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Home My WebLink AboutPermit Electrical 2008-8-20 -~~ CITY OF SPRIN\.Jl' lELD ' Building/Combination Permit Status Issued PERMIT NO ISSUED: APPLIED. EXPIRES: VALUE COM2008-01252 08/20/2008 08/20/2008 02120/2009 225 FIfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspechon Lme SITE ADDRESS 141 J ST ASSESSOR'S PARCEL NO 1703352213900 Sprlngtield TYPE OF WORK Electncal Work Only TYPE OF USE New ReSidentIal PROJECT DESCRIPTION Changmg out panel Owner BERGEN GREGG & STEPHANIE Address 141 J ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrlcdl Contractor OWNER License Expiration Date Phone BUILDING INFORMATION' # of UDlts Prtmary Occupancy Group Secondary Occupancy Group Primary COllstructIon Type Secondary ConstructIOn Type # of Bedrooms # 01 Stories HeIght of Structure Type of Heat Water Type Rdnge Type Energy Path Sprinkled BUlldmg Lot SIZe Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load nla I DEVELOPMENT INFORMATION I Front yard Sethack SIde I Setbdck S,de 2 Setback Rearyard Setback Solar Setbacks Overlay Dlst # Street Trees Rqd Paved Drive Rqd % of Lot Coverage REQUIRED PARKING Total HandIcapped Compact Notes r\l I L;1'l IIVI'>J " ~ ~.... .... follow rules ".IPUBLlC IMPROVEMENTS I Notification Cenll' " , h In OAR 952-001-(,,,, , _ , 1'- 0090 You may obtalfl (_',J, "", I J ' iJY calling the center (1 I", J ,..9 'J rll~ll@ number for the Oregon Ulllity NG!ifl9glHlfl Center IS 1-800-332-2:J44), SIdewalk Type Downspouts/Drams Street Improvements Storm Sewer AVailable SpectallnstructlOn Tvpe of ConstructIOn f!GTIC~~..,~ C'u~11 FXPIRE IF THE~?RK I HI,) rLl'I..., - R THIS Pt\iIVlI; 'u ,In I ValuatIOn Descrmtion I AUTHORIZED UNRID~S ABANDONED FOR . . , COMMENCED 0 Square FootagK NY 180 D~\lefRIOD Date Calculated or B,d AmounP DescnptlOn $ Per Sq Ft or multIpher Paee I of2 -~~ Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO. COM2008-0I252 ISSUED' 08/20/2008 APPLIED. 08/20/2008 EXPIRES: 02/20/2009 VALUE: 225 F,fth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme Total Value of ProJect Fees Pal~ I Fee Descrmtlon + 10% Admmlstrahve Fee + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 dmps or less Amount Patd Date Patd ReceIpt Number $730 $876 $365 $73 00 8/20/08 8/20/08 8/20/08 8/20108 1200800000000000888 1200800000000000888 1200800000000000888 1200800000000000888 Total Amount Patd $92 71 I Plan RevIews , To Request an IDspectlOn call the 24 hour recording at 726-3769 All mspectlOns 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 ReolJlred Inspecttons I ElectriC ServIce Approval reqUIred prim to utlhty compdny energlZmg servIce. By SIgnature, 1 state and agree, that I bave carefully exammed the completed apphcatlOn and do hereby certify that all mformatlOlI hereon IS true and correct, and 1 further ccrtlfy that any and all work pertormed shall he done m accordance WIth the Ordmdnces of the CIty of Sprmgtield and the Laws of the Stdte of Oregon pertammg to the WOI k descnbed herem, and that NO OCCUPANCY WIll he made of any structure Without permIssIOn of the CommuDlty Services DIVIsIOn, Bulldmg Safety 1 further certIfy thdt only contrdctors and employees who dre m comphance WIth ORS 701005 will he used on thIS proJect I furthCl dgree to en.ure that all requIred mspectlOns dre requested dt the proper time, th,lt edch address IS readdble from the street, thdt the permIt card IS located at the front of the property, dnd the approved set of plans will remam on the SIte at all tImes dUring construction Owner or Contractors SIgnature Ddte Paee 2 of2 225 FIfth Street Sprmgfield, Oregon 97477 541-126-3759 Phone ~~ ,aLai _ CIty of Springfield OffiCIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 1252 COM2008-0 1252 COM2008-0 1252 COM2008-0 1252 Payments Type of Payment Cred IlCard cRecemtl RECEIPT #. 