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Home My WebLink AboutPermit Electrical 2003-06-27City of Springfield Electrica! Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00161 6t2712003 6t2712003 12t2712003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 1465 30th St 1702303401901 Service reconnect Springfield TYPE OF WORK: TYPE OF USE: New Residential OWNER/APPLICANT: JENKINS KERBY & PAULINE 1495 N 3OTH ST SPRINGFIELD OR 97478 ELECTRICAL CONTRACTOR: OWNER CCB #Expiration Date: Descrintion + l0% Administrative Fee + 7oh State Surcharge Service Reconnect Amount Paid s.00 3.50 50.00 Date Paid 06t27/2003 06t27t2003 06/2712003 Receiot Number l 20020000000000 I 6s2 l 20020000000000 I 6s2 12002000000000016s2 To Request an inspection call the 24 hour recording at726-3769. All inspections 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 working day. Required Insnections: 1 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 information hereon is true and correct, and I further certify that any and all work performed the Ordinances of the City of Springfietd and the laws of the State of Oregon pertaining to the work be used ls Owner or Conffactors Signature ss do hereby certify that all shall be done in with I further further agree and that Paee I of I sILtllD certify that only contractors and who are in compliance to ensure that all required the approved set ofplanso .{ 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Oflicial Receipt DeveloPment Services DePartment Public Works DePartment 7 1 s.00 3.50 50.00 #z ELE2003-00161 ELE2003-00161 ELE2003-00161 + l0o/o Administrative + 7Yo State Surcharge Service Reconnect Fee Item Total: Type of Payment Paid By Check PAULINE JENKINS Received BY djb Batch Number Authorization Number How Received In Person Payment Total: Amount Paid $s8.s0 -555.5',' ( Construction Contractdrs Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: Address: Issued by: -b< -crol6i I LtL {orL sI- Date: ob Z7 03 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. Thts statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), neednot submit this statement. This statementwill befiledwith thepermit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: -h' 1. 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 o'r'-r)(ccB #) I will instruct my general conhactor that all subcontractors who work on the sffucture must be licensed with the Constuction Contractors Board. OR 38. I will be myown 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. (Date) (White copy to issuing agency permitfile, pink copy to applicant.) Propert5r_onme r.doc 03 / I I / 03 ,tr Ar:timg ss lfsuf Own Gcmeral C*xrtract*r? *tr{FSRI'SAT}SN T'ISTICT TE FffiSPHRTY *WNTR$ &ffisrJT C$N$TRUCTISN KHSp*rd${Si r-{T'g$ i'J0ff: Ifiis ;nfcrrra#on ldofice fo trraperfy Ovyners a&ouf eansfrucfr*n ffesponsr*ilif;'es was develope'J *y fhe Cc*s*ruc#o* Ccnfracfrre Board in accardance with 08$ 7S?"S55{5J, passed by the 1989 Oregan LegisJafurc" trf you are a*ting a$ usilr own contractrr ts ccn$truct a new ircrnc cr make a substantlal irnprov*rnent {* iin *xisting slructure. yo* can p:event r*any prcl:l*ms by being arvare *f th* f*ll*rvl*g resp*nsiL:itritieii anel **trecrns. fi mployer See$psnsibilities You wilI, in most ir.stances, be ruIed to be an "erfiployer'" and thc contractors you conkact with wiii be "empltyees" if ysr: use contractors not licensed wi.th the Conskuction Contractors Board to d<l labor in constructing or to assist in the ccnstru*tion or imp:ovement of a residential $truoture" As the ernployer, you musf *arnply with the follorving: Oregon's Withhol*ting Tax Law: As an employer, you must r*"ithhold income taxes &orn empir:yee lliages at