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Home My WebLink AboutPermit Electrical 2003-10-16Building/C ombination Permit Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 54l-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-01058ISSUED: 1011612003 APPLIEDT 1011612003 EXPIRESz 0411612004 YALUE: SITE ADDRESS: 1168 35TH ST ASSESSOR'S PARCEL NO.: 1702303410000 PROJECT DESCRIPTION: Relocate electrical service Owner: GARy WHITE Address: 1384 TAMARACK ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential Phone Number: Phone Number: 541-736-8428 541-912-1235 Contractor Type Electrical Contractor OWNER License Expiration Date Phone CONTRACTOR INFORMATION BUILDING INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # ofStories: Height of Structure Type of Heat: Paved Drive Rqd: Vo ofLot Coverage: NOTICE: THIS PERMI T SHALL Sidewalk Tvoe: "{,imFilf,fiufl#' ngANOONED FOR R-3 VN {UTHORIZE OMMENCE D UNDER DORIS Square Footage or Bid Amount Lot Size: Sq Ft lst Floor: Compact: Area: l./ Y 1BO DAY PERIOD $ Per Sq Ft or multiplier Total Value of Project Pase I of2 PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated \AW Valuation Description I Building/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: COM2003-01058ISSUED: 1011612003 APPLIEDz 1011612003EXPIRES: 0411612004 VALUE: Fee Description + l0o/o Administrative Fee + 7o/o State Surcharge Service Reconnect Total Amount Paid Amount Paid $s.00 $3.50 $s0.00 $s8.s0 Date Paid t0t16t03 10/16/03 t0n6t03 Receipt Number 1200200000000002332 1200200000000002332 1200200000000002332 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. I Electric Service: Approval required prior to utility company energizing service. Reouired Insnections By signaturer l 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 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 of2 Hees Felfl I 225 FIFTH STREET . SPRINGFIELD, OR97477 r PII:(541)726-3753 o E LECT RI CAL P E RMIT AP P LI CAION CityJobNumber6(7l(]fi) C tC>fK Date aPPr oV6l t0 d )Zoh!ng 0, 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 above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit Pump or irrigation Sign/Outline Lighting l[ I ' ;l!lilg has the loltowing specitic land use 1 $ 106.00 $ 19.00 ss0.00 $ 63.00 $ 75.00 $12s.00 $ 163.00 s375.00 $100.00 $ 43.00 $ 3.00 50.00 > (r 1 3. B. C. D. City //69 3s =?trt}deTn 7 LEGAL DESCRIPTION i70z=o3q JOB DESCRIPTION >:l*o'L rcl{ 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 Contractor Address Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signahrre of Supervising Electrician Owners Name Phone 0 (- Address //bY S o city 9fF/ Q .,/ p {?{ZY E. 00 00 00 00 Fee is $45.00 * Surcharges OWNER INSTALLATION The installation is being made on properly I own which is not sale, lease or rent. 1 se sJ.O7Yo State Surcharge 10% Administrative Fee TOTAL -s.c> 5-c Owners 726-3769 4 Shared Drive(T:)/Building Fonns/Electrical Pennit Application I -03.doc A. Ne* Residential - Sin$le or lVlulti-Family pei drvelling unit' ' , ,JP \, Construction Contracfors Board 700 Summer St llE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress: ryfulgg@ permit g, CCtrnzotd -- O I Ogg I I b7 3rrt^5.Address Issued by:\4 Date:o O 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 wtll befiled with the permit. Fill in the appropriate blanks and initial boxes I andZ, and either box 3A or 38: k .K 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. 