HomeMy WebLinkAboutPermit Electrical 2009-11-12
225 Fifth Street. Springfield, OR 97477.PH(541)726-J75J+FAX(541)726_J689
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I Date: /1- / Z - O"} I
Ele~tril:l.ll Permit Application
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This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I;',':;" " ,", :['OCAV'GOVER/IIMENn~p.~BOVALG\~,*,i~"';;l!f\'1 1",,\~'i-lii~~.;,'I."1'f1'\IIli.\-}I{F;EEiiSCHE[jUt:Ei'm;~f~B:)';f"'f.~~~l
I Zoning approval verified? EfVes 0 No I 1';..~~~~,~~(?r4,fr:f~e\2~i~-e;~r.p:~[:-i~t~~;~'~'.,.~'~~~:~~JRtf:13'.~~~{,:~._l{1~t~L~-.:I
i;~~j~~~~~::::~~:;~;;~;:::l~:~;~~;r:i~~ll'B' : ~~~:::ti;I,~el::,n(:;serviceincluded: $134.00 $ I
1 Job site address: ;:Lo:L/ /;U LA-I./!J . j)/ -+y. I ~~~~:ritional 500 sq ft or portion $ 25.00 $ I
I City: J: l' A~/ "ub"~ate: OJ!:( I ZIP: 97 7' n 1 Limited energy (2) $ 32.00 $ I
[~Reference:'(~~~~I?D~~F'.w~;~::~:~~~'~': ,~;;~I~~nS~~~~~r~~~e~~:r(~)odular $ 63.00 $ I
1 -+-,---,//11> / ee:. ;;:-e;eV /' C~icel/O"'" aCio )tEJ\,!:Vi~j",oq!i;~~~rs: ,"slalla/lOn, allerallan, relaca/lan I
/b/"/o <- "r,,_ nr.o~ -~ilMsG'r- ;~V<lro 1
I 0090"'" &b2'001_0"' -RBs" .J;,i- il&W1Jtn,,-_ $ 81.00 $
. y~. ( I~ 112 '~.JI{.f>.:7"')- 1
I . -PROPERTY' OWNER" 'Cal/inci-:-"::"'YObl~il W~Ili"l\"fSfDJfOTfh $ 95.00 $
1 Name: L-tft/!J:S tA-L(}.I~mberto~t;,:nJf~. (ViYft~t!ftfJlf~~1it:Ot. $158.00 $ I
I Address: 12721 ~L(/ /z/u A--~ter;aj'~f;1~'W;,=1., $205.00 $ I
1 City: 77Gtf?/<.P I Statet'^, I ZIP:Cj122'3 ~m Its (2) $469,00 $ I
1 Phone:t?f);J 7tf7J-tfD 1 Fax: 1 Reconnect only (2) $ 63.00 $ I
\ E-mail: 'I Temporary services or feeders: ins/al/ation"alreration, relocatiop J
This installation is being made on residential or farm property I 200 amps, or less (2) I $ 63.00 $ b ;j-
owned by me or a member of my immediate family, This 1 201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, se or rent. OAR I I
479.540(1) and 479,560(1). 401 to 600 amps (2) $126,00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
I '.::C.0NTRACrOR"INSTALLATIOpf ,'u ' ,. 1 Branch circuits: new, al/eralian, extension per panel
I Business name: ~LJ N Evt, I 8, Fee for branch circuits with pu!chaseofa service or feeder fee;
I Address: I' Each branch circuit 1 $ 6.00 I $
I City: I State: NOTt~: T'; ",,' ~"I:, b;i-F:.~~,:.{9r:pJ:~.I);~h. ~ircuits without purchase ofa service or feeder fee:
I Phone: I Fax: n-llS PERMTT SHAl.L E)( PI":ti,'-II"" ti/N;lll'J I I $ 55.001 $
1 E-mail: ~UTHORIZED UNDER n ~~h circuit $ 6.00 I $
1 CCB license no.: 1 BCD li~~'WJ:"NpED OR IS J BJ ,IlW@fOI!DffRes: service or feeder not included
1 Signing supervisor's license no.: n,.l au 1.1111 t'l:MIUu, I Each pump or irrigation circle (2) I $ 63.00
1 Print name of signing supervisor: 1 Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor: I Signal. circuit or a li~ited-energy panel, $ 63.00 $
alteration, or extensIOn (2)'
I Each additional inspection: (I) $58.001 $
