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Home My WebLink AboutPermit Electrical 2004-01-09Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-00029ISSUED: 0110912004APPLIED: 01/0912004 EXPIREST 0710912004 VALUE: SITE ADDRESS: 880 25TH PL ASSESSOR'S PARCEL NO.: 1703361107400 PROJECT DESCRIPTION: Add 2 circuits for heat pump Owner: ETHEL HARDING Address: 880 25TH PL SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PhoneNumber: 541-988-5913 License Expiration Date PhoneContractor Type Electrical Contractor OWNER CONTRACTOR INFORMATION )RMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # ofStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: o/" 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 VN SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: lHIS PER ABANDON PARJilNG OR IS PERIOD Total: Handicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page I of2 PUBLIC IMPROV Description Type of Construction Yalue Date Calculated ': Overlay # Street Paved DAY Status 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: COM2004-00029ISSUED: 0110912004APPLIED: 01/0912004 EXPIRESz 0710912004 VALUE: tr'ees Pa Fee Description + l0oh Administrative Fee + loh State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Amount Paid Date Paid y9t04 u9t04 u9t04 U9t04 $4.60 s3.22 $43.00 $3.00 Receipt Number 1200400000000000030 1200400000000000030 1200400000000000030 1200400000000000030 $s3.82 Plan To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wiII be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. 1 Rough Electric: Prior to Cover 2 Final Electric: When all electrical work is complete. Renrr 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 Springlield 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? .l 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 oF ELECTRICAL P ERMTT APP LICATION approval City Job Number(r,: 1a /e O\ -'cy'.-O Z f Zoning Date o -o 1. LOCA'TION OF INS:TALIA?ION 3. COMPLETE LEGAL DESCRIPTION A.r-erv Residcntial - Single or Nlulti-Farnily pcr drvelling unit' l7 =3611 c7L(oo JOB DESCRIPTION $ 106.00 $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. . COATILACTOR INSTALTAruON OAII,}'L. Services or Feetlers - Installation, Alteralions or. Relocation:B. Electrical Contractor $ 63.00 $ 7s.00 $125.00 $ 163.00 $37s.00 $ s0.00 Address Phone Supervisor License Number C Temporarl' Sen'ices or Feeders 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 rcf as submitted has the following not require specific land use fr>(L $s0.00 Date City Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name 2 Address f,fo N ar rr €/ Phone q88 -$713 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ffi$FlEffi,'.iRF,l., ABANDoNEtrftttt $ 6e.oo 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel . oneCircuit / Sor.oo Each Additional Circuit or with Service or Feeder Pemrit E.N'Iiscellaneous (Seri'ice/feeder not included) -Each Installation Oregon law requtres the ruiesmB L/ (, /^-^l^t\a I q9 3zz q60nr City 7o/o State Surcharge l0% Administrative Fee TOTALInspection Request: 726-37 69 Shared Dive(T:)/Building Fonns/Electrical Permit Application l -03.doc 9*o .)t) ,Jr t( Srra l/a Construction Contractors Board permit *: C\t*rzr<..-- - ocx>e ) 700 Summer St IrlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address: ZgO ZS+r ?L Issued by:\K Date: l-7-Oq Statement: Information 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 submtt this statement. This statement will befiled with the permit. -N A Fill in the appropriate blanks and initial boxes I andZ, and eitherbox 3A or 38: -ft l. 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. 3A. My general conhactor 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 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 f have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. o (Signature of applicant)(Date) (While copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 ;r4- Wn-^nr-,-t' - Actimg as Your Own General Contractor? lhlp#K$.fi&TIsN pd*Ttcffi T* pR#pffiffiTy *wNfrRs AfrSUT **NSTR{JCTIG$U Rffi $P*M$IMXLIYIH$ ,fCII$: Tttis l*{*rrna{ion ldrflc* fo Properfy Owners ab**f Consfrucffon R*sponsl*iiifi"cs i,t/*$ der,reloped by the Consfrucficn Ccnfra*{ore Soard in accordan as with OSS f$ ?. S55{$J, passed by the 1 989 Oregan legrslafure" trf y*u ar* a*ting ;l$ .v*lir r:-r.vn c{rntract*:r t* co*struct e ne.}r h*m* *r x":*ke a sribstantial improv*m**i tr: ;;n ,:xisti*g $trl:ctrurf , ysil *an pr*vei]{ :xany pr*htr*ms by being aw*r* *f ti"r* l'*ll*rvurg r*sp*xsibitriti*s and **xs*rns. Hxmplcyer See$B*msihilities You rviil, in rnost instimecs, be ruied tc) h* afi o'empi$yer" and th* contrastors you er:ntr*ct with will be "ernpk:yees" if you iis* c*Rlractcrs n*t lice*sed rvith the C*netruction Conlractcrs Ilaard tc d* labor in constructlng or to assist i* tire c*nstrxctio::l *r imprr:v*ment tr{a residential strileture. As *}re *rxrpl*yer, you milst r*mply with the fallowing: Oregox's lVithh$lding Tax Law: As an employer, ys$ must wi.thhald in*ome taxes from ernployee vlage$ at the time emptroyees are paid. Yru will be liabie fcr the tax payments even if you don't actually withhald the tax from your emplayees. For * Stale llusiness IS nurnber, cali the Business Infcrmation Center at 503-986-?20$. fln*mploym*nt Insuraxce Tnx: As an ernployer, you are required to pay a tax f*r unenrpl*yment insurance purp*$es on the lyages of ali employees. For more inf*rmation, call the Oregon Emplol"rne*t Departmant at 503-947*1488. Workers' Compemsation trnsurnnee: As an emplcyer, you are subject to the Oregcn Workers' Compensation Law, and must obtain workers' cornpensation insurance for your employees" If you fail to obtain workers' compensation insurance, you could be subject to penalties and be iiable for all ciaim costs if one of yaur emplayees is in3ured an the job. Sor more information, call the Workers' Compensation Division at the Separknent of Cansumer and Business .:Services at 503-947-78i5. U.S. Internsl A,eyenue Service: As an employer, you must withhold federal i*come tax from employees' wage$. You rvill be liable for the tax payment eyen if you didn't actually withhald the tax. For a Federal EIN number, call the IRS at 866-816-20S5 or fax thern at 801-62CI-7 t 15. Other Responsibilities xnd Are*$ $f C*neernr Codc Cornpliance: As the permit hclder for this project, you are responsible for res*lving any failu.re t* rneet *ode requirements that may he brought to your attention threrugh in*pectir:ns. tiability and Property Damrge fnsuranee: Contact your insurance agent to $ee if you have adequate insurance coversge for accidents and omissions such as falling tools, paint oyer $pray, water damage from pipe punctmes, fire or work that must be redone. Time: Make sure you have si:f{icient time to supervise your ernplayees. f,xpertise: Make sure you have the skilis tr) act as ysur own general c*ntractor, to c*ordinate the wcrk af rough-in and finish kades, and to noti&/ building officials as the appropriate times so they can perform the required rnspections. If you have additicnal questians call the Canstruction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Froperty*owner.doc 031 I 1 103 225 Fifth Street Springfield, Oregon 97 477 541-7263759 Phone t t City of Springlield Official Receipt I)evelopment Services Department Public Works Department # coM2004-00029 coM2004-00029 coM2004-00029 coM2004-00029 Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7%o State Surcharge + l0o/o Administrative Fee Item Total:$s3.82 43.00 3.00 3.22 4.60 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check ETHEL HARDING djb In Person Payment Total: $s3.82 $53.82