1200800000000000888 Date: 08/20/2008 DeSCriptIOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdmIDlstratlve Fee PaId By STEPHANIE BCRGEN Item Total Check Number AuthorizatIOn Received By Batch Number Number How Received nJm 054498a In Person Payment Total Page 1 of I 9 36 56AM Amount Due 7300 365 876 730 $92 71 Amount Paid $9271 $9271 8/20/2008 C t' -- 00,.5 2- ~lI1flf m ~~lFlllElUi>>., (Q)~ BPA:NO"BLD ~ ZON l rt .; ~fI.fI-----/ '" INITIALS ('\ (Y) - Lf'.&. <... DATE r, r II -0(:5 WOII)II' "" SOURCE m (J:>P-- ) Date 'K/---w! () R' I COMPLETE FEE SCHEDULE BEWW ZZ5 FIITH STRFET . SPRINGFIELD. OR 97477 . PH (54I)726-37S3 . FAX (541)726-3689 ELECTRlCALC;;::;T APPLICATION City Job Number /f7) )( - WS:2 I I WCATION OF INSTALLATION: 3 I '11 :-\ &feLl- LEGAL DESCRIPTION \ I - 03 - ?"s d-d. - I 3'too JOB DESCRIPTION 'tl ec.:tnCC.J 'Pone.! ~~ 0 J. Permits are non-transferable and expire If work IS not started wlthm 180 days o(lssuance or .fwork IS Suspended for 180 days 2 I CONTRACTOR INSTALLATION ONLY I Electrical Contractor Se l ~ ( ~ ()l.'f\.eY" ) Address \ 4.1 :r- S\:Yl:.~+ City S~rl~~.f.LL UPhone ~1'944~ Supervisor License Number ~. --- EXPlratlon~te ___ __r .-- Constr Cantr N umo ......, __....- ~.,.,... ....., EXplratlq,n Date ~ ~ '-'SIg;~I:re ofSupervIsmg ElectricIan ~ Owners Name ~!~~~, S-\~Vv-LV\l~~-e() Address \4t ~ '9Yf'0--\- City ~nY'lQr~l~ Phone ~ OWNER INSTALLATION The mstallatlOn IS bemg made on property I own which IS not Intended for sale, lease or rent Owners Signature Inspechon Request 726-3769 A I New ReSldenhal- Smgle or Multl-Famll)' per dwellmg UDlt Service Included 1000 sq It or less Each addItIOnal 500 sq It or portion thereof $12100 $2200 Each Manufact'd Home or Modular Dwellmg Service or $57 00 Feeder NOTICr:; B I Servtt'8cOIhFee\lf~-Sln'taJll\119nl Alterations or RelocatIOn _, nluxtKlvlIl_ HA'=L-I:XP RE-IF-THE-WORK 200 A~WS~~r.5.IZED UNDER THIS~ERf\fIll"fij~<NOT7-5' 201 AW~/,IJ~~&j}\Ji.PsOR IS ABANDONm 8"Q)flP 401 Afi\Wto\(lll> !(/l,~sPERIOD $14300 60 I Amps to I 000 Amps $186 00 Over 1000 AmpsNolts $42600 Reconnect Only $ 57 00 c I Temporary Services or Feeders ATTENTION Oreqon law reQUlle5 \I(1L' to InstallatlI\9HM~!Rl'('~l?s'l!~o!llv 01 ~glln L<lllIlj 200 Amtf!lohllll;!ltlon Center Tho:,e rUle', ,$ 5ioofclth 201 AmJ~rQilGV~p;101-0010throug~, Or'f7'fooG01 40] Am~qgQ;Qa\\\\'\llay obtam COplJ5 01 f$\]4 00" oy calling lfie center ("u,o '"~ tcfepl x' Over 600 ~rj~IYe>1!}~61~'Lab!l~k-,Jlw. :lc,n D I Branch Clrculteentel IS 1-800-3~2- :~1,4) l New AlteratIOn or ExtenSIOn Per Panel One ClfCUlt Each AddItIOnal CirCUit or WIth Service or Feeder Penmt $ 50 00 $ 5 00 E I MIScellaneous (ServIce/feeder not meluded) -Each Installation J Pump or lITIgatIOn $ 5700 Slgn/Outlme LIghtmg $ 57 00 " LimIted EnergyIReSldenllal $ 29 00 LimIted Energy/Commerclal $ 52 00 Mm,mum ElectrIC Permit InspectIOn Fee IS $52 00 + Surcharges 4 I SUBTOTALOFABOVE ""Z$. tJV 12% State Surcharge ,~ _ & :; JO%AdmmlstratIveFee ~ 7(4 5% Technology Fee '7.....s (!j q-;)./f TOTAL Shared Dnve(T )/Butldlng Forms/Elcctncdl PermIt Appllcilllon 7-08 doc - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone. 503-378-4621 Web Address' www ccb state.or us Penmt # (/ r ,- (J/;J s:2 Address /7"/), J :s? Issue~..nJ1 / . I tU Statement: Information Notice to Property Owners About Construction Responsibilities Date S-bn/()~ / i Note Oregon Law. ORS 701 055(4) reqUires residential constructIOn permit applzcants who are not lzcensed with the ConstructIOn Contractors Board to sIgn the followmg statement before a bUlldmg permit can be Issued ThIs statement IS reqUired for residential bUlldmg, electrzcal, mechamcal and plumbmg permits Licensed architect and engmeer applzcants, exempt from lzcensmg under ORS 701 010(7), need not submit thiS statement This statement Will be filed with the permit FIll m the appropnate blanks and IllitIal boxes I and 2, and eIther box 3A or 3B RI D 2 I own, resIde m, or wIll resIde m the completed structure I understand that I must become lIcensed as a