1~~~~M't~~~iA~e~Tt_:~Nt~i:t)sE~t:~li$fi1~;:1i~~NtL~::~1
I (A) Enter subtotal of above fees $ I '7
(Minimum Permit Fee $58.00) b;>
.1 (B) Enter 12% surcharge (.12 x [AD $ 7S'I-
I (C) Technology Fee (5% of [AD $ ~ 1.11
I TOTAL fees and surcharges (A through C): $ -'"7 7]"
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$
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440-2584-J (9/08/COM)
Status' In Review
225 Fifth Street, Springfield, OR
541-726-3753 Phone-' ,
541-726-3676 Fax ".:" ",:,!;" '
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541-726-3769 InspectioilLine
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CITY OF SPRINGFIELD -
Building/Combination Permit
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PERMIT NO: COM2009-01591
ISSUED:
APPLIED:
EXPIRES:
VALUE:
()
10/29/2009
05/12/2010
$ 158,464.00
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SITE ADDRESS, " :'2021 INI;AND WAY
ASSESSOR'S PARCEL NO.: 1803023308000
Springfield' TYPE OF WORK: Single Family Residence
TYPE OF USE: New Residential
PROJECT DESCRIPTION: 'Single, family:.residence. Replacing existing manufactured home- Radiant floor heat.
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Owner:
Address:
.;~_., <Of. : 'J.~. _~*. \",::-:;;'1 ;~~:> .'
, V ALUSEKLUCIUS' ,,;.
2021 INLAND WAY ,
SPRINGFIELD OR 97477
Phone Number: 503-780-8837
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.. ; N fol!oll[j;'lJ"~{lRW.0l',w},INFORMA TION I
hi OMicaTIo' I -~,,(j"led b ~ . "Wlfe
Contractor Type ContractorOO~1l'i 952"-fo~r!it. Tho;et~~ OreiM?~to Expiration Date Phone
General , ': OWNER;;". CaIU YOU may Ob01~ Ihroug~ es are sel f~/ty
Electrical .~,.:", V .'!,t'OWNER;,.,' i1umbng Ihe cenle 16m COPies o~AR 952-oo7h
Mechanical . j; " :,' <: OWNER '. eT for Ihe 0 r. (Note. th the rUles by-
Plumbing "'" OWNER Cenleris :~~~nYtilit/^~~~~fhone
it;, ,; I BUILDING I~Fbi&1Vf'i()N11J
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# of Units: 1 # of Stories: 1 Lot Size: 8,712
Primary Occupancy Group: ' R-3 u Height of Structure 18.00 Sq Ft 1st Floor: 1,432
-,..j'" . Type of Heat: Sq Ft 2nd Floor:
Se~ondary Occupa?cy Group'~ ,"Fij .
Pnmary ConstructIon Type ,-, "'-1' -,~, VB Water Type: Electric Sq Ft Basement:
Secondary Con~inicti~n Type: ;Y", Range Type: Electric Sq Ft Garage/Carport 525
# of Bedrooms: ; 3 Energy Path: Sq Ft Other:
, .. '. Sprinkled Building: n/a ' Occupant Load:
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Storm'water to curb and g~tter
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Froutyard Setback:
Side 1 Setback:
Side 2 Setback:' i,' of'
Rearyard Setback: ;'
Solar Setba.cks: I"" "
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Street Improvements:
Storm Sewer Available: ,
Special Iustruction:
Notes:
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I, DEVELOPMENT INFORMATION I
REQUIRED PARKING
46,00 ,> Overlay Dist:
, 'U-"5.00" # Street Trees Rqd:
NOfil:oa:. Paved Drive Rqd:
T '.va..
