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Home My WebLink AboutPermit Electrical 1998-5-1 L' , zoning, ~d d~:}; =bmjttoo.~as ~hafullOWlfl@ approve,. L.(}./V ra specmc land US0 Zonji'l~ , Data 11 . YVl 225 FIFTH STREET Aut ..' SPRINGFIELD OREGON ~7~2'f7SIQli1alure ,. ~ INSPECTION REQUEST: 726-3769 OFFICE: 726~3]59 1: LOCATION?F. INSTALLATIONn _ ,.;:,~'3-.2.. \ 1'""\, , ('€n+en("cY l '!o~3J144TIO~)D~) JOB DESCRIPTION -t-~ ",~ L ~ lc... Address ,City Supervisor Expiration Constr Contr. ~ .~ e of su~e'ViSing Elect~' ::::::sN:me(~~ lA ~~~Y\t~ City ~@ ,PhO~\ ~O\~ \NSTALLATION The installation is being ~ade on property I own which is not intended for sale 1 lease or yen t. Owners Signature: <:..:-.--- , ~~' ~~iM:kc--- , ~~~~~--~~--a:Tq~--(~-!~11-11 RECEIPT W: I n ~~\~ V'f RECEIVED BY: 't=t\\ ~ \ ELECTRICAL PERMIT APPLICAT~ --~ Ci ty Job Number . Q~~ 3. COMPLETE FEE SCHEDULE BELO~' A. New Residential-Single or Multi-Family per dwelling unit. Service Includ~d: 1000 sq.ft. or less Each additional 500 sq.ft or portion thereof . Each Manuf'd Home or Modular Dwelling Service or Feeder Items Cost Sum Permits are non-transA~able and expire if wod<. is not started'~J:IC).n 180 days of issuance Oi' i f wlftts~s ~pended for 180 days. "'(jrlit 'l:1T4f!'J' Q OIY;>,..;. 8liAI ' CONTRACTOR I~~R~:row~L~ls-...rA B. Services or Feeders ~IA~ VeD . ~~lYn rlY~/~ Installa~i?n, Alterations contractow~)_K (;/jI.S/t ~~ rlis-~or Relocatlon: ~'.'(l~J1tDo. ~4!lr/S Oft6 amps or less' /" ~O,ca Na~J1 amps to 400 a.mps Phone 'It 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only $ 85:00 /.., $ 15.00 ,$ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps"o-r less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alteration or Extension Per Panel ) One Circuit Each Additional Circuit or with Service or Feeder Permi L E. $ 35.00 $ 2.00 no t included) Miscellaneous (Service/feeder -Each installati6n Pump' or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm 5'. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL' $ $ $ $ 36.00 ~ ~~ c;() - T-' I f1 l ~O c; ~J. 'XI) 40.00 40.00 20.00 -\" . Permit #: ~\{j~~C\ Address: ~ ?> 1- ~ '\ ~Q 1\ \ ffi(\~a ( ,./ \~. - \ [)V Issued by: ~ ~ Date: CS. . ~ D Statement: Information Notice to Pro'perty Owners , About Construction Respons'ibilities' Note: Oregon Law, ORS 701.055 (4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a buil{iingpermit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits, Licensed , architect and engineer applicants, exempt from registration-under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill inthe appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ,r" ~ lJJ 1. I own, reside in, or will reside in 'the cOPlpletedstructure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ,,~A. My general contr~ctor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR ~ 38. I will be my own general contractor. If! hire subcontractors, I will hire'onlysubcontractors registered with the Constructionqontractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is ' -registered with the CCB and wilhmmediately notify the office issuing this building permit ofthe name of the contractor. lhereby certify. that the above information is correct and that I have read and dound~rstand theInformation Notice to Propcrty O:e~b",nt Construction Responsibilities on tbe revcrse.side ofthis fOr~, L- ~~~ 'J-zV 7$ ,/ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) ~.,..,.;-----....