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Home My WebLink AboutPermit Electrical 2009-1-27 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD , Building/Combination Permit PERMIT NO: COM2009-00126 ISSUED: 01/27/2009 APPLIED: 01/27/2009 EXPIRES: 07/2612009 VALUE: Springfield TYPE OF WORK: Single Family Residence SITE ADDRESS: 177 38TH PL ASSESSOR'S PARCEL NO.: 1702314200108 Pnblic PROJECT DESCRIPTION: ~eplaceelectrical service TYPE OF USE: Remodel ~' '""UC 'M,"OV<M"'" I \}\ Owner: , LLOYD JC Address: 177 38TH PL SPRINGFIELD OR 97478 Contractor Type Contractor # of Units: Primary Occnpancy Group: Secondary Occnpancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Sethack: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Constmction ATTENTION: Oregon law,re:tu~~:!~~i}i~" follOW rUles aUUI...HvU......J ..'- -- -..., "h -. ....1__ ......q <"''3t fort ~lcCON:roRA:€'T0R' INFORMAT,ION,t_001_ In UKn ~"'~vv . ;bt~;n oopi~ of the rules by , 0090, Youhmay ter (Note' LicenseJhot\Expiration Date Phone callit\gt eoen. '.':'-"",'" _ ,_~M 'M th<> nrRC10t\ Utllitv Notification . l'OUlLJ}I<N<9'IN'F0RMATION'f')' R~3 # of Stories: Lot Size: Height of Structnre Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft GaragelCarport Energy Path: Sq Ft Other: N OTI~inkled Bnilding: nla Occupant Load: -',- ~:;,'a:1 "',IL'!.LI','''','N ;~rll:'!J€fII~ I.DEVELOP.~EN'T,,~~1'{'t~A'J:I~'1r IS NOT MUIIIVlllt..l-....'.....'.~_.. -- -- COfVi~itEW~En OR IS ABANDONED FOR Over~~"'UlSt.Rlnn ANY #~rt!.4'irre~s R'qif: Paved Drive Rqd: % of Lot Coverage: VB REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: DownspoutslOrains: I Valuation Descriution I $ Per Sq Ft or mnltiplier, Sqnare Footage or Bid Amonnt Valne Date Calcnlated Pa2e 1 of 2 Status Issued ,CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00126 ISSUED:' 01/27/2009 APPLIED: 01127/2009 EXPIRES: 07/26/2009 VALUE: 225 Fifth Street, Springfield, OR, 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less Amount Paid Date Paid $9.72 , $4.05 $81.00 1127/09 1127/09 1127/09 Receipt Nnmher 1200900000000000053 1200900000000000053 1200900000000000053 Total Amount Paid $94.77 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspectio'ns requested before 7:00 a.m. will be made the sam~ working day, inspections requested after 7:00 a.m. will be made the following work day. I Re{]~ire~ I.n.~l1ec.~i~n,~ ,I Electric Service: Approval reqnired prior to utility company energizing service. Final Electric: Wben aU electrical work is complete. By signature, I state and agree,that I have carefnUy examined the completed application and do hereby certify that aU information hereon is tme and correct, and I further certify that any and aU work performed shaU 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 he made of any structure without permission of the Community Services Division, Bnilding Safety. I fnrther certify that only contractors and employees wbo are in compliance with ORS ,701.005 will be nsed on tbis project. I further agree to ensure that aU required inspections are reqnested 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'aU times during construction. ('--~ ' ./" ....", Owner or Contractors Signature' / -----._._~..~_._-~"._~_.._--_.~.. / - ?.( -cPO\. , Date Pa2e 2 of 2 225 Fifth- Street Springfield, Oregon 97477 541-126-3759 Phone Job/Journal Number COM2009-00 126 COM2009-00 126 COM2009-00 126 Payments: Type of Payment Cash Change Job/Journal Number COM2009-00126 COM2009-00 126 COM2009-00126 Payments: Type of Payment Cash Change cReceintl RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department 1200900000000000053 Date: 01/27/2009 ,Description .' PennServlFdr 200 amps or less + 5% Techoology Fee + 12% State Surcharge Paid By JC LLOYD Item Total: t.:heck Number Authorization Received By Batch Number Number How Received cjc In Person In Person Payment Total:' Description Perm ServlFdr 200 amps or less + 5% Technology Fee + 12% State S nrcharge Paid By' JC LLOYD Item Total: Check Number Authorization Received By Batch Number Number How Received cjc In Person In Person Payment Total: Page I of I '10:14:54AM Amount Due 81.00 4,05 9,72 $94.77 Amount Paid $100,00 ($5,23) $94.77 Amount Due 81.00 4,05 9,72 $94.77 Amount Paid. $100,00 ($5.23) $94.77 112712009 Electrical Permit Application l~liDUEe~R-IMEN';f'BSEro"'Ni!.Y.E~,1 ~~;J%'!;~>':;;:"["~)'!;';;';i'",,,'o;::;~0i\>';;;:::~iF. I Permit no, I ID.