constructIon contractor If the structure IS sold or offered for sale before or on completIOn D 3A My general contractor IS (Name) (CCB #) I WIll mstruct 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 C ~-rt€<.cAL ') IfI lure subcontractors, I WIll lure only subcontractors lIcensed wIth the ConstructIOn Contractors Board IfI change my mmd and lure a general contractor, I WIll contract wIth a contractor who IS lIcensed wIth the CCB and WIll Inunedlately notIfY the office Issumg tlus bUlldmg permIt of the name of the contractor I hereby certIfy that the above mformation 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. ~ d <'\,t "'.) G r \.,7\~ r::\ 1'1 ~ rn) 0 ~ (Signature of permIt a~artt) (Date) (White copy to Issumg agency permit file. pmk copy to applzcant) Property_owner doc 06-01-04 - Actipg as -your ?wn General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CpNS,TRUCTION RESPONSIBILITIES' \ \ - , NOTE This InformatIon Notice to Property Owners about ConstructIon Responslbtldles was developed by the Construction Contractors Board In accordance wdh ORS 701 055(5), passed by the 1989 Oregon Legislature If you are actmg as your own contractor to construct a new home or make a substanllallmprovement to an eXlsllng structure, you can prevent many problems by bemg aware of the followmg responslblhlles and concerns Empnoyer Responsibilities You WIll, m most mstances, be ruled to be an "employer" and the contractors you contract WIth wIll be "employees" If you use contractors not hcensed WIth the ConstructIOn Contractors Board to do labor m constructmg or to assIst m the construction or Improvemen~ of a resldenllal structure As the employer, you must comply with the following: Oregon's Wlthholdmg Tax Law: As an employer, you must wIthhold mcome taxes from employee wages at the tIme employees are paId You wIll be hable for the tax payments even If you don't actually WIthhold the tax from your employees For more mformatIOn, call the Department of Revenue at 503-378-4988 Unemployment Insurance Tax: As an employer, you are reqUIred to pay a tax for unemployment msurance purposes on the wages of all employees For more mformatlon, call the Oregon Employment Department at 503-947-1488 .' The Oregon Busmess IdentificatIon Number (BIN) IS a combmed number for both Oregon Wlthholdmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or W'l>iW dor state 01 us/forms1)av htmll for the appropnate forms Workers' CompensatIOn Insurance. As an employer, you are subject to the Oregon Workers' Compensallon Law, and must obtam workers' compensatIOn msurance for y~ur _employees If you fall to obtam workers' compensatIon msurance, you could be subject to penaltIes and be hable for all claIm costs If one of your employees IS mJured on the Job For more mformatIon, call the Workers' CompensatIon DIVlSlon at the Department of Consumer and Busmess ServICes at 503-947-7815 ~ U.S Internal Revenue Service As an employer, you must wlthhold'federal mcome tax from employees' wages You will be hable for the tax payment even If you dIdn't actually Withhold the tax For a Federal EIN number, call the IRS at 1-800-829-4933 or VISIt theIr web sIte at www II S QOV , Other Responsibmtnes amll Areas of COlIH:ernS Code ComplIance As the permIt holder for thiS proJcct, you are responsIble for resolVl~g any faIlure to meet code reqUIrements that may be brought to your attentIon through mspec~_ons LIabIlity and Property Damage insurance: Contact your msurance agent to see If you have adequate msurance coverage for aCCIdents and OITllSSIOnS such as fallmg tools, pamt 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 slalls to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIf'y bUlldmg offiCIals as the appropnate tImes so they can perform the reqUIred mspectIons If you have addItIonal quesllons call the Construction Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Property_owner doc 06-01-04