r ndation inspection. l'1 .:,117rr,rre, I state and agree, that I have carefully examined the completed application and do hereby certify that all i rnrr ,',rn hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with : .i)rtli:rancesof theCity of SpringfieldandtheLawsof thestateof Oregonpertainingtotheworkdescribedherein,and r ;, I NO OCCUPANCY wilt be made of any structure without permission of the Community Services Division, Building Safety. I l'r'rthcr certify that only contractors and employees who are in compliance with ORS 70f .005 will be used on this project. I I trrr trcr agree to ensure that all required inspections are requested at the proper time, that each address is readable from the srr ,. r. tt,.rt the permit card is located at the front of the property, and the approved set of plans will remain on the site at all l',, i rlr,' ing construction. t l'(ll'Date Pase 3 of3 :- l(eourreo lnsDecttons 5-L) -/ s 225 Fifth Street Springlield, Oregon 97 477 541-726-3759 Phone City of Springfield Development Services Department Public Works Department Official Receipt Receipt #z 120020000000000 13 1 9 Date: 0512312003 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 coM2003-00320 Addressing Assignment Willamalane Manuf Home Private Manufactured Home Feeder Manufactured Home Service Plan Review - Planning Building Permit Manufactured Home P lacement Manuf Home State Issuance Sanitary Sewer - lst 50 Feet Water Line - 1st 50 Feet Storm Sewer - lst 50 Feet Manufactured Home Connection + 7Yo State Surcharge + ljYo Administrative Fee Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC lmprovement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin 8.00 1,000.00 s0.00 50.00 59.00 s2.80 160.00 30.00 45.00 45.00 45.00 45.00 34.50 49.28 623.78 441.80 335.80 160.87 709.81 332.86 34.83 10.00 81.72 50.77 Item Total:$4,455.82 Payment Total:$4,455.82 5123/2003 l2:05:37PM Page I of I cReceipt.rpt tFtnltlfiFr*L& LONNY 4,455.92 {- Willamalane Fark & R-ecreation District Job- No- SYSTEM "fi[?i?s,trs cH ARG E tmtn$ maz0 NAME:PHONE: ADDRESS: LOCATION OF PROPOSED BU ING SITE: Street Address:5\^wh srArE:DP- zre: ft14D5 Plat Name:- rax Lot Nunrb"rr n D[3t3t 0 R\DO 1. .-DEVELOPMENT TypE (Check appropriate dwelling(s). sDC catcx,rlations and dwelting t ype detinitions are on the back) A Single-Family Detached I t r --. -r- J..-^ NO. OF UNTTS \ x $1,ooo per unit = $ B. Single-Family Attached C. Multi-Family APartment D. Manufactured Home Park X $699 per unit = $ $oo \.d 2. sDc cREDtT (if appticable) sDcaayer must-{umlsh proof of wigamatane ireaiirpprovat. see doc creat wotlaheet. $ 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced forCredit) $ NO. OF UNITS WILLAMALANE SDC ment e <-)l5a-o City of Springfield epartment Z3 f OD -t4r t .!_ permit *: (liizoo1 - @3ZOConstruction Contractt --s Board 700 Summer St NE Suite 300 ,i PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Address: Issued by:L( v sf Date:5 z 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 and2, and either box 3A or 38 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. 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 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 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 Information Notice to Property pwners about Construction Responsibilities on the reverse side of this form. 4 ,o-a o3 (s of permit applicant)(Date) (llhite copy to issuing agency permit file, pink copy to applicant.) prop-own.doc 05/22/00 - )x^ Acting as -/our Own General Contractor? INFORMATION NOTISE TS PROPTRTY CI$'NERS ABOUT CONSTRUCTIOh' RESPONSIBILITIES NOffj This lnformation Notice ta Propedy Awners ab*xt Cons*.ructio* Resp*nsibilities was developed by *e Consfrucfi*n Confracfors Soard rn acc*:rd*ncs wilh ORS fS1"#5S{$}, p*ssnd *y f&a f SS$ Sr*gon tr-mgfslnfure^ if you are acting e$ your swn cofitractor to construct a fiew h*me cr make a substantia] trnpror,fffirrii {o ffr rxisrir,e sil:t:etui:e. ]iou can 1lrevi-rrtt many problenls 'L"ry being aware of thr follq:rq.,ing responsibiUties and cr:u**rns. trrmptoyer $e.e$p*n si hilities Oregon'* lYithholding ?ax Lap: As ar: empioyer, y'ou rnust rvithhold incc:ne taxes iiom employee walles at the time employees are paid. Yau will be liable forthe tax payment$ even if you don:t aetually,'i,,ithhold the tax ftom your emplol'ees. $or a State ilusiness $) numher', caii the Business Inlbmration Llenter al5A3-98{t-2222. Un*mployurent Insurn*ee Tnx: As an employer, you are re*;uired to pay a tax for unernp$*yment insurasce purposes' on the wages of all empioyees. For mcre information, *all the Oregon Empl*yment Department at 503-378 -3524" Wcrkers''Cnrnp*nsation Insurance:'As atr ernployer, you are subject to the Oregan Workers'Cornpensation La,w, and must obtain w*rkers' compensation insurarce for your e*ryloyees. tf you fail to obtain workersS'ecmpensation insurance. you c**irl he subject to penalties and be liai:tre f*r atrl cl*irn costs if one of your er*ployees is i*"jrx"ed c* thejob. For r'.rore infomaii*n, call the V/*rkers' Compensation Division at the l)epartment of Coneumer and Buslness Services at 503-947-78 I 0. U.S' Interaal R"*venne Sen'ice: .4s an empl*yer. y'-.*u rnu:ii *,:thh+ld {'edrral in*t'mc tax {ior* empioST*es' ivag,-.;. 1'o* will llq liable fbr the tax payrrrent even il5'*u didn'r ao&letriy lvithhuld th* tax. F*r a F*d*rai *.IN number, lax tj:ie IRS at 8iS-620-71 I5 ora,rile to them ai IRS, Maii Stop 6271,?O llox 994i. Ogden. UT 84.109. #ther Respons$bilities s*S Areas s{ Cq}ncer&s requirements that i::a1,' ir* brrii;x]-tt to vour attentir:n th::ough i*spe ,:r.ii;cs. I-iability *nd fr*p*rty flamage lusur*nr:e: Conra*t your insura**e agent to see i{'.l,ou have aclequale insulance cor:'er?g€ lirr accid*nts an<l omtsstons such as faliing toois. paint over sprali, n'ater Camage *om pipe punctures, .'i:e ,"'rr' rvork that rnust be re-dnrr*^ As a*y empi*yer, y*u nr$:\r be resp*r'rsihle f*r iniuries sust*insei !:y your ernpla5'ees. Time: Make sure -vou have suffic:rent time to supervr.ic v*ur rmployees^ Expertise: h{ake sure ;,,cu have the skills to act as y$ur o\4r} generat contractcr, tc coordinate the rvork of rou-eh-in and finish lrades, and to n*tily building *fficials as the ai:pr*priat* tiree-o sio !ile), i:a* perf*rr* iir* r*qr.rireci insper;tions. If you have additional qur"<tions *ail the {lonslruction Contract*rs lloard (503-37ti-i6? I e xf. 4900) *r u,rite the ege.ncy at FS llox 1414*" S*Ien:, {iR }730q-5052. prop-otn.do* 05i?2.;00 CITY OF Sl-'rlNG FIELD SYSTEMS DEVELOPMENT WOR KSH EET JOURNAL OR JOB NUMBER: Com2003-00320 NAME OR COMPANY Lonny Bessett LOCATION 272 35th Street TAX LOTNUMBER 17023131rL08100 DEVELOPMENT TYPE: NEW DWELLING UNITS BUILDING SIZE (SF) O LOT SIZE (SF): (nr! oQ ElFU) r! r070 109 I to92 109-3 tw4 1054 1055 t054 1056 1079 1078 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEMt rMFERVror.ls sf. x | 22t2.oo COST PER S.F $0.282 CHARGE $623.78 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. 0.00 x COST PER S.F. $0.282 x DISCOUNT RATE 507o DISCOUNT $0.00 ITEM l TOTAL. STORM DRAINAGE SDC i623.78 2. SANITARY SEWER - CITY A. x COST PER DFU $22.09 B. IMPROVEMENT COST: NUMBER OF DFU's 20 x COST PER DFU $ 16.79 = I $335.80 ITEM 2 TOTAL. CITY SANITARY SEWER SDC $777.60 DFU's 3. TRANSPORTATION A. REIMBURSEMENTCOST: ADTTRIP RATE 9.s7 NUMBER OF UNITS 1 x COST PER TRIP $ I 6.81 x NEW TRIP FACTOR 1.00 = f--t6oa7 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 x NUMBER OF UNITS 1 x COST PER TRIP $74.17 x NEW TRIP FACTOR 1.00 = | $709.8r ITEM 3 TOTAL. TRANSPORTATION SDC 4. SANITARY SEWER. MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's