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Home My WebLink AboutPermit Electrical 2014-08-22Eaectrical Permit Application SPRINGFIELD } ® , ® ® ff r k ,•... tt t k i 225 Fiftb Street *Springfield, OR 97477+PH(541)726-3753*FAX(541)726-3689 ` This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION . . ❑ Residential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION 11 ( Job site address: `] 1 S -S D QtA Ave - City: _ Sp L _ State: -OR_ -ZIP; 974? g Reference: Taxlot.: DESCRIPTION :OF WORK` i e is e --$36:00- _ PROPERTY OWNER ' . Name: b^ ! Address: S 5'A t' i,, v� City: t State: of?- ZIP: 97479 Phone:S[I-Slo -4b0 . I Pax: - - E-mail: 4p,w.oAVk"1 @V\o4wwi 1. Coy%,% This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1 . Signature: CON RACTOR INSTALLATION ' Bu ss name: f'3 ker o 5 Address: City: State:,, -'ZIP: Phone: ax: E-mail: CCB license o . BCD license n .- Signing -supervisor's license no.: r t name of signing supervisor: Signature of signing supervisor: ATTENTION: Oregon la)^t requires you to f nr r, 41 _ �tiopted by the Oregon Utility N.It ti. Lti m Confer. Those rules are set forth in OAR 952-001-0010 through OAR 052-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). 440-2584-3 (5/21/2014/COM) FEE SCHEDULE Number of inspections per item O Qty. Cosf ea, - Total cost Residential, per unit, service included: 1,000 sq. ft. or less (4) $151.00 $ Each additional 500 sq. ft. or portion thereof $ 28,00 $ - -Limited energy (2)-_-- -- — -- -- --$36:00- -$— Each manufactured home or modular dwelling service or feeder (2) $ 71.00 $ Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 91.00 $ 201 to 400 amps (2) $106.00 $ 401 to 600 amps (2) $178.00 $ 601 to 1,000 amps (2) $230.00 $ Over 1,000 amps or volts (2) $527.00 $ Reconnect only (2) $ 71.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 71.00 $ 201 to 400 amps (2) $ 98.00 $ 401 to 600 amps (2) $142.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extensionperpanel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit 1 1 $ 7.00 1 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 62.00 $ Each additional branch cir�Pj` Y1' Bb It e f AM �c 00 pt��lfr ' a i n Wed $ 7.00 $ 71.00 $ $ . e fnDrQAI ' Ming (2) $ 71.00 $ S' l;�ij'cvui r a tmited-energy panel, a t88ration, or extension (2) $ 82,00 $ Each additional inspection: (1) $82.00 $ APPLICANT'USE ' (A) Enter subtotal of abimejee (Minimum Permit �ce$82.0D) $ (B) Enter 12% surcharge (.12 x [A]) $ �, t (C) Technology Fee (5% of [A]) $ (D) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through D): $ S' J v 7 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: 'A(Am�- f Name CCB# Expiration Date ❑ I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. 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 select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. A�JAM Print Name of Permit Applicant Signature of Permit Applicant Permit #: Address: Issued by: Date: `6- 22 - I LF Date This Copy for Permit Offices Xv • • • - • • -About Construction Responsibilities #> •rte •- Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages atThe time employees are paid. You will be liable for the tax payments even -if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to http://www.oreaon.ciov/DOR/BUS/docs/211-055.pddf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their 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 workers 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. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable 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 website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough -in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 — Fax: 503-373-2007 Website Address: www.oregon gov/ccb f/property_ owner adopted 9-23-08 This Copy for Permit Applicant Etc ELD - CITY OF SPRINGFIELD 225 Fifth St �TRANSACTION RECEIPT Spdngfield,OR97477 OREGON 541-726-3753 811-SPR2014-01835 w .spdngfieldacgov 5755 OBSIDIAN AVE permitcenter@spdngfield-or.gov RECEIPT NO: 2014001859 RECORD NO: 811-SPR2014-01835 DATE: 08/22/2014 - Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00 Branch circuits with service or feeder each circuit 224-00000-426102. 1004 TOO Branch circuits without service or feeder - 1st circuit 224-00000-426102 1004 62.00 Electrical Continuing Education fee 224-00000-425606 1032 2.50 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 9.84 Technology fee (5% of permit total) 100-00000-425605 2099 4.10 TOTAL DUE: 98.44 adamjames 223051 TOTAL PAID: 98.44