The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2005-02-22Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00206ISSUED: 0212212005 APPLIEDz 0212212005 EXPIRESz 0812212005 VALUE: SITE ADDRESS: 205 S 44TH ST ASSESSOR'S PARCELNO.: 1702323105600 PROJECT DESCRIPTION: 200 amp service upgrade Springfield TYPE OF WORI(: Electrical Work Only TYPE OF USE: Repair Residential PhoneNumber: 541-746-6603 License Expiration Date Phone Owner: Address: Contractor Type Electrical KATHERINE KELLEY 205 S 44TH ST SPRINGFIELD OR 97478 Contractor OWNER CONTRACTOR INFOR]! # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: R-3 VN Size: Ft lst Floor: Ft 2nd Floor: Ft Basement: Ft Garage/Carport Ft Other: Load: REQUIRED PARI(NG Total: Handicapped: Compact: 01 0090 $ Per Sq Ft or multiplier Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh ofLot Coverage: Utilrty Square Footage or Bid Amount PUBLIC Valuation Descrintion Description Type of Construction Pase I of2 Value Date Calculated # in EXP\RE \F 1HE t0R Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-00206ISSUED: 0212212005 APPLIEDT 0212212005 EXPIRESz 0812212005 VALUE: Fee Description + lDoh Administrative Fee + 7oh State Surcharge Perm Serv/Fdr 200 amPs or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Total Value of Project Date Paid 2t22l0s 2t22t05 2t22t05 Receipt Number 1200s00000000000226 1200500000000000226 1200s00000000000226 Fees Pa 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 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 Contractors Board 700 Summer St llE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503'3784621 Web Address : www.ccb.state'or'us Permit #:&rn @6.--OO?96 Address:ZO;s q,/t I SI Issued bY:)(Date "z-a fZ- 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 c)ntroitors Board to sign thefollow-ing statement before a building permit can be issued. This statiment is requiredfor r"iid"ntiol building, electrical, mechanical and plumbing permits. Licensed architect andingineer applicants, exemp-t from licensing under ORS TLt.0l0t(7), need not submit this statement. This statement will befiledwith the permit' Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 38: ff r. 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' tr 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 W 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 theCCB and will immediately notiff 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. ' .^/^ Zz ctl" (Signature ofpermit (Date) (White copy to issuing agenq) permilfile, pink copy to applicant.) Property_ovrner.doc 06-0 I -04 Acting as Your own General contractor? I NFORMATION}.IOTICE TO PROPERTY OWN ERS ABOUT CONSTRUCTION RESPONSIBILTTIET You will' in most instances, be ruled to baan "employer" and the confractors you "ontract with will be .,erryloyees,, ifyou use conhactors not licensed with the construction contactors Board,to do labor in constructing or to assist in theconstruction or improvement of a residentlal stru*ure. ar in"-*-ployer, you must ;;;ffiH;,;'fu,11oi|"H;u,"' 't" oregon's \ilithholding Tax Law: As an employer, you must withhold incometaxes from employee wages at the timeemplovees are paid. You wiil be liable roritre tax paymenrr "r* iiy;; d*;;;;ualy witirhola *," 1* fro* yo*employees. For more information, call the Departnent of R"rr*r" at 503-37g4ggg. . ;: f . ri.i,i unemployment Insurance Tax: As an emproyer, you are required to pay a tax for unemploymentiasuranee purposds>on the wages of all anployees. For more information, call the oregon -Employment Deparrmen t at 5a3-947-l4gg. 1- The Oregon Business Identification Number_(BIN) is a combined nunrber for both Or"gor,witthotding anfUnernployment Insurance Tax. To file for a BIN, call 503-945_g091 or Xryw.dAJ,st?1e.or,. for theappropriate forms. \Yorkers' Compensation fnsurance: As an employer, you are subject to the Oregon Workers, Compensation Law,and must obtain