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Home My WebLink AboutPermit Electrical 2004-05-07Building/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: COM2004-00544ISSUED: 0510712004 APPLIEDz 0510712004 EXPIRESz 1110712004 VALUE: SITE ADDRESS: 2648 33RD ST ASSESSOR'S PARCEL NO.: r702193100909 PROJECT DESCRIPTION: Reconnect/Relocate Electrical Service Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PhoneNumber: 541-988-0150 License Expiration Date Phone Owner: Address: FERGUSON JEFFREY B & SAMANTIIA J 264833RDST SPRINGFIELD OR 97478 Contractor Type Electrical Contractor OWNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: # of Stories: Height of Structure Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: SETBA€R$iNg numDer the ce nter- (r lorthe Frontyard Setback: Center Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: TiCE: s Pffidd{,["ft14,hb:EXP|RE lF THE W0RK Ar r{0sr&FRJluREilfrhus PERMTT ls NoT CC:,,1 i\I TNCED,OR IS ABANDONED FOR ANi' JB(] DAY PERIOD. REQUIRED PARIflNG Total: Handicapped: Compact: $ Per Sq Ft or multiplier THI Square Footage or Bid Amount Total Value of Project Pase 1 of2 PUBLIC IMPROVEMENI Description Tvpe of Construction Value Date Calculated llof3,.D EL- l, U ILUII\ G l1\ rl Ur(1vr,q,!!l21l l 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: COM2004-00544ISSUED: 0510712004APPLIED: 05/0712004 EXPIRESz 1110712004 VALUE: Fees Paid Fee Description + l0oh Administrative Fee + 7o/o State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.50 $50.00 $s8.50 Date Paid 5t7t04 5t7104 5t7t04 Receipt Number 1200400000000000674 1200400000000000674 1200400000000000674 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. 1 Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAI\CY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pa,se 2 of 2 .T 11 }.l Kequtreo rnsDectrons I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone 'ty of Springlield Official Receipt -oevelopment Services Department Public Works Department RECEIPT #: 1200400000000000674 Date: 0510712004 11:52:43AM Job/Journal Number coM2004-00544 coM2004-00544 coM2004-00s44 Description Service Reconnect + 7Yo State Surcharge + l0% Administrative Fee Amount Due 50.00 3.50 s.00 Item Total:$s8.s0 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Cash JEFF FERGUSON llh In Person Payment Total: $s8.s0 -sffi- s17t2004 Page I of I MED Construction Contract0rs Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress: www.cc$ltgt@q 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 the following 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 and2, and eitherbox 3A or 38: 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 contractor 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. rwilbe*r"*PM#&CI. 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 on the reverse side of this form. of applicant)@ate) (White copy to issuing agenq) permitfile, pink copy to applicant.) Date:Issued by: Permit #: Address: Property_owner.doc 03/l l/03 f ',tt.-.]I).r:',1 I Acting ab Yo-ul own Generatr contractor? IHFORMATfON NSTICH TO PROPHRTY SWNHRS A8otlr Gon*rnucTtoN RESpO$$tBrLtTrH$ ##l-tr: I&i.t l*fu:rna*ron *J**r** fo Pr*p*dy *r.v*ers n&*:r.if S**sfrxc#*r ff*sp*i:si*i/r*is"! w*s d*r*J*pe# &y f31e#**sfrue#*n Co*fr*cfsrs #*ard in ae*ardaxee witt1fifi,S TS?"OSS{$J, possed by the f $SS t}reg*:r fbgrslaturo. If y<}}: are a*li*g as :l'fi$r *wn *onkaet$r tc) corrst.ruct a n*w hom* <ry r*ake a sxlrstantjai irntrrr*v*m*r:t {* an *xisting stru*iur*, ysli *tlfi pr*l-:*nl r*any pr*b}*ms by being awar* *f the {*ii*lving req:**tii:iiiti*s arrd *ox**rns. Xrnploy*r K*$pw msibilities You will, in m*st i*staxces. be ruled t* bs an "empl*yer" and th* c*ntractrrs yori contra*t with wiil he "employe*:s" if ysil l"is* e*ntract*rs not licensed rvith the ilonstruction C*nkact*rs Br:ard t* do iab*r in *gnstructing or tg assist in the c*nstrur:tion or improveme*t *f a residential $trurture. Ar the *rmployer, you must c*mply with the f'ollowing: Srego:r's Wifhhcltdiilg Txx L*w: As an employer, y*u r]lust rvithh*l<line*me t*xes k*m *mploye* \tuage$ at the time c:r:pir:v*es xr* p*id. Y*rr rvill he liahle f*r th* tax pa),rne*t* *vcr if'ycu <irin"t aetually withh*ld th* iax fi*m yrxr *mpi*ye*s. !'