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Home My WebLink AboutPermit Electrical 2003-11-26Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-01185ISSUED: 1,112612003APPLIEDz 1112612003 EXPIRESz 0512612004 VALUE: SITE ADDRESS: 360 22ND ST ASSESSOR'SPARCELNO.: 1703361303200 PROJECT DESCRIPTION: Service reconnect Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PhoneNumber: 541-746-9423 License Expiration Date Phone Owner: Address: KIA ARNOLD 1390 N ST SPRINGFIELD OR 97477 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Contractor OWNER Vlhr # 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: R-3 SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: E: THIS PERM AUTHORIZE COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Sidewalk Tvoe: iT SI-1ALL TXPIRE IF THE WORK Bq:r,tgryqt/Rs?Eh rur rr I s N oT REQUIRED PARIflNG Total: Handicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page 1 of2 CONTRACTOR INFORMATION DEVELOPMENT INFORMATION Description Type of Construction VaIue Date Calculated LL- rl r UtilitY 3r r6s of the rules I 'rhe telephone ;il*:lY;lffi*'u.'on TION:0regon lrulLLrINU lNruKivlql Valuation Description I 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: COM2003-01185ISSUED: 1112612003APPLIED: 1112612003 EXPIRESz 0512612004 VALUE: Fees Pa Fee Description + l0%o Administrative Fee + 7oh State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.s0 $50.00 $58.s0 Date Paid tU26/03 tu26t03 tu26t03 Receipt Number 1200200000000002519 1200200000000002519 1200200000000002519 Plan Reviews To Request an inspection call the 24 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. I Electric Service: Approval required prior to utility company energizing service. Reou 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 of? [:TL i 225 FIFTH STREET . SPRINGFIELD, OR97477 c PH:(541)726-3753 o FAX' ELECTRICAL PERMIT APPLICATIAN City Job Number(41 ynz-e3 - O{l8f Date 4c o3 1.3. LEGALDESCzuPTION A. lzosjLlj o3260 JOB DESCRIPTION ILLC oocr:mtez- 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 Electrical Contractor Address Phone Supervisor License Number Expiration Date Consff. Contr. Number tl Expiration Date Signature of Supervising Electrician 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 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 Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited EnergyiCommercial as submifted h as the lollowi ngnot require specific land use $ 106.00 $ 19.00 ss0.00 approval Zoning Llete City B. C. D. $ 63.00 $ 75.00 $ 12s.00 $ 163.00 $375.00 $ s0.00 $ s0.00 $ 50.00 $ 2s.00 $ 4s.00 5E 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 orl V "B" above. Vt ,A Ar^"{J New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with Service or Feeder Permit S 3'00 Owners Name Address 13 7 O SI City 5?FC Phone 7z) ,-; OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. E. N TI A C * Surcharges Owners A iIY 1 BO'6AFtPERX&S.C" 10% Administrative Fee TOTAL s7) 3rot60 ;3\:2Inspection Request: 726-37 69 Shared Drive(T:)/Building Fonns/Electrical Pennit Application 1-03.doc --T C onstruction C ontracto-is Board Permit *: Cfuuzs;< - - c> I lB { 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ry!61!g!4 Address: 3LO Zz"- L .i + Issued by:\6 Datet //Z6 o3 & Statement: lnformation Notice to Property Owners About Gonstruction Responsibi lities 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 stdtement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: -.,fu ,. 