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Home My WebLink AboutPermit Electrical 2005-11-08Status: Issued 225 Fiiftdt Street, Springfi eld, OR 541:726-3753 Phone 541-726-3676Fax 541:7 26-37 69 I ns pe ction Line Buildin g/Co mbination Permit PERMIT NO: COM2005-01583ISSUED: 11/08/2005 APPLIED: 11/0812005E)GIRES: 05/0812006 VALUE: SITE ADDRESS: 1274 33RD ST ASSESSOR'S PARCEL NO.: 1702303405800 PROJECT DESCRIPTION: Add 2 circuits Springfield TYPE OF TYPE OF USE: Electrical Work Only Addition Residential - Owner: Address: CARROLL BRILEY 1274 33RD ST SPRINGFIELD OR 97478 ATT adoPteContractorto\\ow rule$ on ce nter.Thos ough Phone Number: 541-741-4450 rh -Expiration Date Phonee ru\e e set or Contractor Tvpe Electrical OWI\ER Notrticati 0 thr es by rcne n UtilitY ticationo #of UniS: Primary Occupancy Group: Secondary Occupancy Ptimary Construction Type Secondary Construction # of Bedrooms: U o-332'2 Water Type: Range Type: Energy Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: Yo ofLot Coverage: tB0 OAY 344) Square Footage or BkI Amount Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: nla Occupant Load: VN Frontyard Setback: Side l Setback: Side 2 Setback: Rearyard Setback: Sohr Setbacla: Street Storm Sewer Available: Special Instruction: Notes: 1 $ Per Sq Ft or multiplier DownspoutVDrains REQUIRED PARJ(NG Total: Handicapped: Compact: DEVELOPMENT INFORMATION Description Tvpe of Construction I of 2 Value Date Calculated of Heat: of Valuation Description I F Status: Issued 225 Fifft Street, Springfield, OR 541.:726-3753 Phone 541-726-3676Fax 541:7 26-37 69 Inspe ction Line BuildinglCo mbin ation Permit PERMT NO: COM2005-01583ISSUED: 11/08/2005APPLED: 11/0812005E)PIRES: 05/0812006 VALUE: Fee Description + l0o/o Administrative Fee + 7oh State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Total Value of Project Date PaidAmount Paid $4.60 $3.22 $43.00 $3.00 $53.82 Receipt Number 1200500000000001695 1200500000000001695 1200500000000001695 1200500000000001695 11/8/05 11/8/05 r1/8/05 11/8/05 Fees Pa stree( at all Plan Reviews To Request an inspection call the24 hour recording at 726-3769. AII inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Renuired Insnections By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all , information hereon is true and correct, and I further certiff that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certi$ that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I to ensure that all required inspections are requested at the proper time, that each address is readable from the permit card is located at the front of the property, and the approved set of plans will remain on the site during or Contractors 2of2 Date //- oE \ o{ Construction Contractors Board 700 Summer St ItlE Suite 300 PO Box 14140 Selem OR 97309-5052 Phone: 503-3784621 lYeb Address: www.ccblgtg@ Permit 5, COu+VA---S - Ol S g3 Address: lzl q 33eL >|- Issued by:4 Date: //'_os Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensedwith the Constructton 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 be filed with the permit. Fill the appropriate blanks and initial boxes I and 2, and either box 3A or 3B l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction conhactor if the stnrcture is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subconfiactors who work on the stnrcture 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. It- 6-o)- applicant)@ate) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 X Acting as t our Own General Cbntractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES If you have additionai questions call the Constnrction Contractors Board (503-3784621i or write the agency at PO Box 14140, Salem,OR 97309-5052. . : .,-;,:, : ,!