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Home My WebLink AboutPermit Electrical 1993-5-20 'f1.."I.,!!"",;..." l-......,\<\d r'~ rd:m::i'::r':,tE'.G tho tolk ... ' ~w~..:; nCt. i ..:...,~ ...:;~'O c~: ".;\:::t;iC ~(A~ld use L' -. . 225 FIFTH STREET C'~ '';is.;;.;., LV \2. ELECTRICAL PERKIT APPLICATION SPRINGFIELD, OREGON 97477 . ZOi1iri{1. . INSPECTION J.;lliOUEST: (7.26-37.~~)~/'2--o(~1 City Job Number4()O.7V D OFFICE: 72'6-3759 .---'~,," Cfr:- '. Authorized SJil=tlature _3_._COHP-I.E+E-F-BE-SCBEDULE BELOV LOCA!t9~ f_OF I~. ~~~';^J\J1TIV\.~/NIl( 11,\ V I ')~W rVV\~ r t rl A. New Residential-Single or Multi-Family per dwelling unit. Service Included: 1)1. '" LEGAL DESCRIPTION .,/7 0:3 2-5 =7':::> - 07 So c) ~ JOB DESCRIPTION .3J 8... !1e::;eV/CE c:.I-IA~~ 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. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phon'e Supervisor License Number Expiration Date " Constr ContI'. Number .' , ..-.... Expiration Date Signature of Supervising Electrician Owners Name '?afn'-'c teL. " \ tJYl eS Address 1~{P(p C evr!--e h VI. ~aJ 154d Ci ty >f-ftdl Phone 72); ~ I L/q {,-, OVNER INSTALLATION The installation is beirtg made on property i own which is not intended for sale, lease or rent. Owners Signature: \:::> rX~ f\. ~~.D . ---~-----------~----~---------------- DATE:,__ .. ?-;zP -13 t.t.l.JU 1'J: .: Y5 7 ~ZJ RECEIVED BY:" / / IU... " L-/ ~ /""") - () ~ G 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 I 201 amps to 400 amps 401 amps to 600 amps . 601 amps to 1000 amps Over 1000 amps/volts Reconnec t Only # $ 50.00 Sb.~' $ 60.00 $100.00 $130.00 $300.00 $ 40.00 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 D. Branch Circuits $ .40.00 $ 55.00 $ 80.00 see "B" above New, Alteration or Extension Per Panel One Circuit . Each Additional . Circuit or with Service or Feeder Permit E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm 5. SUBTOTAL OF ABOVE 5% State Surcharge TOTAL $ 35.00 $ .2.00 . not included) $ $ $ $ ~.~ /),59 ~S~.S9 40.00 40.00 20.00 36.00 Permit No: 9~ftSlO r - 13~ c;, r'c- NT"e;..IN,-h '--' 6/~~ Date: $~:;1fJ.- Z3 () FOR OFFICE USE ONLY Address: Issued by: STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: \ ~ 1.,'K.. 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. 3. A.I I My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3. 8.1 I I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~~ -A_ ~Q[) Signature of Permit ~Iicant 5-- dO -q3 Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COpy TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ,- INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ~... ' NOTE: , Thi,sii1farmaiian Natic~ ta ~roperty Owners Abaut Canstructian Responsibilities was develape9,by the Can,struction Cantractars Baard in accardance with ORS 70:1 ~055(5), passedby,-the 1989 Oregon Legislature. '~'''L . .' '- \' .,$" . ~.... . I. . . -. If' you are acting as yaur aW,n' cbntractor to canstruct a new hame .or make a substantial.improve.ment ta an existing structure, yau can prevent ~any prablems by being aware .of the fallawing respansibiliti~s and areas afcancern. ' ' . , ' . .. -.. . EMPLOYER RESPONSIBILITIES: .,' If yau hire persans nat registered with the Canstructian Cantractars Baard. ta dalabar in canstructing .or assisting in the canstructian' or'impravement .of a residential stru,cture, yau will,in mast instances, be ruled ta be an "emplayer" c=fnp the peaple yau hire will be "employe~s':. As the ~{11player" yqu must cam'p'ly with the fallawing: I.~ '. .. . .... . I '. ..,... ~ .. , ' . .- . \ . " . Oregan's Withhalding lei)( LalJ)/: ,A$'an employe'r; yau must withhol,d 'in'come tc~.xes from emp)ayee wages at the time emplayees are paid. Yau will be liable far,the tax payments, even if yau dan't actually withhald the tax fram yaur. emplayees. For mare infarmatian, call the Oregan Department .of ~evenue ,at 378-3390. '. ; . I. ~<t'. Unemplayment Insurance Tax: As an emplayer, yau are required ta pay a tax far unemplaym?nt insurance purpases an the wages .of all; emplayees.,: Far:more infarmation, calUhe Oregan ,Emplaymen.t Divisian DHR at 378-3224, . ' . '~ 4 Warkers' Campensatian Insurance: As an emplayer, yap are subject ta the Oregan Warkers' Campensatian Law, and must .obtain warkers' campensatian insurance far yaur emplayees. If yau fail !a .obtain warkers' campensatian insurance,'yau.may be subject ta penalties and will be'liable for allcla'imcasts if .one .of yaur emplayees is injured an the jab. For mare infarmatian, call the Warkers' Campensatian Divisian DIF at 373-7434. . . ~ 'I.... . . I U.S. Internal Reve.nue Se.rvice:As an.emp'ayer, ya.l! must withhqld feder~1 incame t?X fromemplayees' wages. Yau will be liable for the tax payment 'even if you didn't actu?lly withhald the tax. :Fo~ mare infarmatian, call the Internal Revenue Service 'at 221-3960. ' ' .. OTHER RESPONSIBILITIES AND AREAS OF CONCERN): ':, . I ~ ';. Cade Camp,lia'nce: As the permit halderfar this praject, yau' are respar:lsibl~, for resolving any failure ta meet cade requirements that, may be .broughHa yaur attentian thraugh inspectians. .- . Liability and Property Damage Insurance:, Cahtact your insuraMceagent ta see if yau have adequate insurance caverage far accidents and amissians such as falli,l}g taals, pa.int averspray, water damage from pipe punc- tures, fire, .or wark that must be re-dane, .~ ' . Time to Supervise Emplayees: Make sure yau have sufficient time ta ,supervise yaur. emplayees. Expertise: Make sure you have the expertise ta act asyaur awn general cantractar, ta caardinate the wark .of rough-in and. finish trades, and ta natify building .officials at the appropriate times sa they can perfarm the required inspectians. If yau have additianal questians, write ta: Canstructian Cantractars Baard 700 Summer St. NE, Suite 300 , Salem, OR 97310-0151 Phane 503-378-4621 -' "0244.1"10/24/89 . '. .. . . ,'~' . ~.. l -;/' ~ r '. _ -~..: ^'" ' . : -".. -... ~ .' . -- '-:'_$~ 1 .',1, -;