HomeMy WebLinkAboutPermit 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)