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 3B. I will be my own general contractor. If I hire subconhactors, 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 nirme of the contractor. I hereby certify the above information is correct and that I have read and do understand the Information Notice to Owners about Responsibilities on the reverse side of this form. -o @ate)of permit applicant) (While copy to issuing agency petrnitfile, pink copy to applicant.) Properfy_owner.doc 03/l I /03 tr Actimg as Your Owm Gemeral Contraetor? Itr{TSRffiATION ruOT*SH Y* P&OPffiKTY MWNffiffi$ AtsOtiT S*r{ $TK{JCTIO}\, RXSp*rriSi ml tlT* *$ It'#IS: T{tis lx{*rntafl*n ff*fi*e fc flr*p*rfy #w#er"$ ***uf C*nsfrurcff*n ff**p**sr*illtiss +v*s d*u*lopeS *y ftre #o*sfruefrc:* #cnfr*cf*rs Soard in eccordan*s with *trS 7#f "$SS{SJ, p*ss*d by f}le f $S$ #reg*n legrsJ*fr.r*" if y<tu *re a*ting a$ yar$r" *lvn contract{}r t$ conslruct a nsw h*rnr *r make a substar:tial irnprover**xi tr} ;xt *xisting slrur;tur*, you *afi pr{*r"renl ::lany prohl*nrs by being arn ar* r:f the t"*}}*:rvtng rcsp*r:sii:i}it{** *nd **n**rr:s. f, rmpl*y*r Re$pomsibilities You wili, in m*st inslances, be nrled t* he an "empl*yer" and the cotltractors you **ntract with will be "empl*ye*s" if y$u u$e c*nlract*rs not lieei:sed rvith t}:e C*nstn:*lion Cr:ntract*rs Board to do iabor in c*nstructing or to assist in the c*nstr*r:tio* *r imprr:r'em*nt cf a residential sffucture. As the ernployer, y$u mrist **rnply with {he fo}lcwi*g: Oregon'* lYithh*lding T*x Law: As an emplcyer, you rnust withhold incrme taxes from employee $isges at the time emplcyees are paid. Ycu will be liabie fi:r the tax payments eve$ if yor: dcn't actually withhold the tax fr*m your emplcyees" For a State Business II) number. cail the Business Information Center at 503-986-220S. Uncrnployment lxsurance Tsx: As an employer, you are required tCI pay a iax f$r uriernploy*rent insurance prrpose$ on the wages of ail employees" For more inforrnation, call the Oregon Ernployment Departrnent at 503-94?-i488. Warkers' Compexsatiox fnsuranee; As an employer, you are sutriect to the Oregnn Workers' Compensation Law, and must obtain workers' compensation insurance for your *:rnpicyees. If ycu fail to obtain workers' compensation insurance, you could be subje*t to penaities and be liable for ail clain: costs if one of y*ur empiayees is injured on the job. F*r m*re infonnaticn, call the Workers' Compensation Divisi*n at the l)epar"tment of Consumer and Business Services at 503-947-78i5. U"S, lnternal &evenxe $jervice; As an emplcyer" you must withhcld f*deral i*eorne tax from employees' weges. Y*u r.vili be lial:le for the tax payment evrn if y*u didn't actually withhclei the tax. Fcr a Federai EIN nunrtrer, call the IRS at 856-8 I 6-2065 or f,ax them at 80 1 -6?0-? I 15. *ther Kesp*nsibiliti*s and Ar*as of C*ncernr Code Compliance; As the perrnit halder for this project, you are responsible for resotrving any faihxe to meet c*de requiremenls that inay be trought to your attentior lhrcugh insp*cti*ns" Liability xnd Frop*rty Xlxm*ge Imsaraace: CE:*tael ycur i:rs*raft** *Ssnl {$ ${:e if y*u have a*equat* insurance csverage fbr accidents and ornissions such as failing t*ols. paint $ver spray, warer d**age from pipe punctwes, fire or w*rk that must be redons. Time: Make sure you have sufficient tirne t* supervise your employees" Expertise; M*ke sure you have the skills ts act as your own general c*ntractor, to caordinate the work of rough-in and finish trades, and to nCItif,/ building officials as the appropriate timss so th*y can pe,rfonn the required lnspections. If you have additir:nal questions call the Ccnstructio* Contrai:tors Board {503-3?8-45?1} or write the agency at PO Sox 14140, Salem, OR 9?309-5052. Properfy_owner.dac 0311 1 /03 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department 1 2:34225PM 3.50 5.00 50.00 ltem Total:$58.50 coM2003-01058 coM2003-010s8 coM2003-01058 + 7o/o State Surcharge + l0o/o Administrative Fee Service Reconnect Type of Payment Paid By Received By Batch Number Authorization Number IIow Received Amount Paid CreditCard GARY WHITE djb 000196 082900 In Person Payment Total: $s8.s0 $s8.50 ( (