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Home My WebLink AboutPermit Electrical 2003-09-15Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line ITY Building/C ombination Permit PERMIT NO: COM2003-00895ISSUED: 0911512003APPLIED: 09/1512003 EXPIRES: 03/1512004 VALUE: SITE ADDRESS: 320 38TH ST ASSESSOR'S PARCEL NO.: 1702311306400 PROJECT DESCRIPTION: Install electrical for hardship Owner: GRAy THOMAS E Address: 320 N 38TH ST SPRINGFIELD OR 97478 Springfield TYPE OF WORI(: Electrical Work Only TYPE OF USE: New Residential License Expiration Date PhoneContractor Type Electrical Contractor OWNER CONTRACTOR INFORMATION m # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 VN $ Per Sq Ft or multiplier os Square Footage or Bid Amount REQUIRED PARI(NG Total: Handicapped: \t Type: Total Value of Project Page I of2 Description Type of Construction Value Date Calculated ffi ,',":s3 $J ..r.]$t{ \ $e( \5 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: COM2003-00895ISSUED: 0911512003APPLIED: 0911512003 EXPIRES: 03/1512004 VALUE: tr'ees Fee Description + l0o/o Administrative Fee + 7oh State Surcharge Add, Alter, Extend Circ Minimum/Adj ustment Electrical Total Amount Paid Amount Paid $4.50 $3.15 $43.00 $2.00 $s2.65 Date Paid 9nst03 9nst03 9t15t03 9nst03 Receipt Number 1200200000000002r23 1200200000000002r23 1200200000000002r23 1200200000000002123 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 Rough Electric: Prior to Cover 2 Underground Electric: Prior to cover 3 Final Electric: When all electrical work is complete. 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 Pase2 of? t}- l(equrreo lnsDectrons I Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us O,lvtz.cc -CX)E?J- 3zo 3 g*l >]- Permit #: Address: Issued by:\(Date:5 .s 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 will befiled with the permit. Fill in the appropriate blanks and initial boxes I arrd2, and either box 3A or 38: 1. I own, reside in, or will reside in the completed structure. ,d 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. I will be my own ge,neral confractor. 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 Owners about Construction Responsibilities on the reyerse side of this form. 07 -/9 ^ CI'3 (Signature permit (Date) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 \-,Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNER$ ABOUT CON$TRUCTION RESPON$IBILITIES NOIS: This lnformalion Nofrbe ta Property Owners about Construcfion Responsibilities was deizeloped by the Constructian Contractars Board in accordance with ORS 7A1.055(51, passed by the 1989 Oregon Legislature. If you are acting a$ your own cofitreetor to construct a new home or make a substantial irnprovement to an existing sttucture' vou can prevent ** -"t';;;;ffir#;:nsibilities and concerns' You wrll, in most instances, be ruled to be an "€mployer" and the contractors you contract with will be "employees" if you use ccntractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, yor must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold incorae taxes ffom employee wages at the time employees are paid. You u,ill be liable for the tax payments even if you don't actually withhold the tax frorn your employees. For a State Business ID number, cali the Business lnformation Center at 503-986-2200. IJnemployment Insurance Tax: As an employer, you are required to pay a tax for uaemployment insurance purposes on the rvages of all employees. For more information, call the Oregon Employment Departmant at 5A3-947-1488. 'lVorkers' Compensation Insurance: As an ernployer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' corhpensation insurance, you could be subject to penalties and be liabie 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 503-947-7815. U.S. lnternal Revenue Service: As an ernployer, 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, call 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 failure to meet code requirernents that may be brought to your attention through inspections. tiability and Property Damage fnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling toois, parnt over spray, rvater damagg from pipe punctures, frre or work that must be redone. Time:Makesureyouhavesufficienttimetosuperviseyouremployees. Expertise: Make sure you have the skills to act as your own general conffactor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate times so they cim perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at pO Box 14140, Salem,0R 97309-5052. Property_owner.doc 0311 l/03 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #z Date: coM2003-00895 coM2003-00895 coM2003-00895 coM2003-00895 + 7o/o State Surcharge + l0%o Administrative Fee Add, Alter, Extend Circ Minimum/Adj ustment Electrical 3.15 4.50 43.00 2.00 Item Total:$s2.6s Type ofPayment Paid BY Received By Batch Number Authorization Number How Received Amount Paid CreditCard THOMAS GRAY djb 000167 015581 In Person Payment Total: $s2.65 $s2.6s ) 225 FIFTH STREET . SPRINGFIELD, OR97477 . PH:(541)726-3753 o FAX: E LECTRI CAL P ERM IT AP P LI CA:TI O N City Job Number CjtrvtZooS -<><> 3'7{ Dare Zoning 1.L O CAT' I O N OT' INS'Ii4' I.AT' I O N 3Z u 3g/k LEGAL DESCRIPTION l"c z3r r 3 o6vo o JOB DESCRIPTION I Lb z r, *r-*; i,- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Date o uthanzed 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 SUBTOTAL OF ABOVE 7o/o State Surcharge l0% Administrative Fee TOTAL 3. CAMPLE'TE T'EE SCHED -O $50.00 7 C O NT RACT O R I N S TALIATION OIil, I'B. Services or Feeders - Installation, Alterations or Relocation: Electrical Contractor City Address Phone Supervisor License Number *C. Temporar.v Services or Feetlers Installation, Alteration or Relocation $ s0.00200 Amps or less 201 Arnps to 400 Amps $ 69.00 401 Amps to 600 Amps $ 100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits Neu Alteration or Extension Per Panel ,OneCircuit / $+:.Oo Each Additional Circuit or with Service or Feeder Permit $ 3'oo q3 E.N"Iiscellaneous (Service/feeder trot included) -Bach lnstallatiott i"{ rruftmr irrigation $ 63.00 $ 7s.00 $ 125.00 s 163.00 $37s.00 $ 50.00 t)Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name .nl* Address 3ZO 38+l =r Cify S?A Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. $ s0.00 SigruOutline Lighting Limited EnergyiResidentiai c otdMt+{Ltrgs4p8nA8m0D 0 t',i E p+08_ $ rvrfi ltXufi S 0AnrYd*fi Jff O, ".0"","" r". ii6fr $ $ 50.00 25.00 4s.00 * Surcharges L{4.Signature ) 3ti 7togzfInspection Request: Shared Drive(T:)/Building Fonns/Electrical Perrrrit Application l -03.doc CITY OF-OREGON A. New Residential - Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less $ 106.00 Each additional 500 sq. ft. or portion thereof $ 19.00