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Home My WebLink AboutPermit Electrical 1991-7-5 ~ 225 FIITH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 97477 726-3769 1. LOCATION.QF INSTALLATION r2(o fi .3 CPA'. -Iex1 n dl ( I3/V"/ I LEGAL DESCRIPTION /70 <., 2-5 44- Sf'ld A. a:J5tJ4 cay Job Number 3. COMPLETE FEE SCHEDULE BELOV 9/()25"2- New Resident1al-Single or Multi-Fam1ly per dwell1ng un1t. SerV1ce Included' Items Cost JOB DES};RIPTION , , 1000 sq. ft. or less ChIJM4'" f-IIiM,<J[ t add NJ/Y'Il~'0 L'1!2euJ.Each addlt10nal 500 J U sq. ft or port1on Perm1ts are non-transferable and exp're thereof if work 1S not started w1th1n 180 days Each Manuf'd Home or of 1ssuance or 1f work 1S suspended for Modular Dwelling 180 days. SerV1ce or Feeder 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address C1ty Phone SuperV1sor L1cense Number Exp1rat1on Date Constr Contr. Number Expuatlon Date Slgnature of Supervising Electrician Owners Name Address C1ty Phone OVNER INSTALLATION The 1nstallation 1S being made on property I own Wh1Ch 1S not 1ntended for sale, lease or rent. Owners Sign1're: r 7 ~/lkzxL4t-aJ/LHu ---------~f-----------11-------------- DATE: U 7/5"/'/ r RECEIPT II: 2;{':::;JI>~ RECEIVED BY: A'/~ ~ B. Serv1ces or Feeders Installat1on, Alterat10ns 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 Sum $ 85.00 $ 15.00 $ 40.00 $ 50 00 5.tJ,<'o $ 60 00 $100.00 $130 00 $300.00 $ 40.00 C. Temporary Serv1ces or Feeders Installat1on, Alteration or Relocat1on 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 Extens10n Per Panel One CUCU1 t Each Add, tlonal C1rcu1t or w1th Serv1ce or Feeder Perm1t ~ $ 35 00 $ 2_.00 ~ E. M1scellaneous (Service/feeder not 1ncluded) -Each 1nstallat1on Pump or 1rr1gat1on $ 40.00 Slgn/Outl1ne L1ght1ng $ 40 00 L1m1ted Energy/Res $ 20.00 L1m1ted Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE ~ ~ ,~ 5% State Surcharge - 2_9'() TOTAL /-..1'/ ,90 . - Permit No 7/ D 2. 5" 2- Address 2(~ 53 ez,~A.)o+-t' Issued by ~ Date -?'/~/ FOR OFFICE USE ONLY STATEMENT" INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note Oregon Law, ORS 701 055(4), requires residential bUilding permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the bUilding permit can be Issued 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 box 1 and either box 2A or 2B 1cz'b I own, reside In, or Will reside In the completed structure 2 A L-J My general contractor IS Contractor registration number I Will Instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board OR B L6-J I Will be my own general contractor , If I hire subcontractors, I Will hire only subcontractors registered with the Construction Contractors Board If I change my mind and Clo 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 ~AU J?,h/'tJd-4/r-' SlgnaturCf Permit lp~rnt CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 7-:;-11 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT "" . . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBIUTlES NOTE ~_~':: Thls':::intormatlon Notice to Property Owners About Construction Responsibilities was' developed by the Construction Contractors Board In .::.. \, '\ _-..;ac.co~dance':,wlth 0.R~I01 055(5), passed by the 1989 Oregon Legislature \. ~ \ , \..... ;, ... ,.. . \'::' ......; ,..." ',~. "':.. ....'.... ....~ It you are acting as YOUT,own cootractor 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 It you hire persons not registered With the Construction Contractors Board to do labor In constructing or ass/sting In the construction or Improvement 01 a reSidential structure, you Will, In most Instances, be ruled to be an "employer" and the people you hire Will be. "employees" As the employer, you must comply With the follOWing Oregon s Withholding Tax Law As an employer, you must Withhold If1COme taxes from employee wages at the time employees are paid You Will be liable for the tax payments even /1 you don't actually Withhold the tax lrom your employees For more Inlormallon, call the Oregon Department 01 Revenue at 378-3390 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 Informallon, c~11 the Oregon Employment DIVISion DHR at 378-3224 Workers' Comoensatlon Insurance As an employer, you are subject to the Oregon Workers' Compensa- tion Law, and must obtain workers compensation Insurance for your employees If you fail to obtain workers' compensation Insurance, you may be subject to penalties and Will be !table for all claim costs If one 01 your employees IS Injured on the Job For more information, call the Workers' Compensation DIVISion DIF at 373-7434 U S Internal Revenue ServICE? As an employer, you must wftnhold federal !I1oome tax from employees wages You will be liable for the tax payment even If you didn't actually Withhold the tax For more mforma- tlon, call the Internal Revenue Service at 221-3960 OTHER RESPONSIBILITIES AND AREAS OF CONCERN Cooe Comollance As the permit holder for thiS protect, you are responsIble for resolving any faIlure to meet code reqUirements that may be brought to your attention through inspections liabIlity and Prooertx Damape Insurance Contact your I,nsurance agent to see If you have adequate Insurance coverage tor accIdents and omiSSIons such as failing tools, pamt overspray, water damage from pipe punctures, fire, or work that must be re-done Time to SupervIse Employees Ma~e sure you halle suffiCient tIme to supervise your employees Expertise Make sure you halle the experllse to act as your own general contractor, to coordinate the work of rough-m and flmsh trades, and to notify bUlldmg offiCials at the appropriate times so they can perform the reqUIred inspections It you halle additIonal questions, write to ConstructIOn Contractors Board 100 Summer St NE, Suite 300 Salem, OR 9731(}()'151 Phone 503-378-4621 0244J 10/24189