HI9-<t,OQ,:' % of'Lol:,C:()V~rage: '
, , ~UTlJ~M7~!I,~,~~LL fXPIRr:~;~"1i--"l;'l':;:!i'.)":'! ""',
. XK;{VJENCEDfiiJ*~idJiipK --. ,
180 DAY PC"'R " .IL,;, 'LJu'JUED PO'''' ,,;:,
" (00 1"1 11 ., -,'
. :/;:,;2;}~':':
'-~'. - . :.": .>
Urban Fringe
I
No
22.46 '
Total:
Handicapped:
Compact:
2
Sidewalk Type:
DownspoutslDrains:
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
225 Fifth Street, Springfield, OR:.:,i},!;,,;;,.
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541-726-3753 Phone':. ',:,';. : <'::..}i;{:?-"J., ,
26 3676 F ',' ',' ':"t. "c:."'" "~''-'{:
541-7 - ~x " ':-;~''''....-.'' ~/ 1,
541-726-37691~spectiori Line
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PERMIT NO: COM2009-01591
ISSUED:
APPLIED:
EXPIRES:
VALUE:
In Review
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,1 Valuation Descrintion I
Description Type ofConstr.uc\!on
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Garal!e/Misc "it':.' .,::V:'y'B tJtilitV,:;~.-"'.
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SFilluplex '\i' " .:-R-3 VB 1&2 Family
, .
,) $ Per Sq Ft
or multiplier
$37.72
$96.83
Square Footage
or Bid Amount
525,00
1,432.00
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Total Value of Project
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Fee Description
Plan Review Residential.- ',_
-, .
+ 12% State Surcharg.t.,
+ 5% Technology Fee.
Temp Power 2QO ~IJlP~ ,or less
, '_ :" If 11 . " ~ . . .
-Amonnt Paid
Date Paid
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"~'T
$643.23
$7.56
$3.15
$63.00
10/29/09
11112/09
11112109
11112/09
Total Amount Paid
$716.94
".,.- ,0 Plan Reviews ,
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Initial Review .. ::.:\ 11102/2009 11102/2009 APP LLH
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Initial Review; : ' ' 11103/2009 11103/2009 APP LLH
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Planmne: ReVIew f. t '
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Structural Review
Structural Review
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11102/2009
..~- 11103/2009
CJC
CJC
11103/2009
11103/2009
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Planninl! Review,
11105/2009
11105/2009
APP DDK
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Pal!e 2 of4
.
10/29/2009
05/12/2010
$ 158,464.00
Value
Date Calcnlated
$19,803.00
$138,660.56
$158,463.56
11103/2009
11/03/2009
Receipt Number
1200900000000001212
2200900000000001279
2200900000000001279
2200900000000001279
Revised drawings forwarded to
Chris Carpenter
Scale on plot plan is not correct.
Need setback information/distances
and height of structure. Left
message for owner.
Plans incomplete
Plans incomplete: Need floor
framing and foundation plans, truss
doc's to match building plans and
energy path and specific type of
radiant heating system.
Floodplain line must be staked and
marked in proximity to new buildin!
footprint. NO PART OF
STRUCTURE MAYBE IN THE
FLOODPLAIN. IF ANY PART OF
STRUCTURE IS IN THE
FLOODPLAIN A FLOODPLAIN
OVERLA Y DISTRICT
APPLICATION WILL BE
REQUIRED. Existing street tree(s)
may be counted towards street tree
requirement.
CITY 01' ~rKmtJl'lJ!,LD
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Building/Combination Permit
Status In Revie~(:';~;;'o;,ii.{j&i.;i' .
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225 Fifth Street;Sprlngfield;OR"
541-726-3753 Phone
541-726-3676 Fax ;::}-;:,~' ,
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541-726-3769 In'spection Line "f ~F-. .
PERMIT NO: COM2009-01591
ISSUED:
APPLIED:
EXPIRES:
VALUE:
10/29/2009
05/1212010
$ 158,464.00
Structnral Review
11105/2009
11/0512009
WE
CJC
Fondation /Iloor framing plan,
e-option and Iloor heat type
recieved, still need revised truss
docs.
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Public Works Review
11102/2009
11/09/2009
APP
TSS
Spoke to homeowner about the scale
on plan set. He indicated on
11/6/2009 that the plans were on a
1/4 scale and that is what was used
to calculate rooftop impervions.
Floodplain certificate included with
application.
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Stormwater to curb and gutter.