~ ' I 225 Fifth Street. Springfield. OR 97477tPH(541)726.3753tFAX(541)726-3689 This permit is issued under, OAR 918-309-0000. Permits are nontransferahle. Per'mits expire if work is not started within UIO days of issuance or if work is suspended for 180 days. 1~IEO:CAl.GO~E~NI'iIENJ~A~P.1:l.0VALt~ I Zoning approval verified? 0 Yes 0 No ~~111.1\,;!tCAmEG<D~X~oEJ![GQNSjIiI:l.I!JClTiI0,N~$,~~ I I Residentia'l, per unit, service included: ljii'Residential , D Government I D Commercial 1.~'.(QI3J!$lmEJINF,:QRMA'"lijoNiJl:Ntl.liI10G:A'f;fQNil1i!\~J1\'J1 11.000 sq, ft, or less (4) $134.00 $ I Job site address:-17i 3$"" PI I I ~~~~oa?ditionaI500 sq, ft, or portion $ 25,00 $ I City:5pIJ':!5'--<-1 J I State: OR I ZIP: 07t/7f31 I Limited energy (2) $ 32.00 $ 1~=llRDE$'C~I~t:'ON[0FJiJ~~~~J~~~~ I ~~~71~;ns~~~~~r~~ ~e~~~r (~)odular $ 63.00 $ I <J I / ) '! /I I r Services or feeders: installation, alteration, relocation '/~e[}I<4> () / sPIlJiU2- IZt.L 1~,i7V\ lJ.e.w I I I 200 amps or less (2) $ 81,00 $ lilIii~~~RROgE~j1)t(4ioVVN.ER{~fi~.\i;jIj;kv~'iiic!i1~i~1 I 201 to 400 amps (2) $ 95,00 $ I Name: -.Jc.... LLoYD I I 401 to 600 amps (2) $158.00 $ [Address: I'll 3SJ',. ?\ I 160ttol.000amps(2) $205,00 $ I City: Svr)'Vl ~ _\ J I State: 0\ <( I ZIP: 074 "IS I I Over 1,000 amps or volts (2) $469,00 $ I Phone:S~/-5~/cSlJ\1 Fax: _ _ I I Reconnect only (2) $ 63,00 $ I E I ij - I . \ '\ r. \ , \ I Temporary services or feeders: installation, alteration, relocation -mai: -nw- ('e<-, ;\c... tlcJVO l""'_ ~"'\ i CO"" , This installation is being made on residentitrl' or farm property 200 amps or less (2) $ 63.00 $ owned byme or a member of my immediate family, This I 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, 'or rent. OAR 479,540(1) and 479.560(1), I 401 to 600 amps (2) $126,00 '$ I Signature: lOver 600 amps or 1,000 volts, see services or feeders section above Im~:,I;G,Gr':mi~<;;1IL~~jlINsflfAl'!~AmION~!~~tf~1 I Branch circuits: new, alteration, extension per panel I Business name:" . 8z.,v rJ~--. j I a. Fee'for branch circuits with purchase of a service or feeder fee: I Address: I 'I Each branch circuit I I $ 6.00 I $ I City: J State: I ZIP: I b. Fee for branch circuits without purchase of a service or feeder fee: I Phone: I Fax: I First branch circuit (2) I $ 55,00 $ I E-mail: ,. ... I Each additional branch circuit I $ 6.00 $ I CCB license no.: I BCD license no.: I Miscellaneous fees: service or fteder not inc'tuded I Signing'supervisoe's license no.: I Each pump or'irrigation circle (2) $ 63.00 $ I Print name of signing supervisor: I I Each sign or outline,!ighting (2) $ 63,00 $ I Signature of signing supervisor: -I I Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) I Each additional inspection: (I) .. $58,00 $ (A) Enter subtotal of above fees '(Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (,12 x [A]) I (C) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A throngh C): $ $ $ $ ,! 440-2584-J(9/08/COM) I I '1 I I I I I I I I .1 I I \ , I ):> i' 1d;J , , -' , , , , , . ". .,' '. .,. 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 Permit#:~.:k"b'Y- CkJ(2~ Address:/'7'7 JO""'- P: Issued by: c:::::.,. '-- Date: f;2'7/~,7 Statement: Information Notice to Property Owners About Construction 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 b~ilding permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer lfpplicants, 'exempt from licensing under ORS 701.010(7), need not submit this statement. Thisstatement will befiled with the permit. Fill in the appropriate blanks ~d initial boxes I ami 2, arid either box 3A or 3B: .N;j.. 1. I own, reside in, or:will reside in the oompleted structure. -6Y- 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. , : D 3A. My general contractor is (Name) (CCB #) , I will instruot my generiil contractor'that all subcoJ;ltractors who work on the structure must be licensed with the Construction Contractors Board. OR ~itJ-- 3B. [will be my own general contractor. " , . IfIhire subcontractors, I will hire only subcontractors lioensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contraot with a contractor who is licensed with the CCB and will immediately notify 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 construct~ibiIities on the reverse side of this form. , ..