I x = f--J32a6 B. IMPROVEMENT COST: NUMBER OF FEU's I x = f-----$.?18-J MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = = | $0.00 = I $10.00 $377.69 COST PER FEU $332.86 COST PER FEU $34.83 SUBTOTAL (ADD ITEMS I,2,3, & 4)649.75 .5. ADMINISTRATIVE FEE: SUBTOTAL $2.649.75 x ADM. FEE RATE 5Vo CHARGE s132.49 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: D. Wright 5t20t2003 PREPARED BY DATE TOTAL SDC CHARGES 20 i70.68 l-Sso-7- f@ r,T U NUMBER OF NEW FIXTURES x UNIT EQUIVTENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODEIS, CAI-CUI-ATE ONLY THE NET ADDITIONALFXTURES) NO. OF FIXTURES DRAINAGE NEW OLD UNIT EQUIVALENT FIXTURE UNITS 1 0 3 3 FOUNTAIN 0 0 1 0 DRAIN 0 0 3 0 totLt / ETC.FOR 0 0 3 0 FOR SAND / AUTO WASH / ETC.0 0 6 0 LAUNDRY TUB 0 0 2 0 ASHER / MOP SINK 1 0 3 3 CLOTHESWASHER - 3 OR 0 0 6 0 HOME PARK TRAP PER 0 0 12 0 RECEPTOR FOR REFRIG/W TION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SINGLE STALL 1 0 2 2 GANG OF 0 0 2 0 SINK: COMMERCIAURESI KITCHEN 'l 0 3 3 BAR 0 0 2 0 WASH BASIN/DOUBLE VATORY 1 0 2 2 LAVATORY/RESIDENTIAL BAR 1 0 1 1 STALL/WALL 0 0 5 0 PUBLIC INSTALLATION 0 0 6 0 ATEPRIV 2 0 3 6 MISCELLANEOUS DFU ryPE NUMBER OF EDU'S 20 0 TOTAL DRAINAGE FD(TURE UNITS +EDU isa toa unit set at 167 DRAINAGE FIXTURE UNIT CALCULATION TABLB MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALIIB YEAR ANNEXED CREDIT RATU$I,OOO ASSESSED VALUE IS LAND ELCIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENTELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 0 0 1979 CREDITFOR LAND (IF APPLICABLE) VALUE/ IOOO $0.00 CREDIT RATE $4.92x I so.oo CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / lOOO CREDIT RATE $0.00 x $4.92 =l 0 TOTAL MWMC CREDIT I $0ro BEFORE 1979 $4.92 1979 $4.92 r980 $4.83 l98l $4.77 1982 $4.64 1983 54.47 1984 M.30 | 985 $4.09 I 986 $3.78 1987 $3.41 l 988 $2.98 1989 $2.52 1990 $2.06 r99l $l.e 1992 $1.45 l 993 $r.31 1994 $r.r3 1995 $0.97 t996 $0.82 t997 $0.63 1998 $0.41 1999 $0.22 2040 $0.04 FIXTUREryPE Construction Contractu- s 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 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. Thts statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from 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 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 F ,, 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 narne 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. 4 .Ss .ot of permit applicant)(Date) Permit x' LoMzaa -&3Zo Address Z-tL Js*u.. :;f Issued by:\(Date '2 o3 prop-own.doc 05122100 (llrhite copy to issuing agency permil file, pink copy to applicant.) r I ^j i_t _ ...)-. '\--' ...,i., .l ,..r i,. f.1 !.,: lonfractor?'- f._i: .: , INFORMATION NOTISr TO pROpERTy OWilERS . : ABCIUT CONSTRUST1Oil RESPONSTBTL|TIES : , -!. ru0 ffi Ihis ff*flce to Froperty e*ouf fronsfrucfror by ftue 6*ard ,n 741 0ssa$J s.t f&s f iiyou are acting as )''or.il 9J$cqstraqtor,to conqt4u-c.td$q+homeor make asubstantial rmprovement ro an exisrrng structure, You can pre vent manl'problems by being au'are of the follou'ing relpor:sibilitiei and concerns. : Employer Rs$ponsibilities l": '1' 1' _:You willnin most instances, be nrla{..1o pg an,"emp}oyer" and the contractors your contract with will be "employees" if i;rl use coniiactors not licensed ri,ittr ttre Cbristruction Coiilractors board to do iabor in consiiuiting oi to'ass,st in the construition or improvemelr! of a residential s'tructwe. As ihe,emnfo.vriii you xrist complJ', ditn tf,ii fottowing: Oregon's Withholding Tax L*w: As an employer, y$.u must withhold income taxes from employee li/ages at the time employees are paid. You wil] be Iiable for the'tax payme.r$s even if yoir donrt aatualty wlttrnofB,*r.