11/10/2009
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11110/2009
APP
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As noted on plans and in review
letter
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To Request an inspection call the 24 hour recording at 726-3769. All inspections 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. t'.: .~..-::~f'~i; :; :;(
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Erosion/Grading In'spection: ,Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install gronnd rod at footing and call for inspection in conjunction with footing and/or
foundation inspection" ~)
I Rrollirpll lr~lP..tin'\\J
Footing: After tr_enches are excavated.
Foundation: 'After forms are erected but prior to concrete placement.
, .
Floor Ins.ulation:, Prior to decking.
': ~ ! -
Shear Wall Nailing: Before covering sheathing with finish materials.
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Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
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Ceiling Insulation: Prior to cover.
Drywall:! Pri~r to taping. . ~
Final Building: ~fter all required inspections have been requested and approved and the building is complete.
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Underslab Plumbing:' Prior to filling the trench and including required testing,
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Rough Plumbiog: Prior to cover an~,incInding required testing.
Water Line: Prior to filling t!ench and including required testing.
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Sanitary 'Sew~r Lhie: 'Prior to filling trench and including required testing.
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CITY OF SPRINGFIELD
"
Building/Combination Permit
225 Fifth Street~;Spr!ngl!eld, OR
. 541-726-3753 P~,one'>;',L:.. ,,,,.t'.".,\- ,,:
541-726-3676 Fax ,,' ..,' . "''';'>'':'' ':'i' '
541-726-37691nspection Line -'
PERMIT NO: COM2009-01591
ISSUED:
APPLIED:
EXPIRES:
VALUE:
Status
In Review '
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Line to Septic Tank: Prior, t~".Iilling trench and required testing.
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Storm Sewer'Liri'e: prloiio'filling trench.
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final Plumbing: When all plumbing work is complete.
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Underslab M~ch~~ic~l. Prior to insulation or decking and including reqnired testing.
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Rough Mechanical: Prior to',Cover
Final Mechanical: When all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
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Rough Electric:' Prior to Cover
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Electric Service: Approval required prior to utility company energizing service.
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Final EleCtriC: ,When all electrical work is complete,
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Tem'porary Electric: Approxal required prior to Utility Company energizing pole.
10/29/2009
05/12/2010
$ 158,464.00
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 OCCUPANCYwill be made of any structure without permission of the Community Services Division, Building Safety.
I further certify thai only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agre,e to ensure that all required inspections are requested at the proper time, that each address is readable from the
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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 cODst,ruction. . li'~
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Owner or Contracto~ Signature:: .~;~
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Date
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Co'nstruction Contractors Board'
700 SummerSt NE Suite 300
PO'Box 14140 ' .
Salem OR 97309-5052
Phoue: 503-378-4621 \
Web Address: www.ccb.state.or:\1s
permit#: COYl(\ZhOC,-Q./ S''71
Addtess: z...q 2-\ , L I A'~:.L _ LJ At
. ISSUe~bY: ~~ .,' Date: I//;z/o 7
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..' Statement: Information Notice to PropettyOwners
, '- ' About Construction Responsibilities
Note: Oregon t~w, ORS 701.055(4) requires residentialcdnstrnction permit applicants who are not
lidensed with tlie Construction Contractors Board to sign th~following statement before a b~ilding .
permit cart be issuea. Thi~ statement is required forresidential building, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from licensing under" ,';
. ORS 701.01 W7), need not submitthisstatement. TNss,tat,ement }Vill be filed w(th the permit. '
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FiI\'in the appropriate blanks and initial boxes t and 2, an_d.eithe~ box 3A or 3B:
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'1 own, reside in,.or wjli reside in the completed structwe. , .
v,
I understand that I must. become licensed as a constrUctiOIi. contractor if the structure is-sold or
offeii:d for sale before.or on completion.
D 3A. My general contractor is
(Name)
(CCB #)
'~ ,~
'I ,~i11 instruct my gen~ral contract.or that all subcontractors who work on the:structure must be
licensed' with the Construction Contractors Board.. ~, .
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~ 3RT wHl '" my:' .,.,,01 00""""", . '. . . ." . . .' '.' '.:
. If I hire subcontractors,.! will hire only subcontractors licensed with the. Coristriiction' Contractois
. , Board. If I change my mind and hire a general-;;ont!actor, I will contract ~ith a contractor ~ho is
licen~ed with the CCB and will immediately ll<;>tify the office .issuing this bujIdingpermit of the
name of the" contractor.