the time empk:yees are paid. Y*u uriil be liable for the tax payments even if you don't actualiy yithhcld the tax fram your employees. For a State Business ID number. call the Business Informaticx Center at 503-986-2200. Un*mployment Inourxncc Tnx: As an employer, you arc required to pey a tax fi:r unernployment insurancs pilrpo$qs nn the wage$ of ail ,:mpioyees. For more inforrnation, call the Sregon Emplc3ment Department at 5S3-947-1488. \Yorkers' Comper,satlon Insurnnce: As an employer, you are sutrject t* the Oregcn 'Workers' Corrpensation Law, and rnust obtain workers' cornpensation insurance foryour cmplayees. If you fail to sbtain wcrkers''cotnpcnsation insurance, you couiC be subject to penalties and be liatrie for all claim costs if one of yaur ernpioyees is injured on the job. For mcre i*formatiem, call the Workers' Ccrnpensation Division at the Department of Consumer and Business Services at 503-947-78 15. U,$, Internal Revi:nue Service: As an employer, you must withhold federal income tax frorn employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax" For a Federal EIN numtrer, cail the IRS at 866-816-2065 or fax them at 801-620-?115. *ther Kesponsibilitiss xsrd "&r"*a$ $f C*xrc*rms Code C*mpli*xee; As the permit h*lder f*r {his p:roject" y*u *r€ resp<mtible f*r resi}trvifig any fbilu-re t* m**t e*de requireme*ts that xray'be br*ught to y$rrr att*ntiein lhrough inspecti*ns" tiahiiity xnd Pr*glerty llxrrrxge Insuran*e: C*r'rtarl y*ur insur*fi** ag€fit t$ ser if y*x have *dequatu tnsur*nce csterage fcr ac*ide nts and *missions such as failing t*ols. paint sver $pray, \r-rater damage from pipe punctres, fire or wnrk that must be redone. Time: Make swe i'r:u have sufficient time to supervise your emplcyees' Sxpertise: Mak* *ure y*u have the skills ro act as your own general ct:tltraotor, to ccordinate th* w*rk,:f rough-in and finish trades, *nd tc notifu building offi*ials as thf appropriate timer so they can perform the reqnired inspections. If you have additional questions call the Cnnstruction Contraetors B*ard (503-378-4621) or w:-ite the agency at P() Box i4140, Salem,0R 97309-5052. Property*owner.doc {}31 1 1 103 225 FIFTH STREBT . SPRINGFIELD, OR97477 r PH:(541)726-3753 r FAX: (541 E LE CTI1"T CAL P E RfrruT AP P LI CATIOiI City .Iob Nun-rber Date U:Z ZC'3 L flcA ?TON o.tt .rN"$ ?){I,LA ?roN D,A. NewI-EGAL DESCRIPTION z 3csv 7c Service 1 City JOB DESCRIPTION 2ccaa/N€c-.7 Sertv rc{ Perrnits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 1 Electrical Contractor Address Phone Supervisor License Number Expiration Date v Constr. Contr. Number Expiration Date Owners Name l-r C. Temporar.v Services or Feeders Installation, Alteration or Relocation 200 Arnps 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. llranch (.'ircuits New Alteration or Bxtension Per Panel One Circuit $43.00 Each Additional Circuit or with Service or Feeder Permit C6}:VTf,{.AC[O& -f&E?:4I.tA?'f*}trO&-L}' B. Sen,ices or Feeders - lnstall*ti*n, Alteratians or Relocatitn: $ 63.00 $ 7s.00 $ 125.00 $ 163.00 $37s.00 $ s0.00 1000 sq. Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Ser-vice 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 per dnelling unit. $ 106.00 $ 19.00 $50.00 SC Address lYGf -3d{S+ Cify =Phone Owners Signature E. O\\T{ER INSTALLATION The installation is being made on property I own which is not intended for sale, Iease or rent.Minimum $ 50.00 $ 25.00 $ 45.00 Permit Inspecfion Fee is $45.00 * Surch arges 5o 7%o State Surcharge I0% Administrative Fee TOTAL 3so soo x_ Inspection Request: 726-3769 4. Shared Drive(T:/Building Fonns/Elecldcal pennit Application I _03.doc ilo ?o$tsg Signature of Supervising Electrician g\ Installatiou $o' :*(\(