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. u 3A. My general contractor is (Name)(ccB #) I will instrrct 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 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 Notice to Property Owners about Construction Responsibilities vil A'"Ll have read and do understand the Information on the reverse side of this form. It lzu hs,r lolte) (While copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/l I /03 4 Actfrmg as Y*ur Swn Gcmeral Contractor? $}.TFORffiATIfiN HfrYiCH TS P&SPffiffiYY *WNHR$ ASfi UY SOrd$TR{,J*TtON RH$r*ru$'ffi I [_*Ttf; $ ff#ftr: Iltls J*f*rna$o* lV*ii*e f* Prcp*#y *wners ab**ri ***sfrru*fr*n ff*sp*rrsi*rjffi*s was d*y*J*p*d *y f,he *orsfrucfi** C**fra*f*rs &aard rn accorda*c* lvifft SfiS IS?"SS5{$J, passed *y f&* f $$$ Sregcln legrsfaflrre. {f y<lu are acting *:i }*ur *1}u contra*t*r t* construct a r*w }rome or make a substanrjal improvemrnt rd} an cxistmg $ffuf ture, y*u {:aft pr*venl many profui*ms i:1t h*ing arvan: *f th* ii:tr}i:iving resp*nsibiiitlcs and c**c*ms. fi mployer Respsxesihitrities You wi1l, in most instances, be ruled ta be an o'empioyer" and the contractors yor] contract with rvill Lre "employees" if you use *onkactors not licensed with the Constru*tion Contract*rs Board lo do labor in constructtng or to assist in the ccnstrueticn or irnpr*vement of a residential $fructure. As the employ*r, yoil mr$t comply with the following: $regon's lVithk*lding Tax Law: As a* empXoyer, ycu must wrthhrld inecrne t*x*s fr*m empl*y*e wages at the time empk:y*es ar* paid. Y*rr will be triahle fcrr the tax payrn*nx$ e!er: if you il**'t ac{ua}ly rvith}'r*}d t}rc tax irr:rn ycur enrpioyees" For a Stale i3*siness 11) number, cali the Susiness krf*rmati*n Clenter at 503-985-??**. Unemploymenf lxxilrauce Tnx: As an ernployer. you are required t* pay a tax {*r ur:.emp}c1"ment insuran*e pilrp*$e$ nn the wage$ *f ail empir:yees. For more infarmation, eali the Oregon Bn'rp1*3'rnent Departme,nt at 5*3-94?-1488. lYsrkers' C*mpens*tion lusurante: As an employer. ysu are subject to the Or*g*n Workers' Compensation Law, and must obtain workers' compensation insurance for your en,pi*yees. If you fail to obtain worker$' compensation insurance, you coukl be subject to penalties and be liabie for all ciaim costs if one of your emplayees is injured on the job. F*r m*re information, call the Warkers' Cornpensation Division at the Department of Consumer anei Business Services at 503-947-?8i5. U'S. Internal Reverue fierviee: As arl empioyer, you mi.lst withhold federal income tax from employees' wage$, You will be liable for the tax paylnent even if you didn't actually withhold the tax" For a Federal EiN number, c*11 the IRS at 866-816-2065 or fax ttrem at 801-620-7115" {}tfu*r Responsibilitiss amd Aren$ of tqlmeerms Code Cornplianee: As the permit h*lcler fbr this project, y*u are respansii:ie fcr resoiving any failure tr: me*t cnd* req*irernenls that may i:e br*ugi:t to y*ur attention thr*ugh inspcctiems" I-iabiti$ und Fr*p*rty $xmage In:**rraNce: C**tact ycur insurarc* asent tfi s*e if _v*r: hav* *dequ*te insura*ec c*verage for a*cidents and omissions su*h as failing toals, paint over spray, water damage frorn pipe punctures, fir6 or wcrk lhat rnust be redone, Time: lvlake sure you have sufficient timr to supervise your employees. Sxper*ise : Make sure you have the skills to act as your own getreral contractor, to ccordinate the w*rk of raugir-in and finish trades, and to notiEr building officiais as the appropriate times so they can perform the required inspections. If you hal'e additional questions call ths Constructior Contractors Board (503-3784621) or write the agency at P0 Box 14140, Salem, CIR 97309-5052. Propert_v_*rvner.dac 0311 I i{)3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springllbld Official Receipt Development Services Department Public Works Department Receipt #z 12002000000000025 I 9 Date: 1112612003 Job/Journal Number Description AmounITAftI coM2003-01185 coM2003-01185 coM2003-01l8s + lYo State Surcharge + ljoh Administrative Fee Service Reconnect 3.50 5.00 50.00 Item Total:$58.s0 Type ofPayment Paid By Received By Batch Number Authorization Number How Received Amount Paid Cash Change KIAARNOLD KIAARNOLD djb djb In Person In Person Payment Total: s60.00 ($ l.5o) $58.s0 coM2003-01185 coM2003-01185 coM2003-01185 + 7%o State Surcharge + l0%o Administrative Fee Service Recormect 3.50 5.00 50.00 Item Total:$s8.s0 Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Cash Change KIA ARNOLD KIA ARNOLD djb djb In Person In Person Payment Total: s60.00 ($ l.so) $s8.50