- .'"i. :!I' Owners , ;Vrjte: This fr!fi~rmation Notice to Pr.operty Ol~'!1~r~ (}Q?U!: Construction Responsibilities "was deveh;pet(by the Construction ContractOl;s Board in accordance with ORS701.055(5). If you are acting as vou can prevent w' , "~ 1 own contractor to construct a new home or make a substantia! improvement to an existing structure, prob1e.ms bybej,nga,ware of the responsibi!itj~s an)! areas of concern. " -.. .' -'.J~" ~.,' ;;., - . :; .~. " If you hire persons {::g,ist~red w~tr the Con~tructiOl~, C,Dptrat.;torSi Board t9 do labor inc(:m~tructing or assisting in the constwction Of imp'rovcment 'ofa rc;'idential str'uc'~urc, YOtl \vill~ in'most inst<tnces;be wled~6 bc:ari ell1'p1oyef and the people YOll hire will cmployee~:' A:qheemp!6yei', y6~ inust: c()n~plY ~vith rtillov.,lfi1g: ' .'" '\' " ~ ..',. : ' " 'I ',. ' _ ," ,~ . ' . ",'. :, ~ ,.-.' , :, " .... , " ~, law:' Asan elnplo;ye'r;'You I'nust\vithhold iricometax~s fro111 e'lhployee \'vagcs a:hh'e'timeemployees are wilibe ' the~taxpaym:ehtseveri if YOU' don't actually withhold the tax, from yoilremployees. For more information, call the Oregon Dept. ofReven'ue at ,9451.:809 h. ,. ".. . ',' ,..,,', "'. ':;' \.' '. insurance tax': As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employe~s. For more infOl:mat.i.on,c_alltheQnyg0I1;f~mpI0yment",p'epartment ~,t 37;8.~3?~4,. ; ,',,-' ,f' '. Workers' compensation As an empJoyer,.y;o\f are to the Qr.ego!1,Workyfs' CompepsationLa~vl and m;!1st " compensation insurance for,your e,mployees. Ify()U to obtai11 workers' compensatJOi1.inslirance, YOli mayl i be subjecttopen<!Jties3iicl wiJIbe)iabie fora,!l claim costs if6Iie'bfyqufeinployei:,s i,s injured on thejob. formo,re)nformation,:- call;ih~ \Vorkers' Ctm;penJittJ"onD'iv'isioi1 arfhe Depart~eilt ofC~~ilsumer andBu~ih€SSS~rvices at 945~ n18S',' , ., . [ ~ .' . U.S. Service: As an employer, you must withhold federal income tax from employees' wages, You will be liabldorthe 6ix payment even if you didn'tactually withhold the tax. For more informati611; call the internal Revenue Service at 1-800':829-1'040.' ',;,.:, .1: ',:;';:,', . :.t", ,. ?-~ ' "_~ >Ii '" '" t, OTHER RESPONSIBILITIES AREAs' OF CONCERN:' ,Code compliance: As the permit holder forth is project YOll are responsible for resolving any fai lun:!-t.() meet code requirements that may be brought to your attention through inspections, . ','rJ,: ,.:' t f' . i Liability and insunmc,c: Contact your insurance agentto see if you have adequate insurance coverage for accidemsa!1(lo?1i~?iRl)s ?~ch as fa!lingto,ol.s"raj!:t>o';:\",r;spray,"water~damage from pipe punctures" or,work rhat must be ;. 1'~ ' ~ ...:. 1" . _' :6. ., (-,: . , . Time t~'~~pcrvise empl~lyce~: ~faKe sure you have I , . . f j" ." ':; 1- time to supervIse )'om empl~):yees. - ':~';-"-' 1, ,',' Exp~rtise:Make sure you ha,-:e the expertiss: to act as y~)ur own general contractor, to coord inate the work of rough- in and finish trades, and to'I)'Otify huildi.ng offiCiaikatthe ftpprcip'ri~te times so theY,canpt'rforri1 f~ereqllired inspedions. ., -;," {.. - . \.J /t -' \:L" ~~ -:; ~.- :' J'.)~. ... :, If you have additional questions, write or call the Construction (::ontractors Board (PO Box 141,40; Salem;Qf{. 97309-5052, 503/378-4,62:n:, 'r1~ Boare! is!.o~ated at_ ~9q~llmr!~er. St. Suite 300, in Salem.. ' " ~.......' ".. '_.; If , I prop-own.pm4 1194 . ~ " ., - ,i .~ \' ~".