workers'compensation insurance for your employees. If you ra;ito obtain workersi compensationinsurance, you could be subj6ct to panalties and be liabie for all claim costs if one "rvo* "*piil;;;r i1*"a on thejob' For more information, call the Workers' Compensation Divisiorr at the Departrnent of Consumer and Business Services at 503-947 -7 81 5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax frorn ernployees, wage\-r You will be iiable for the tax payment erlen ifyou didn't actuaily withhold the tax. F'or a Federal EIN number, call thi IRS at 1-800-8294933 or visit their web site ar ypstlrgdey If you are acting as your own contractor to construct a new home or make a substantial rmprovement to an existingstrucfure,you can prevent many problems by being aware of the following responsibilities and concems. Cade Compliance: As the permit holder fcrr this project, you are resp<nsible for resolvrng any failure to meet cottre requirements thal may tre brought to your attention through inspections. , Liahility antl Property f)amdge Insuiance: Contact your insurahce agent to see if you have adequate insurance ' coverage for accidents and cmissions such as falling toals, paint over spray, water damage from pipe punctr"rres, fire or wark that must be redcnr. ?ime: Make sure you have sufficient time to supervise your employee$i\ ,i- ,' . ,r-,, , ,, .,.., '* , Expertise: Make sure you hrii,!'$e skills'to act as yiru o-n'gener:il cclniiactor, ro coordinate the work of rough-in and finish trades, and to notify building nfficials as the appropriate times so they can perform the required inspections. If you have additional questions cail the Construction Conkactors Board (503-378462i) or write the agency at PO Box 14140, Salenq 0R 97309-5052. Property_owner.doc 06-{i 1 -04 TE:NO Ttris Information Natice ta OrynersProperty abaut Construction Responsibi}lles was thedevelopedbyConstructionContractorsnBoardaccordancewithoRs701passed055(5),the 9891tby Legislature.Oregon r f 225 Fifth Street Springfield, Oregon 97 47 7 541-726-3759 Phone City of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 1200500000000000226 Date: 0212212005 10:0e:04AM Job/Journal Number coM2005-00206 coM2005-00206 coM2005-00206 Description + 7%o State Surcharge + l0% Administrative Fee Perm Serv/Idr 200 amps or less Amount Due 4.41 6.30 63.00 Item Total:$73.71 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check KATHY KELLEY djb 5017 In Person $73.71 PaymentTotal: ffi 2/2212005 Page I of I 225 Ftyfld STREET . SPRINGFIELD, OR97477 o PH:(541)726'3753 o FAX: E LECTRI CAL P ERM IT AP P LI CATT ON City Job Number CDvvt@rcf- OO LOa Date Z'LZ 1. LOCATION OF INSTALIATION 3. (s4t 'zos S L(q+r S LEGAL DESCRIPTION t7 oz3'23 I o;6C(]- JOB DESCRIPTION 700Awe 9tA_,/tC_t:?GeA[{ 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. New Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact' the o 'qb $00 $s0.00 Alterations or Relocation: (,3 You $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ s0.00 $ orth,etS 7 City Electrical Contractor Address Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signanrre of Electrician owners Name f '. . .' i ,i .. i -i i i .2 '', C. Temporary Services or Feetlers 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 Amps or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with S. the E. 1000 Amps 1000 AmpsA/olts Reconnect Only Address 1io5 fti I luv City Phone ') *b -b,Uc ) OWNER INSTALLATION The installation is being made on properly I own which is not intended for sale, lease or rent. Owners Signature: Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is M5.00 * Surcharges Pump or irrigation Sigrr/Outline Lighting Limited Energy/Residential $ 50.00 $ 50.00 $ 25.00 6'S vn// n/i( 7o/o State Surcharge l0% Administrative Fee TOTAL $2r 73=/Inspection Request: 72G3769 4. Sharcd Driv{T:/Building Forms/Electrical Permit Application l -03.doc I - Single a{e tRe not included)