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Home My WebLink AboutPermit Electrical 2004-06-09Status 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: COM2004-00675ISSUED: 0610912004APPLIED: 0610912004 EXPIRESz 1210912004 VALUE: SITE ADDRESS: 425 26TH ST ASSESSORTSPARCELNO.: 1703361420300 PROJECT DESCRIPTION: Reconnect new meter base Owner: TERWILLEGAR Address: 425 26TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PhoneNumber: 541-747-9014 License Expiration Date PhoneContractor Type Electrical Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: uto Sprinkled Building:nla Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: {ollow rul N IT lHE WORK OTIGE: ANY 1 BO DAY $ Per Sq Ft or multiplier ERM\1 \S NOI Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: REQUIRED PARIflNG Total: Handicapped: Compact: A C PER\ Total Value of Project DEVELOPMENT INFORMATION Valuation Descrintion Description Type of Construction 1 Value Date Calculated L uuN rKAUruK rN.ru]ry..] Notification gplling the number tor %o of Lot SH -lruILDIr\ u lN r t,KluA. I !!lN-l Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00675ISSUED: 0610912004APPLIED: 06/0912004 EXPIRESz 1210912004 VALUE: Rees Paid Fee Description + lOoh Administrative Fee + 1oh State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.s0 $50.00 $s8.50 Date Paid 6t9t04 6t9t04 6t9t04 Receipt Number 2200400000000000726 2200400000000000726 2200400000000000726 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. Insnections 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 wilt 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 Pase? oI2 L] Construction Contractors Board Permit #:COvn@U t -()<)bZ f 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:7 ZC-+t- Sts Issued by:$4 Date 9 Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and,2, and either box 3A or 3B: A'r. -Et- 2. I own, reside in, or will reside in the completed strucfure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will inskuct my general contractor that all subcontractors who work on the strucfure must be licensed with the Construction Contractors Board. OR 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. L.?-L) of permit applicant)(Date) (White copy to issuing agency perrnitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 A Aetimg as Ysur Own G*neratr Contractor? *T,$TORMATION ru*TI$H T# PRSPTKTY #WNEffi$ &ffi stlT e0ru $TR|"JsTtcN ft Hspmr\t$*wxL;Ttffi $ td0lfj T"flis lnf*rn*#o* i/*#re fo Properfy Owners ab*uf C*nsfrucfian ff*sp*nslbili{r'es was devei*ped *y ffie Gorslnrcfior f**frarfars Saard in a*c*rdance with OtrS 7S?"055f$J, passed by f*e f 9$$ Oregran legisiai*re" 1 y*r; ar* acti*g a$ y*rur *&fi contract$r to c*nstru*t a new h*m* cr r*ake a rubstantiaX irnprovem':e*t t* an e,xisting $tru*iure, y*rx *an prr\:{:fii m;i:r3, pr*}:l*ms i"ry being aw*r* *f th* {'cil**"vu:g r*sp*nsihi}iri*s atleX c*::c*rns" H mploy*r Rs$prxrsi bilities You will, in rnost ir:st*n*es, be nrled t* be an "'emplcyer" *nd the contractors you contract with wiil be "er:-:pioyees" if you u$c c*ntractors not licensed rvitSt lke Cq:nstru*tion Cs:ntra*t*rs B*ard t* d* lai:or in c*nstru*ting or to assist in the canstm*1i*r-r cr imprr:vernent *f a r*sirierrtial $trTucture. As th* ernployer, yo$ m$$t eclrnply w'ith the followirag: Oregon's lVithholding Tax Law; As an employer, you must withhcld income taxes from empbyee lvages at the timp emplcyees are paid. You will be liable for the tax payrnents even if you don't actually withhsld the tax fram your employees. Sor a State lSusiness ID nurnber, cali the Business Infarmation Center at 503-986-2200. Llnemployrnent Insurxnce Tsx: As an emplcyer, you are required to pay a tax frr unemployment insurance purpoQes rn the wages of all ernploy*es. For more informatiori, cali the Oregon Emplo3,nrent Department at 503-94?