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Home My WebLink AboutPermit Electrical 1996-1-26 ,> . . The iollow!ng protect Bfl eu.bmttted ,t-r:.s the follr:wl zoning, and does nOt reqll1re speclHc !5l.nd U;";9 appro.3/., ,f)rc Zcmnc ~ c; I _ ELECTRICAL PERMIT APPLICATION 9747fJata \. - d-.ln - lJO 726A~€~zedSlgnature ,C'f City ',lob Number -9'60//Y 3. COKPLETE FEE SCHEDULE BELOV 225 FlITH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 1. LOCATION OF INSTALLATION /'i"l C/.). G.M.I....'''1/'''~( LEGAL DESCRIPTION 11'-/J':?>-27. yy ~9~ , / JOB DESCRIPT~ ~~C':-'-:'Y-~/~~~-=-':: 'i:)' "1 /C~..c.v/r, ' Permits are nOIT-frans~efable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2, CONTRACTOR INSTALLATION ONLY Electrical contractor~~~' Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date ~ Signature of Supervising Electrician- Ovners Namefia..IJ,d /I. 1l.o.Lt'lPl,t Address ILjI.f. W. Cex..Je...,"'fp/:;" 't , Ci ty 'fcf Phone 7'112- 7 ~ K The installation is being made on property I ovn vhich is not intended for sale, lease or ren t. Ovners Signature: ~fCDe-~ ----------~----------------~---------- DATE:_ 1-26 .q?-. RECEIPT #: :2 d/' I '9 "2 ..........,..........-..,T........... nv_ """""'-.A6""':':'- ........ A. Nev Residential-Single or Multi-Family per dvelling unit. Service Included: Items Cost Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Kodular 'Dvelling Service or Feeder $ 85.00 $ 15.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less I $ 50.00 ~CJ,(:JO 201 amps to 400 amps $ 60.00 401 amps to 600 amps $100.00 601 ,amps to 1000 amps $130.00 Over 1000 amps/volts $300.00 Reconnect Only $ 40.00 C, Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or 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 Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Addi tional Circuit or vith Service or Feeder Permit / $ 2.00 1..06 E. Miscellaneous (Service/feeder -Each installation' Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm no t included) _ 5, SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAl. $ $ $ $ 52.~ :z.~O /,~ L;'':;. /(b 40.00 40.00 20.00 36.00 :.,4 . . ,. Permit #: ?L6/~ Address: __/~~ / ~/r,;;-k'-fr/:te'L ISSUedbY:~ Date: /-~~~ 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 1 and 2, and either box 3A or 3B: [2J o 1. 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 i< (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 ~ 3B, 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 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 of the 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 Construction Responsibilities on the reverse side of this form. CD.. .. {) /(;J e- ~. -€f ___ (Signature of permit ap~ant) /-2-.6 - 1(;" (Date) (White copy to issuing agency permit file, pink copy to applicant) ,~ . . .. .....:... .~- ~ "'\:'. ... ....., . .. Information Notice'to'Property Owners .Ab!)!J~ Cons~r,uction .Responsibilities -'. . -,"'" .\, '. " ' .~ ..."-.....,:... ... - ......-. ----;--.. ':N.ote: This /nformatiOf! fl!.:otir;,f!. ~;J'~roperty Owners about Construction Responsibilities was developed by the 'Coilsi';:iic7io,;'Gontractors Board in accordance with ORS 701.055(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 w\th the Construction Contractors Board to do labor in constructing or assisting in the 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 employees, As the employer, you must com~ly with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the 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 Oregon Dept. 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 Division at the Department of Human Resources at 378.3524, " Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and ~ust obtain workers' compensation insurance for your employees. If you fail to obtain workers' ~ompensation insurance, you may be subject to penalties and wilfbe 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 Busin~ss 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 actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the perinit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections, ',' Liability and propeJ;ty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents,and omissions such as fall,ing 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: Makesure you have the expertise. to aetas yotirown general conttac:to'r, to coordinate the work of rough. in and fi~ish trades, and to notify building officials at the appropriate times so they can perform the requirep inspections. ~, ~ . -'" ,". '. - . - ,."',\". ~-........ \\;--, "', ;--,........, If you have:addltlOnal'questlOns, wnte or call the ConstructIOn Contra7tots Board (PO Box l4140. Salem; OR:9730'!:-5052, 503/378-4621), The Board is located at 700 Summer Sl. NE Suite 300: in Salem. prop-own.pm4 1/94 . BUILDING DIVISION JOB# 9.14 -LEGAL- LOT BLOCK FI N AL' ~ -ADDRESS- 144 W CENTENNIAL BLVD DESCR:SERVICE/CIRCUIT 1703274406900 -VALUE- . 0 960126 / 96020'6 -OWNER- DAVID DELONG 744-2738 144 W CENTENNIAL BLVD SPRINGFIELD, OR 97477 -ENERGY- HEAT1- H20~ RANGE- INSULATION PATH- -STATS- BLDG ZONE STORIES FLOODPLAIN BEDRM OCC GRP UNITS SQ FEET CONST TYPE -CONTRACTORS- GENL- CONTRACTOR PHONE- PLMB- ELECT-OWNER MECH- DESGN- 2- -INFO- NE\, RESIDENTIAL 1111 QUAD AREA 1RNW .' SEQ-REQUIRED PERMITS----------------FEE--SURCHARGE--DATE--RECPT--CAT-------VALUE 001-004-ELECTRICAL 52.00 2.60 960126 20192 500 o SEQ-MINIMUM INSPECTIONS + REQUIREMENTS--------------------EXP DATE---ACT DATE- 001-042-ROUGH ELECTRIC 002-044-ELECTRIC SERVICE 003-049-FINAL ELECTRICAL 960206 960206 960206 SEQ--INSPECTIONS---------COMMENTS-------------------__-------DATE---RSLT--INSP 001-042-ROUGH ELECTRIC C/N FOR FINAL 002-044-ELECTRIC SERVICE SUB-CALLED 003-044-ELECTRIC SERVICE 004-042-ROUGH ELECTRIC 005-044-ELECTRIC SERVICE 006-049-FINAL ELECTRICAL 960129 POK 61 960129 POK 61 960201 NOTOK 61 960206 OK 61 960206 OK 64 960206 OK 61