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I hereby certify that the above Information,js correct and that I have read, and do understandthe'Information '
Notice to, Property Owners about Construction Responsibilities on the reverse side of this forni. '
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(Signature of permit applicanfj :' ','; (Dats:)
(White copy to issuing agency permttfile, pink copy to applicant)
Property~owner.doc 06.01-04
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A.~tlng\a's "your:Own General Contractor?'., ..
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, '\' - ,. :INFORIVfATION NOTICE TO PROPERTY OWNERS . '
\' '--\\":.'\'\ .. l ABOU1!C,qNSTRUCTI,oN.RESPONSIBILlTIES "
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NOTE: This tnformation Notice to Properly Owners about Construction Responsibilities was developed by the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
If you are acting as your own COl)tract~r to construct a' new h~m~ or make a substantial improvement tii im ~xisting
structure, you can prevent fuanyproble"r!is'by being aware ,<if the following responsibilities and concerns.
"
lEmp~oyer Responsibilities
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You will, in ,most .instances, ,~e I}!led to, qe an ,"employe('.!l!1d the c.ontractors .yo,u. contra~t,Mth. will'be, "employees" if
you,use contractors,.notJicensed v.ciih the Construction Contractors Board to do labor-inconstructing or to assist in the
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construction or, improvement. ofa residential stru9.ture. As.the.eniploy~r, you must c,!l!Dply with the f()J.tl!wi~g:
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Oregon's Withholding Tax Law: As ail employer, you must Mthhold ihcome taxes from employee'wagesatthe time
employees are paid. You will be liable for the tax payments even if you don't a,ctually withhold the tax from your
employees. For more information,call the'))epartnleni'ofReveh'ue'a'tSO~-378-4988. ,- ; , , .
Unemployment Insnl"anceTax: As an etrtployer; you ar6 teqtiiredto pay a tax'for imemplo'yme'nt insurancl;'Purp~-
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488.
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The Oregon Business Identification Number (BIN) is a combwed.numb~r fQr both- Oregon' Withh.olding 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. '
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Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers', Compensation Law,
and must. ogtain workers' c~.....~..sation insurance for your employees. If you fail to obtain workers' compensation
insl,U"ance, you co~la be subject to penalties' and be' iiable for' ~ll' claim costs if <.me' bf your 'elllpl<iyeesis'irijured on the
job. For more information, call the Workers' Compensation bivisioii at the' Depariment'of (';onsumerimd Business
Services at 503-947-7815.
U.S. Internal Revenne ServiCe: As an employer, 'you must withhold. federal"'income tax ,from' erripioyees' wage~
You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, calrthe
IRS 'at 1-800c8i9-4933(or viSIt their web site at,www.irs:l!Ov. ".,' "', , ., '.
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'. ,iOtiier,JResp~)I.-&ibi.iities.~~d Alie~s'.'of CQJ!cer][l~',
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Code Compliance: As the permit holder for this project, you are responsible for resolving imy failundo meet code
requirements that may. be brought. to your attention through inspections.
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Liability and Property Damage Insuranh: .- Contact your 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
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work that mus't,be redone. _ " ,', :; \ ,'.
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Time: Make sure yoIi have sufficient time to supervise your emp]oyees~
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Expertise: Make sure you have the skiils'to aCt as your O\VU' generai' contractor, to coordinate 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 (503-378-462]) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
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Property_owner. doc 06-01-04 .
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225 Fifth Street,;;:i :;.> .;:,"";r~,
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Springfield, (:)rego.ni9~4n' "/ ';,
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Job/Journal Number
COM2009-01591
COM2009-0 159 I
COM2009-01591 ,
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City of Springfield Official Receipt
Development Services Department
Public Works Department
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RECEIPT;#:', 2200900000000001279
Description "
Temp Power.,2QQ :~mps ,<lr less
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CreditCard LUCIUS HOME SRVCS
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, Date: 11/12/2009
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Item Total:
(;heck Number Authorization
Received By Batch Number Number How Received
djb 0473 lOin Person
Payment Total:
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Amount Due
63.00
3,15
7.56
$73.71
Amount Paid
$73.71
$73.71
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