_"i,. .; Property_owner.doc 06-0 1 -04 { q. If you are acting as your orarn'gonhactor to construct a new home or make a substantial improvemant to an existing structure, you can prevent many problems by being aware of the following responsibiiities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an o'employer" and the contractors,you cotrtract with will be "employees" if you use conhactors not licensed with &e Conskuction Contractors Board to do labor in constructing or to assist in the , construction or improvement of a residential structure. As the employer, you must comply wit! the following: Oregon's \ilithholding Tax Lawr As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For mcre information, call the Deprknent of Revenue at 503-3784988. Unemployment Insurance Tax: As an employer; you are required to pay a tax for unemployment insurance pu.po.g}( on tlre wages of all employees. For more information, call the Oregon Employment Deparfment ar 503-947-i488. The Oregon Business Identification Number (BS{) is a combined number for both Oregoa Withholding and' Unernployment Insurance Tax. To file for a BIN, call 503-945-8091 or wnw.dotstate,or.us/formslay.htmll for the appropriate forms. Workers' Compersation Insurance: As an employer, you are subject to the Oregon Workers' Compsnsation Law, and must obtain workers' compensation insurance fo: your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties ani be liable for all claim costs if one of your'employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business services *503'947-7815- ..-.,,- U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wager{ You will be liable for the tax payment even if you didn't actually withhold the tax. F-or a Federal EIN number, call'the IRS at 1-800-8294931or visit their web site at wwrv;ir*"gov i'. : i : Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible far resolvitig ahy failure to meet code requiremenf tnlt may be brought to your attention thrqugl, inspections. : _ Liability and Property Tlamage fnsurance: 'Contact'your insurance agent to see if you hav#iddciubte insuranc€' coverage for accidenls and omissions such as falling tools, paint ov€r spray, water damage from pipe punctures, fire or Time: Make sure you have sufficie,r time to supervise your employees. : ' ": -'-oi\' ');'* ''i'J:st* ') Expertise: Make sure you have th6' skills' to act as yohr own general coirtractor, to coordinate the work of rough-in and finish trades, and tr: notify building officials as the appropriate tinres so they can perform the required inspections. NOTE: Tttis lnformatian Natice to Proparty Owners about Canstruction Responsibitrlies was developed by the Construction Contractars Board in accordance with ORS 7A1.055(5), passed by the 1989 aregon Legislature. 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt :velopment Services Department Public Works Department RECEIPT#: 120050000000000r69s Date: 11/08/2005 2:16:08PM Job/Journal Number ,, coM2005-01583 coM200s-01583 coM2005-01583 coM2005-01583 Description + 7Yo State Surcharge + l0%o Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Due 3.22 4.60 43.00 3.00 Item Total:$53.82 Payments: Tlpe of Payment Paid By Received By CheckNumber Batch Number Authorization Number How Received Amount Paid Cash CARROLL BRILEY djb In Person $53.82 Payment Totat: -551-67 1 ,l 1 tt/8/2005 lofl {,ptl$tcrt-r D ), $9" 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LE CTRICAL P ERMIT AP P LI CATT ON cityJobNumber @t''-*ef - CIS 33 Date - €:- 1.T:ION 2 LEGAL DESCzuPTION702303u1 OStrOO FEE A. New Residential Service Included 1000 sq. ft. or less Each additional500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling ,gto 3. JOB 2e DESCRIPTION 0 d //0 L,;+- $50.00' not started rvithin 180 days of issuance or if work is Suspended for 180 daYs. 2. CONTRACTOR rNST,4LrArroN ONLY Permits are Electrical Contractor Address and expire if work is Feeder eoon \aW i,fu- ilrrEl B. Owners Signature: CE:Limited Aul c0M State Surcharge to Pump or irrigation Sigrr/Outline Lighting Limited Energy/Residential l0% Administrative Fee TOTAL $ 63.00 $ 7s.00 $125.00 $163.00 $37s.00 $ s0.00 $ s0.00 $ s0.00 $ 25.00 $ 4s.00 is $45.00 * Surcharges Ll L 3zz v60 9343 n Ciry Phone Supervisor License N' Expiration Date Constr. Contr Expiration of Supervising Electrician Owners Name (, Address I z-7q 37 S City =?F\phone 7{t -Y"(SO Reconnect Only 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 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits I $ 43.00 / $ 3.oo E. N'fiscellaneous (Sen'ice/feeder not included) -Each lnstallation OD 3 I OWNER INSTALLATION The installation is being made on properly I own $$I[l is not intended for sale, lease or rent. ints Inspection Request: 726-3769 ANY tE0 Shared Drive(T:)/Building Forms/Electrical Permit Application l -03.doc kI 7 $ 106.00 $ 19.00 ftottow OAR 0090. C.