-1488. \fforkers' Compensrtion Insurance: As *n employer. you are sub.ject t* the Oregon Workers' Compensation l-,aw, and must obtain lvorkers' conrpensafion insurance for your ernpl*yees. If ycu fail to obtain worker$' co:npensation insurance, you could be subject to penaities and be liable for all claim costs if one of your employees is injured on the jab. For more inforrnation, call the Workers' Compensation Division at the llepartment of Consurner and Business $ervices at 503-947-78i5. di.li, Internai &*vex'la** $iervice: As ax emplcyer- y$u rl'rl:st withh*:ki fbderal jeeon:e tax fr*m er'rpl*yces* wages" You wrll bc liabl* f*r tl"le tax pal,rnent evsn if y<ru didr't actually rvithh*ld ths tax. F*r a Federal fiIN nurnher, cail the IR$ at 866-8 I 5-2065 *r fax them *t 8{} I -62*-? 1 1 5. *fh*r }*.espcnsibitrities nrad Arsss sf Con*ennx C*de Complian*e; As th* perrnit h*lder f*r this pr*jeet. you are resp*n*ible f<rr r*sc)trving any failure f* meet *ode requirements th*t may be br*ught to your attenti*n thr*ugh inspe*ti*ns. Liabiiity xn* Sur*penfy $nm*ge tr*sur*n**: Ccntael y**r insurax** ag*n{ tr: see if" y*u have a*trequatt: insurancc fr*ver*ge for accide*ts and ornissjons such as falling toatrs, paint clver $pray, water darnage fram pipe punchres, fire or work that must b* redane. Time: Make sure y.ou have sufficient tirne to supervise your employees. Expertise: Make sure you have the skills ts act es your own general ccntractor, to ccordinate the w*rk r:f rough-in ard finish trades, and t* notifu building officials as the appropriate times sc they can perfbrm the required inspectir:ns. If you have additional questions call the Canstructio* Confractors Board (503-378-4521) or writs the age'ricy at PO Bcx 14140, Salem, OR 97309-505?. Properly_"owner.eloc S3l I I 103 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: ELECTRICAL P E RMIT APPLICATIO N City JobNumber ClrtlzDoq- c>O 67f Date I o OF INST'ALI-A7'ION 3 COMPLETE FEE proval Zoning Date b -t o--o A. New Ilesidcntial - Single or lVlulti-F'arnily per drvelling unit. 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 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less $ 63.00 $ 75.00201 Amps to 400 qulres youto- $375.00 $ 50.00 s-(> LOCA'TION1. \zf zG ft^ > )- LEGAL DESCRIPTION t703:6rcl zo 30 c> JOB DESCzuPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. C;O.NTRACTOR TNSTALTArIO]V ONr,v Electrical Contractor Address Phone Supervisor License Expiration Date Constr. Contr, Expiration of Supervising Electrician Owners Name Address OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 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. D. Ilranch Circuits $ 106.00 $ 19.00 $s0.00 Ciry r:i 5',LH#,ffiLt xfitfE"iirFi!'ffi_ $ 43 oo 'll*' -paenrnonfiblrfn OHlliiP&filrrffri lSNOf- - j;i,: ;;Sqilrs qlmesqsA,ffi,,NED F,B_- $ 3.00 R.6 -S T , i:,iI I :lrl'-.lU.' E. " tY,Iiileltaneous (Service/feeder not included) -Each lnstallation ,ofupno,"y)l)-?ar(Pump or irrigation Sign/Outline Lighting Limited EnergyiResidential Limited Energy/Commercial lYo State Surcharge l0% Administrative Fee TOTAL $ s0.00 s s0.00 $ 2s.00 $ 4s.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges "ro 3fo toos8=Inspection 726-3769 Shared Drive(T:)/Building Fonns/Electrical Pennit Application l -03.doc CITYOF OREGON not $12s.00 $163.00 cAR 952=001- ol the ru'lesb#- 0090. You maY copies number r"sfituB6lt 225 Fifth Street Springlield, Oregon 97 477 541-726-3759 Phone ^ity of Springfield Official Receipt /evelopment Services Department Public Works Department RECEIPT #: 2200400000000000726 Date: 0610912004 10:11:05AM Job/Journal Number coM2004-00675 coM2004-00675 coM2004-00675 Description + 7oh State Surcharge + llYo Administrative Fee Service Reconnect Amount Due 3.50 5.00 50.00 Item Total:$s8.s0 Payments: Type ofPayment Paid By CheckNumber Authorzatlon Received By Batch Number Number How Received Amount Paid Check TERWILLEGAR djb 460 In Person $58.50 Payment Total: -$58156- 61912004 Page 1 of I