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Home My WebLink AboutPermit Electrical 2005-06-09o Buildin g/Combination permit Status: Issued 225 Fifth Street, SpringfietG OR 541:726a753 phone 541-726-3676Fax 541-7 26-37 69 Inspe ction Line SITE ADDRESS: Z4g7 37THST ASSESSOR'S PARCEL NO.: 1702194208500 PROJECT DESCRIpTION: Seryice change_out Springlield TYPE OF TYPE OF USE: PERMIT N ISSUED: APPLIED: E)PIRES: VALUE: O: COM2005-00703 06t09t2005 06t09t2005 12t09t200s Owner: Address:]IIM_TER RocER D & LYNN M2555HAYDENBRIDGE RD .. SPRINGFIELD OR 97477 Contractor Type Contractor # of Unib: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: Frontlard Setback: Side l Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: License Expiration Date phone # ofStories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkhd o/o of calling nla rules adopted bY the Oregc n Center. Those rule -001-0010 throLr Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: aw requires y REQUIRED PARKING # Total: Handicapped: Compact:y obtain cop center. (Note: t $ Per Sq Ft or multiplier Sidewalk Type: DownspoutVDrains Square Footage or Bkl AmountDescriptbn Tvpe of Construction lof2 Yalue Date Calculated \ I .I Valuation Description I o Status: Issued 225 Fifth Street, Springfield, OR 541:126-3753 Phone 541-726-3676Fax 541:7 26-37 69 I nspe ction Line Fee Description + l0%o Administrative Fee + loh State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Total Value of Project Date Paid 6t9t05 619t0s 6t9t05 Buildin g/Co m binatio n permit PERIVIIT NO: COM2005-00703ISSUED: 06t09t2005APPLIEDT 06t09t2005E)GIRESz 12t09t2005 VALUE: Receipt Number 1200500000000000812 1200500000000000812 1200s00000000000812 Amount Paid $6.30 $4.41 $63.00 $73.71 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Electric Service: Approval required prior to utility company energizing service. By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that atl information hereon is true and correct, and I further certiS that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCT PANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certi$ 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 Reouired Insnections 2of2 Date J tI Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:www.cc$!g!4q Permit #:rnZrJS'OO-7O 3 Address:,1+h Issued by: Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: Date: I will instnrct my general contractor that all subconfractors who work on the structure must be licensed with the Constnrction Contactors Board. OR 38. I will be my own general contactor. N 1. I own, reside in, or will reside in the completed structure. tr 2. I understand that I must become licensed as a construction confiactor if the structure is sold or offered for sale before or on completion. 3A. My general confractor is (Name)(ccB #) { If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ulq lo r ofpermit applicant)-lDht.)(White copy to issuing agency pennitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT,CQN$TRUCT|ON RE$pONSrBrLrTrES If you are acting as yo$r own contractor to construct a new home or make a substantial improvement to in existing structure, you can preventnumy problenrs by being aware of the following responsibilities and'concerns. E mployer Responsibilities You wilf in most instances, be ruled to be an "employer'i and the confractors you contract with wiil be "employees" if you use conffactors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the foltowing: Oregon's lViihholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For rnore information, call the Departrnent of Revenue at 503-378-4988: \, Unemployment fnsurance Tax: As an employer, you are required to pay'a tax fon unenrploymurt insrrmlce purposg-'r on the \rages of all employees. For more information, call the Oregon Employment Department at 5A3-947-1488. ,j The Oregon Business ldenti{ication Number (BIN) is a combin@, number, for both Orsgon Wi3hholding and UnemploymentInsuraaceTax.TofiieforaBIN,call503.945-8091orforthe appropriate forms. Workerso Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obl4ryr workers' compensation insurance for your employees. If you fail to obtain workers' corxpensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Corisumer and Business Services at 503-947-78 I 5. U.S. Internal Rcvcnue Service: As an employer, you must withhold fedeial iircome tax frorn elnptoyees' wages;r1-' You will be liable for the tax payment evel: ifyou didn't actually withhold the tax. For a Federal EIN number, call tH! IRS at 1:.80S*829-4933 or visit their web site at rvww.irs.gov , Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiroments that may be brought to your attenlion through inspectir:ns. :, Liability and Prop'erty l)amage fnsurance: Contact your insurance agent to see if you have adequate insuranc& coverage flur acoidents and omissions such as failing toois, paint over spray, water darnage f,rom pipe punctures, fi::e or work that must be redo:re, Time: Make sure you:have sufficient time to supervise your employees. , ,:t -. ,,',,..,,,1.' : Expertise: Make sure you have the skilis [o abt as your owr generai contractor, to coordiriate the work of rough-in and finish trades, and to nctifli building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Constuction Contractors Board (503-3784621) cr write the agency at PO Box 14140, Salem, OR 97309-5052 Property_owner.doc 06-0 I -04 t. NOTE: This lnfarmation Natice to Propefty Owners about Construction Respoosrbr?rtr'es 'vas developed by the Constructian Contractors Soard in accordance with ORS 7A1.A55(5), passed by the 19BQ Oregon Legislature. 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LE CTRI CAL P ERMIT AP P LI CATI O N City JobNumber QAYW Date 1. LOCA:TION AF INSTALIATION : .r)ltll 37 th 3. A. New ResidentialLEGAL DESCRIPTION JOB DESCRIPTION Serftco U. Permits are non-transferable and expire if work is ' not started within 180 days of issuance or if work is Suspended for 180 days. 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 B.,, Contractor 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 Installation, Alteration or Relocation 200 Amps or less 201 Amps to,400 Amps 401Amps to 600 Amps Over 600 or 1000 Volts see "B" above. | $ 63.00 bz.oo $ 75.00 $125.00 s163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 )ne tion- phoneCity Supervisor License Expiration Date Constr. Contr. $mber Expiration C. Temporary Services or Feetlers Supervising Electrician D. J-tann -i- Owncds Name New Aueraoril orgEffcruipn8f r1RflIlS. t,.l o,, one circuitlrum b er ror rn e o re j;j*[",$ri#,pJ{ 3:S*.#$:H:,.ffiP *u\ u o5g. r, ror oo Address {d <Y- -(, E. tr'Iiscellaneous (Service/feeder not included) -Eaclt Installa tiort C Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. 6 Pump or irrigation Sigu/Outline Lighting Limited Energy/Residential 7o/o State Surcharge l0% Administrative Fee TOTAL $ s0.00 $ s0.00 $ 2s.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is M5.00 * Surcharges hb,o0 to .5O a .1 | Shared Drive(T: )/Building Forms/Electrical Permit Application I 43'doc FEE drvelling unit. $50.00 CONTRACTOR Inspection Request: 726-37 69 1 225 Fifth Street Springfield, Oregon 97 47 7 541-72G3759 Phone City of Springfield Official Receipt __ _ evelopment Services Department Public Works Department RECEIPT #: 1200500000000000812 Date: 0610912005 12:29:16PM Job/Journal Number coM2005-00703 coM2005-00703 coM2005-00703 Description Perm ServiFdr 200 amps or Iess + 7yo State Surcharge + l0% Adminishative Fee Amount Due 63.00 4.4t 6.30 Item Total:$73JIPayments: Type of Payment Paid By ROGERD. HUNTER Numb€r Check Received By Batch Number Number How Received ddk 35s2 In Person Payment Total: Amount Paid $73.7t $73.7r 'l \ 6t91200s I of 1 APFINQFI'LD