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Home My WebLink AboutPermit Electrical 1997-10-3 ..J,J"; < ' ' " . SPRIFIELD DEVELOPMENT SERVICES DEPARfM~"lrJwinc; >-.,ojcot us '"be1':""; i' ~:. ;" , ZO;)!I~g. an-:'; ~OGS not 06qt;;,".;i t.L~.;.:...~; ....:. .: <:i;:l;:.rov-ai. .' . Zo,nie" L-- c9- V D[~, lQ- 3;q2 AM 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 ELECTRICAL PERMIT APPLICATION 225 FIPTH STREET 'SPRINGFIELD,' OREGON 97477 INSPECfION REQUEST: 726-37-69:00rizod :;;9<10tU'3 OFFICE: 726-3759 1. LOCATION OF INSTAL~ON G 70f ~6_ ,Of sr: LEGAL DESCRIPTION /7/9 2...- ~ /.., 11) <9 3 ~ /"7D JOB DESCRIPTION ( LU I R\ -'J ~ -('t>J I C1 (?,JIlfl.. 10 -> f Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. '.' 2. CONTRACfOR INSTALLATION ONLY Electrical Contractor Address f i\-\e440P.~ City \~C1'\Ct.~ Ph~"ll"j.?IP.~\ ~IS~Oi Supervisor Li{~'Dff~~~~~P. i\'\I~~~\'.\~O fO? hlli\'\O?\ oP. IS p.""h- Expiration Danr~lr.~O _,', CUtl\"'- ,'\jI'i I'fl""'" Constr Contr. ~~e~ Expiration Date Signature of Supervising Electrician Owners Name ~o>~}J 134-' .( ~ ~ ---..J Address.0/ Of Se I c(1li. S'"\: Ci ty ~R\~E\\& Phone 7~6 - 3<'6'0 <J OVNER IN~LATION The installation is being made on property I own which is not intended for sale, lease or rent. II signat~ ~ ~b~)~ DATE~-===~-~/?i--j;;-~ -jr--------- RECEIPT 11:_ ( 0 '27e:; 1!J '7' RECEIVED BY: /"1'7 )N7 "'L-, vr W-. I City Job Number q 7 I ~t, 7J 3. COMPLETE FEE SCHEDULE BELOY A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only ~ $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 ~t).(j-O C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 $ 55.00 $ 80.00 see "Btt above D. Branch Circuits New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit ~ $ $ 35.00 ~ 2.00 ~ Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightin~ Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 ~-;~ SB,u.e ~. 2-,5'1" ~::-;~ ----"74:-~ . b2- .(,Ft ~ ,;,";"} ,-;;... . Issued by: . '97If~o fb75 ,f. 79lh S/' Date: /Vyf7 Permit #: Address: Statement: Information Notice to Property Owners About Construction Responsibilities 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 building permit 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 in the appropriate blanks and initial boxes I and 2, and either,box 3A or 3B: gl E1 I, I own, reside in, or will reside in the completed structure, 2, I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, D 3A. My general contractor 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 ,Bf 3B, I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If! change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit ofthe 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 Constru?\ion .ResponsibiIities on the reverse side of this form. r: 0.0 ~dJ) ~il /"'/3 ~::> - v (Srgrlature of permit awi[? (I5ate)f" (White copy to issuing agency permit file, pink copy to applicant) ,.. .,.... ,. . ,~. ..." nniormato6n Notice to Property Owne~s ,About COi'J~trudioi'l RespoIT'isHo1~ities , , Note: This InjiJrmatio/l'Notjee to.Property Owners ahout Constmerion Responsibilities , was developed by the 'CoiTslrii'etion' Contractors Board in accordance with ORS' 70I,055(5}, ':" 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 by being aware of the following responsibilities and areas of concern, EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Constmction Contractors Board to do labor in constructing or assisting in thc construction or improvement of'a residential structure, you will. in most instances, be ruled to be an employer and the people you hire will be employecs, As thc cmployer, you must comply with the following: Oregon'switbholding tax law: As an employer, you must withhold income taxes from employee wages atthetimcemployees are paid, You will be liable for the tax payments even if you dOli't actually withhold the tax from your employees, For more information, call the Oregon Oepl. of Revenue at 945-8091, Unemployment insurance tax: As an employer, you 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 378-3524, Workers' compensation insurance: As an cmployer, you are subject to the Oregon Workers' Compensation Law, and musL obtain workers' compensation insurance for YOUI' employees, I fyou fail to obtain workers' compcnsation insurance, you may be subjectto penalties and will be liable for all claim costs if one of your employees is injured on the job, For more information. call the Workers' Compensation Division at the Department of Consumer and Business Services at,945-7888, 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 actua Ily withhold the tax, For more in formation, call the I nternal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the perm it holder for th is project. you are responsible for resolving any fai lureto meet code requirements that may be brought to your attention through inspections, Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage,for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. fire, or work that must be re-done, Time to supervise employees: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the expertise toact as your own general contractor, to coord inate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, If you have additional questions. write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052. 503/378,4621), The Board is located at 700 Summcr SI. NE Suite 300, in Salem, prop-own.pm4 1/94