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Home My WebLink AboutPermit Electrical 2004-03-22t Status Issued 225 Fifth Street, Spring{ield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00320ISSUED: 0312212004 APPLIEDz 0312212004EXPIRES: 0912212004 VALUE: SITE ADDRESS: 390 36TH ST ASSESSOR'S PARCEL NO.: 1702311303000 PROJECTDESCRIPTION: Reconnect Owner: DONALD HENDRICKS Address: 390 36TH ST SPRINGFIELD OR 97478 Springfield TYPE OF WORK: Electrical Work OnIy TYPE OF USE: Repair Residential PhoneNumber: 541-747-1501 License Expiration Date PhoneContractor Type Electrical Contractor owNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . R-3 ERM\I SH R\ZED UND DONED OR \S ABAN COMM ANY 1 ENCED go onv PERIOD # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: \TN SETBACKg Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: HIS P $ Per Sq Ft or multiplier Square Footage or Bid Amount REQUIRED PARKING Total: Handicapped: Compact: UlHOt\ to lort Street Improvements: Storm Sewer Available: Special Instruction: Notes: Total Value of Project Pase I of2 Description Type of Construction Value Date Calculated rr Yaluation Description I 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: COM2004-00320ISSUED: 0312212004 APPLTED| 03t22t2004EXPIRES: 0912212004 VALUE: Fees Paid Fee Description + l0Yo Administrative Fee + 7oh State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.s0 $50.00 $58.s0 Date Paid 3t22t04 3t22t04 3t22t04 Receipt Number 1200400000000000363 r200400000000000363 1200400000000000363 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 Springlield 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 I Insnections Pase2 of2 \ Construction Contractors Board Permit #: CAuaz-c)(- 'l ^oo 3 LO 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address: ZlO 36+L sI-- Issued by:B Date: )'zZ 4V Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requtres 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 appltcants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiledwith the permit. Fill in the appropriate blanks and initial boxes I and.2, and either box 3A or 38: E,A 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 strucfure is sold or offered for sale before or on completion. tr 3,A.. My general contractor is O{*r.)(ccB #) I will instruct my general conhactor that all subcontractors who work on the structure must be licensed with the Constuction Contractors Board. OR 3B. 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 notiff the office issuing this building permit of the nirme of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information side of this fgrm. 3 - 2204 Notice to Owners Responsibilities on the reverse D A (Signature of permit applicant)(Date) ffiite copy to issuing agency permitfile, pink copy to applicant.) Propert5r_owne r.doc 03 I I I I 03 --& 225 FIFTH STREET . SPRINGFIELD, OF.97477 r PII:(541)726-3753 o FAX: (541\726-3689 E LECTRI CAL P ERMIT AP P LI CATI ON City Job Number COtue,c,(].4 - O,53ZA Date *zz -oq LEGAL A. 0 3 ofcod 1 S Z-er Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 7 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 $106.00 $ 19.00 $s0.00 $ 63.00 $ 7s.00 s125.00 $163.00 $37s.00 $ 50.00 $ 69.00 $100.00 $ 43.00 $ 3.00 DESCRIPTION Electrical Contractor Address Supervisor License Number Constr. Conk. Number as zoning, and does not requi '180'8ll,"pr$$ HE Zoning Amps to 600 Amps I Amps to 1000 Amps Aurnorized Signature olts C Reconnect Only Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 B. sr ----7-\ City Phone ( NOTICE:HALLExpiration Date Signanrre of Supervising Electrician AU Volts see "B" above. lg$"w Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit fuwgne*U,tnrtl lHOBI ZED UND COM ED OR ANY 1BO DAY PER MENG Owners Name /=,)^) Ltil Address 3q D 3 A?b 5 E. City Phone 7 v OWNERINSTALLATION follow rules .,lotific ation Cerrter' The installation is being made on propelfrSryg gEAhOol-001 is not intended for sale, lease or rent' oogo. You maY catling the numherfor $ s0.00 $ s0.00 $ 25.00 $ 45.00 Fee is $45.00 * Surcharges Owners :io 3 slc7To State Surcharge 10% Administrative Fee TOTAL goD 58>Inspection Request: 726-3769 f^an*at ic Shared Drive(T:)/Building Fonns/Electrical Pennit Application l -03.doc 3. 