-- Z --/""-'-"! ~7/o9 / (Signature of permit applioant) I ~afe) (White cqpy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 _" .t. Acting:as' YOlfr''()wil GeneraR'Contractor? : \ . - ~..:". ~ ,. ~ . . ." . . .. ~:.. . INFORMATION'NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES , --:;- " - ~ . . ", .,: .' ,," -.... ~-', . _ '\ _~":- .J..... , i , J. . .. .t". '.' NOTE: This Information Notice to Property OwnerS about Construction Responsibilities was developed by the Cons(ruction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. ._"'.- , '.:' ~ .... .': . ~. f'\' "'.?'r'~;, " f:..'.. If you are acting as your own contractor to construct a new home or make, a substantial improvement to an existing structure, you can prevent many problems bybeing awareofiheJollowing responsillilities and'concerns. , Employer Responsibilities ., "'::"'~".~ .. ~:.." '~." .:.~"" ,\ ,'j .,"- ,,~,"i . ",. ,~ J' ~ You will, in most ,in~tanc~~, bemJed to be !In. "employer'; ~~ thecontracior~youcontract ~ith .wil! be "employees" il you use contractors not licens~<! with"the ~onstructj?n <;<?ntractor,s B~a~&to,do}l,lbor in c!lnstru~!ing or to l!Ssjst in the construction or jJ11P{?y~m~t o.f.a,residen!i~I,struc!uj"e. As,thee~pI~ye.~, Yl\u must COmply with ~he .fo!1f1wii1,g: .' . . . .. ." ,- ',. " - .. ", .;, ~ . , . '. ...., ,. '. ' ,- " ,', ' '\,'. "' .'f" ( ... , . '.'"" _ .,- . Oregon's Withholding Tax Law: As an employer, you must withhold income'taxes from employee wages' at the time employees are paid. You will be liable .for the tax payments even if you diln'! actually withhold. the tax from y~)Ur . . " ". .. __. .' .,., '...... .L I _. 't _~ :. ' employees. For more information;call'tlie'Department of Reveillle at 503'378-4988: ,.,.;<" ,.' . ' :, ' Unemployment Insurance Tax: As an employei': you'3re,n;qliiied'to'pa:Y:~ tax for unemployment insurance purposes ". on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, .:,";\'.:.;':l'".. '" L-': <~'I~.L! ,.~:L.-...I"'.:~.\.':~.?,-).,...~J'j'H'.~' .':.~;" ..~;-. ."_ _{~ The Oregon Business Identific.ation Number (BIN) is a combined .n>JDlber for ,both.. Oregon Withholding and Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. -, .:~, ..~ ' ~-- .' :,' -.. . , . ' . ' . ' ". . Workers; Compensation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law, andmust.obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation .. . _ r. .! i.... . . . ''-~'' ,'.(. p . . l"",,' I ~"'.' . '. 1.....1> ". .' ':' ',' . :. -. -. I , insuranc'e, you could be subject tbpemilties and be liable 'for all ohlim c'osts if one of your employees is 'injured on the . ,,,,,,..1 _. "- - " ' job. For more information, call the Workers' Compensation Division at,the Department of Consumer and Business Services at 503-947-7815. ",' . 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, call the IRS at"F800.829-4933 or visittheir Vveb site atw\V'\v.irs.l!Ov; . ' .~, ." ,:' co' ..,' , . , .; " , ,~ " . , '.' I \ . . . Othe~':ResponsibiUti'es ~m.d Areas of C_oncerns ~ <, ,! -.: ""'r " . Code Compliance: As the permit holder for this project, you are responsible for resolvihg any'failure'to meet code requirements that may be brought to your attention through inspections. , . ,."'. ~ . . .' ',. ." '. .: ", -... I _ 4 -. I .' .' ._, Liability and Properly' D~mage'insur';mce: Contaci' youi' insJrance agent to 'see if you hi\le. adequate insurance", coverage for acoidents and omissions such as falling toolsc paint over spray, water damage from'pipe punctures, fire or work that must.beredone~' , _. - \ - \ j .. \ ,2.:- _:~ ~ \ Time: Make sure you'\lave sufficient time to supervi'se your cmployees. .. ,:.: ,;,' ---.J -. . ~. r '.. " ~ -;.. . ' Expertise: Make sure you have the skills'to act as you~ oWn 'general contractor: to coorllinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can 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, OR 97309-5052. Property _ owneLdoc 06-01-04