+,-gN .fr&rslbf$ employees. For a State Business ID number, call the Business Inlbrmation Certer a|503-986-2222. finemployment Insurarce Taxr As an employer, yotr brb'reijuirvd to pay a tax for Lherrlployrnenf iniurane e purpoub on the $rages of all ernployees. For more inf,ormation, eall the Oregon Emple-v*rent Department at 503-3?*-3524. wor*E*J'18'oitr;idnsarion Insurinc'e: Asan ernployer, yau iiri siluidbi ta tte Siegon Wr*tcdrSttbonigarlation r-u*i,l and rnust ritrtain wcrkers' compensation insurance for your emff0ydts. ,IF,ysu {ai?tar6btiin'-rsotkeH'=&'mpensation insurance. you could be subject to penalties and tre liabie for all claim costs if one of your employees is injwed on the job. For more infbrmation, caii the Workers' Compensation Division at the Ilepartment of Consur:rer anrJ BusinEss Services at 503*947-7810. :if i.-, ;;i., , i' " '' ) i", , U.$. trnt*nnal Revenue fiem'i*e: As an employer. ycu must withhold {ederr:l incorne tax tnrrn ernpl*yees' wages. You wiil be liable for the .lex.pyrnont even if:you qffirr'tncfreally rtittrhqldft?$.Ax.i ,Fcra Fedoral EINtuniber, fax the IRS at 810-620-71 15 or nryite to them at IRS, Mail Stop 6?7{;PQ.&g+.99/1, Ogde$d*_l'fi 844q9., . ,,; . il Other Responsibitities and Areas of Ccncert$ Code Cornpliance: r\s the permit hoider for this praje*t,you are responsi&le'for rosolving arry' f;ailure tu *eet .o/q requrrements that may be brought to your attentron thrcxgh inspections. Liability and Property llamage lm$uranter C'ontact y*ur rnsurrance agent {r: $re if you h*ve adequatn in**trnr.:r: covsragc l*;r tccidents ixic! on'lissions,sueh as falling tools, paint over sprrly, vrat*r damage fiom pip* pr"rnctrre$, trrie ci u,ork ti:at rnust tie re-don* r\s any empiol'er, !'"oil n:ay b* responiihic for ixjuri;',r iustaincil b;',i'oLrr ernplol'ees. Time : Yllt t"t, you have sulficeni tune t{) supen-ise -iour cmplovces. .! :? i Expertise: Make sttre \'tlu ha',.e the skills to act as,vour ov,'n general cotrtractor. to coorclinate the.*r:rk af ioush-in and tlnt,h iradcs,qnd tr>.rigiii;'brrilding o{'ftcials as thr approprirte tirnr::, sif-rt4*^car, prrJirrrrr l}rr: ruurured in:.1,i r:;it;rir.'-- i :---. l-ll : I "" 'P-.. i If y*u have atiditional que*li*ns cai! thll (lonslnrctrtx {-lt}ntri}{:h}rri }}c;ard (503.3;;Zi *rt. +9ff}1,*,,*it* tlr* cgiency at P0 Box i4140. Salerr.r. OR 97JU9-505:. prop-owr.doc A5122100 INSPECTION REQUEST: OFFICE: 726-3759 225 FIFTH STREET ,-,.,: SPzuNGFIELD, OREGON 97477 ELE. ^tI PER},,flT APPLICATION 3. CON{PLETE FEE SCMDULE BELOW A. Nen' Rc.sidentill-Single or I\lulti-Ftrnill' per drrelling unit. Scnicc Included: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion lhereof Each Manufd Hotne or lvlodular Du'elling $ 106.00 726-3 Sum D Permits are llon-and expire if u'ork is not started u'ithin 180 dai's ofissuilnce or ifrvork is suspended for 180 d.tys. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address /a{2, Supen'isor Expiration Date Signrtturc of Supcn'ising Electrician A$5ooot|Q,men,ice or Feeder or Feeders allirtion, Altcrttions :locirtion: ' 200 amps or less I\Iinimurn Elcctric Permit InsPc .I. SUBTOTAL OF ABOVE 7%o State Surchrtrge 8%o Administrativc Fcc 201 amps to 400 arnPs -10 I anrps to 600 antPs 60 I artrps to 1000 aruPs OWNER TALLATION The installation is being tttade on propefi I olvn rvltich is not intended for sale, lease or rent. Installrtion, 50.00 One Circuit on Per Panel Each Additiolal Circuit or u'ith Service or Feeder Permit $ 3.00 -E. 1\Iiscellrtneous (Scn'icc/fecdcr not included) -Each installation Pump or irrigation 550.00 - Sign/Outline Lighting $50.00 - Lintiteci Energl'/Res $25'00 .- Linrited Energry'Comnr - 515.00 -hirrgcs w D Orvners Signitture TOTAL ction Fcc is SJS.oo * Surc Citv Job $ 19.00 _ A.D1 Expiration Constr Contr. Orvners $ 63.00 _ $ 7-5.00 _ s125.00 --$163.00 _ $375.00 _ $ 50.00 _ Over 1000 ampVvolts Reconnect OnlY $@ $69.00 $100.00 'q\ 6\ $43.00