1dMPLETEFEE scHEDLtT,E BELow ' "-:' tt | ' ' ' " t*i3:1+$ffi{}p$:gt*.t3 ,rV Expiration Date $u 201 \ \) Acting a$ Your Owm G*neral Contract*r? I$FSRMA?IOh* T,I*TI*T TS PffiSPTffiYY *MJNffiR$ AB0UT *Sru$TAUCTISN &H$p*$1r$*mlt*T'H$ N$ftr: trftrs Inf*rm*fion ff*fice t* Froperfy Ourners afi**f Scnstru*tia* R*sp*nsr*ilifres b?*s #eu*Joped by the Consfruclran Co*fracfors Soard in acc*rdance with OS$ fSf.S$S($J, passed by the 198$ Oregon Legislature. trf yon *re n*ting a$ ,v*tlr own *ontract*r t* construct a new hr:me or make a sxbsta*tial impr*vrment t* an *xisling siru*t*r*, yoli eafi prrvrllt m*in;r pr*hXexrs by heing awar* *f th* i'<rii*i.ving reiry*nslbiliti*s an<l ****erns. S rnployer Sl.s$ponsi bilities Yciu,;rili, in m*st irstan*es, be ruled t* he an u'emplsyer" and the o*ntractsrs you contra*t with wiXl tre "empltyees" if y*u u$e e*nkactors n*t licensed with the Conskuction Contr*ctors B*ard rc d* labor "in constructing or to assist in the c*nstrucxion or improv*menl af a residential $ffrlcture" As the employer, you m$$t c*nrply witlt th* following: $rcgnn's \Yithk*iding f*x Lary: As an empl*yer, ysu must withh*ld income taxes liorn ernpi*y*e lvage$ at the time empli:y*e* are paid, Yrlu will he linble f*r the tax payment$ evefl if y*u don't actualiy withh*ld the tcx frrm your er*pl*y*es. F,*r a Staie Business 1I) number, call the Business Infcrmati*n Csrrt*r at 5{i3-1}E6-7?*{i" trJnempi*ym*nt [xsursxee Txx: As an empi*yer, you are required to pay a tax firr unempio3tnent insuranee purp$$es on the wages of *11 employees. F*r more informati*n, call th* CIregon ErqrloSment Depa*:nent at 5{i3-?'4?-}488. Tforkers' Compensatiou Insurance: As an employer, you are subject to the $regon W'orkers' Compensatio* Law, and must obtain r*-orkers' compensatiou insurance for your employees. If you fail to obtain workers' cornpensation insurance, you couid be subject to penalties and be liable for all claim costs if one of yaur employees is injured on the job. For more information, call the $/arkers' Compensation Division at the Department of Consumer and Business Services at 503-947-78i5. U.S. lnternal Revenue Service: As an ernployer, you must withhold fbderal income tax &om employees' wages. You will be liable fior the tax payment even if you didn't actuaily withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. r-*.. Sther Resptxsibilities nnd A,res$ *f C*neernr Code Compliance: As the permit holder ftlr this proje*t. y*u are respon*iblo for resclving any failure tn meet *ode requirem*nts that rnay be br*ught to your attenlion thrnugh inspecti*ns" tiability and Froperty llam*ge lxsnraRcsl Cc*ta*t y*ur insural1ce a$efla t$ $ee it- ycu tr*ve adequate insurance **"*r*g* for accid*nts and omissions such as falling t*ols, paint sver spray) wster damage from pipe punctures, fire or work that must be redone. Time: Make sure you have su{fi*ient time to supen'ise your empioye*s" Expertisc: Mak* surs you have the skills trr act as your own gen*ral contract*r, t* e**rdinate th* vr*rk *f rcugh-in *j fini*h kad*s, anri to notify building offi*ials a$ the appr$priate fimes so th{:y can perform lh* required i*spectir:ns. If you have a{iditi*n*l questi*ns cai! the C*:nstrurtion Clonfra*tors Bnard i5(}3-3?8-46?1} *r wrilc ti:e ageir*3r at FO Box 1414S, Saler:r, {}R 9?3$9-5i)52" Properfy*owner.dsc 031 I I 103 225 Fifth Street ''iy Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #: 1200400000000000363 Date: 0312212004 3:06:07PM coM2004-00320 coM2004-00320 coM2004-00320 + 7o/o State Surcharge + l0o/o Adminishative Fee Service Reconnect 3.50 5.00 50.00 Item Total:$s8.s0 Payments: Type ofPayment Paid By Received By eEeckNumEer Batch Number Authorization Number How Received Amount Paid Cash Change DONALD HENDRICKS DONALD HENDRICKS djb djb In Person In Person Payment Total: $60.s0 ($2.00) $58.50 coM2004-00320 coM2004-00320 coM2004-00320 + 7%o State Surcharge + l0o/o Administrative Fee Service Reconnect 3.50 5.00 50.00 Item Total:$s8.s0 Type ofPayment Paid By Received By Batch Number Authorization Number lfow Received Amount Paid Cash Change DONALD HENDRICKS DONALDHENDRICKS djb djb In Person In Person Payment Total: $60.50 ($2.00) $s8.s0 (