*r a $tat* l3usin*ss lI) numb*r. cclll the Business ini'cmati*n Cent*r *t 5*3-986-220*. tlx*nrploymr*xlt Ins*rsmee Tax: As an ernplcyer, yor; are required tt> pay a tax for unemp}:3rnent ins*rance p1;rp$ses *n the \Yages of all *n:ploye*s" For rnore infirrrnation, call the firegan Hn:ploy,rent Sep*rtrnent at 503-S4?-1488. Workers' Camperlxa{*ox Xnsurance; As an enrployer, y*u are subject t* the Orcg*n \Yorkers' C*mpensation Law, and must $htain workers" c*mpensation ins*rance fcr y*ur empl*ye*s. If yr:u fail t* nbtain workers' compensatio* in$urance, you couid he subject to penaities and be liable for ali claim *osts if $ne of your empiovees is injured on thejob. F*r m*re infbrrnati*n, call the W*rkers' C)*mpensation Sivision at the llepartment cf Ccmsumer and Business Services at 503-947-78 I 5. {"1.S' trnternal Idev*nrn* $ervi*e: As an emplayer, you rnxst withh*}d fud*rai inc*me tax fr$m *ntpl*yees' wage$. Yox will i:e liable f,*r th* tax pa3rment even if'y*u qlidn'i ailtl:ally with!*}cl rhe t*x. F*r 4 Fed*r*l filN nu$rber, call the IRS al86S-8l6-2*65 or fax th*m at 80i-62fi-?t i5" $ther Rnsporsitrilities amd Ansa$ $f Ccmcerns Code Cornpliance: As the pcrmit h*lder fur this Froje*t, y*u are respcnsible f,cr resolving ar3, failure to lneet code requiremerts that rnay b* br*ught to your att*ntiein through inspe*ti*ns" Liafuility axd Pr*per*3' $xn:xge fnsuraxac*: Cc:rtact your insuran** agen{ {t- see if y*u have adequate iasurance coverage for accidents and <rmissions such as falling tools, paint over spray" water damage fram pipe pun*tures, firs or rvork that rrrust be redofie" Time: M*ke sure you irave sufficient tirne to supervise your ernployees. Expertise: Make sure you havg the skills to act as your own general eonkactor, t* coordinate the work of rough*in . and tinish kades, and to notify tiirilding officials as the appropriate times so they can perform the required inspections. i If you have additi*nal questions call the Construction Confractors Board (503-3?8-4621) or write the agency at P0 Box 14140, Salem, CIR 9?309-5052. Proper"fy*owner.doc 0311 tr l{}3 225 FIFTH STREET . SPRINGFIELD, OR97477 o PII:(541)726-3753 ELECTRTCAL Ciry Job Number 3. srtcllcla*Fa El-s Zoning 4.a{tz $106.00 $ 19.00 $s0.00 $ 63.00 s 7s.00 s125.00 zb'{y M,93ra 9L LEGAL DESCRIPTION \T)N app?oval. Iele- Service Included 1000 sq. ft. or less Each additional500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 200 Amps or less to 400 Amps 16 eoo e'np. Date 1. (, NOEB RE,F PE8 A. B. C. JOB DESCRIPTION Address Supervisor Number Date Nofificaflo+r Contr, Expiration Date 0090. you may Signature of 1000 Amps $163.00 000 AmpsA/olts $375.00 Reconnect OnlY --T $ so.oo w7d Alteration or Relocation il,.>fr70.00--a-/- $ 69.00 s100.00 t Permits 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 ZED U, City 180 oAY Phone PEflOO. or less' to 400 Amps to 600 AmpsoAn ho or 1000 Volts see "B" above. ew Alteration or Extension Per Panel One Circuit Each Additional Circuit or with - ' Service or Feeder Permit $ 43.00 $ 3.00/r/Owners Name Ad&ess z b'l P 4r,33 kJ Phone 7n8 o /fi $ s0.00 $ 50.00 $ 2s.00 Pump or irrigation Sign/Outline Lighting Limited Energy/Residential '7o/o State Surcharge 10% Administrative Fee TOTAL E. Cify OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Limited Energy/Commercial $ 45'00 Minimum Electric Permit Inspection Fee is $45'00 * Surcharges .rp Inspection Request: 726-37 69 4. Shared Drive(T:/Building Forms/Electrical Pennit Application l -03.doc d) x)