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Home My WebLink AboutPermit Electrical 2004-01-29Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line SITE ADDRESS: 32S 38TII ST ASSESSOR'SPARCELNO.: 1702311307000 PROJECT DESCRIPTION: Change service panel Owner: JOSEpH BENSON Address: 325 38TH ST SPRINGFIELD OR 97477 Building/Combination permit PERMIT NO: COM2004-00124ISSUED: 01t29t2004APPLIEDz 01t29t2004EXPIREST 07t29t2004 VALUE: Springfield TYPE OF WORK: Electrical Work Onty TYPE OF USE: New Residential PhoneNumber: 541-726-tSS3 License Expiration Date phoneContractor Type Electrical Contractor OWNER DEVELOPMENT # of Units: 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: R-3 VN # ofStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path:AfiENTtON Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport tres you to 6tiiity o/o of Lot Coverage: THIS PERMIT AUTHORIZED UNDER THIS PEBMIT IS NOT COMMENCED OR IS ABANDONED TOR ANY 180 DAY PERIOO. $ Per Sq Ft or multiplier Square Footage or Bid Amount ado Sidewalk Type: Downspouts/Drains: Total Value of Project Page 1 of2 Description Type of Construction Value Date Calculated Valuation Description I F Building/Combination Permit Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00124ISSUED: 0U29t2004APPLIEDz 0U29t2004EXPIRESt 07t29t2004 VALUE: Fee Description + l0Yo Administrative Fee + 7o/o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Date Paid u29t04 u29t04 U29t04 Receipt Number 1200400000000000130 1200400000000000130 1200400000000000130 Plan Reviews To Request an inspection call the 24 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. 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 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 Reouired fnsnections Pase2 ol2 t.: rees ralo I Construction Contractors Board Permit #: CotvtZ-oq' OOlZcl Address: 3Lt 3g*L ) | Issued by:b,4 Dut", l:Zj'9A 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ryfolglq 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 submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and,2, and eitherbox 3A or 38: K t I own, reside in, or will reside in the completed structure. X Z. 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. ro* Uf 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 conhact with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the nzrme 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. L yL {V*,_*/ -Lq-oq (Signature ofpermit applicant) @ate) (White copy to issuing agency pennitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 Acting as Your Own General Contractor? INTORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES il0fEj Tltis lnfarmation Natice ta Propefty Ovvners abouf Construction Responsrb/rties was developed by the Constructian Contractors Board in accardance with OR9 701.A56($), passed by the 19Bg Oregon legrsfature. If you are acting as yolr own contractor to conshdct a new home or make a substantial improvement to an existing siructure, you can prevent many problems by being aware of the following respcnsibilities and concerns. Employer Re$ponsibilities You will, in most instances, be ruled to be an 1'empioyel" and the contractors you contract with will be "employees" if you use contractors not iicensect wrth the Consfruction 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 with the following: Oregon's'lilithholding Tax Law: As an employer, you must wrthhold income taxes frorn 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.ForaStateBusinessIDnumber,calltheBusinesslnformationCenterat503-986.2200,>. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposQs on the wages of all employees. For more information, call the Oregon Employment Deparlment at 503-947-1488. i \' Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insurance, you could be subject to penalties and 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 at 503-947-?8 I 5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, cali the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failue to meet code requirements that may be brought to your attention through inspections. Liabitity and Property Damage fnsurance: Contact yow insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish kades, and to noti8/ building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agericy at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 031 I I 103 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Oflicial Receipt Development Services Department Public Works Department I coM2004-00124 coM2004-00124 coM2004-00124 Perm Serv/Fdr 200 amps or less + 7Yo State Surcharge + l0o/o Administrative Fee 63.00 4.41 6.30 Item Total:$7371 Type of Payment Paid By Received By Batch Number Authorization Number How Received CreditCard JOSEPH BENSON In Person Payment Total: Amount Paid $73.7r djb 000287 029001 $73.71 ( 225 FIFTH STREET . SPRINGFIELD, OR97477 o E LE CTRI CAL P ERMIT AP P LI CATI O N City Job Number COyn Z:cal - O O tZL{ Date 1.'32{ 3tr/^ s +- LEGAL DESCzuPTION i70z gt=OToz:<> JOB DESCRIPNON g ?*ruor Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor Address Phone Supervisor License Number ,O(V Expiration Date '..1 sv- Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name o R.-o11 Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion ttrereof 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 Limited Energy,/Residential 7%o State Surcharge 10% Administrative Fee TOTAL Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps 4orraffu B{;Ud:ilrpg,r,:i law r s PH:(54L)726-3753 . FA*-:(s41 as submitted has the lollowing requlre sPecific land use -a s r 06.00 $ 19.00 $s0.00 -O ,r rur r4{ru slgnature J A. B. C. $ 63.00 s 75.00 s 125.00 $ 163.00 $375.00 $ s0.00 s s -f Cily 3pu:;t D. E.Address J Z f /4/ . City P-,vr l, (- 3 Pump or irrigationPhoneJ Sign/Outline Lighting 50.00 50.00 25.00OWNER INSTALLATION The installation is being made on PropefF{ISPEFlffiFF SHALL E*nf,d plHgtfrggpid s 45.00 is not intended for sale, lease or rent. AUTHSRIZED U I,l UEFirftUtG fl Efi ifl ?{&dtfitrspection Fee is $45. 00 * S urcharges NOTICE: Owners Signature:6s ULTI b3" Inspection Request: 726-37 69 O0MMENCED 0R lF ANY 1BO DAY PERTO Shared Drive(T:/Building Forms/Electrical Pennit Application l-03'doc ()/^Z1 I rules t oredl@tthe center"(Note: the Service or s 3.00 -74