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Home My WebLink AboutPermit Electrical 2008-1-18 , t' Ii ~ .,"'; ~""; .~'" ~ k' + ,,~, . . "" , -.;~' :~ !t~J.:.r~ic9f:~~J?~gJ~I?~ '~IWG<g~~;',:",L ! __ OJp. ~ 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PIWNITOe..LJc;tATION City Job Number l \,b..-f }{ 1 ) ~ \ Date ~evr~Q'~~m~. 3, LE\1Y(~i~TIif\'?J (j)QlJ4 w--- JOB DESCRIPTlOt _ 1000 sq. ft. or less fl erx: ~n)\ 0~ ~n() fir, ~:~~~o:d:~~:~l 500 sq. ft. or Permits are non-transferable and expire i;w:r: "'\ Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder ~ ~:::::qi!t~-i'~!:l!:~~QlYl'~:~,:~Q B. 200 Amps or less Ele\ 20 I Amps 10 400 Amps Addres\\ 40 I Amps to 600 Amps 60 I Amps 10 1000 Amps City Over 1000 AmpsNolts '" RecoDDectCblly , Supervisor Licens~N .,_,)i'imnq;,*r*'WJThhtw;iM'tp~H'~:Y;Z)q'rfu~~"'m:f'1'1\FfrCjfuP"&{1ii4hGiVjj~~[fy.0:0':'t'1I1W%#:i;0lf;- "'2'1:iI A. '~~!",J!e~lderlltt~Wt~g!~!~J1J!1La-",dY,l!~.2:!!!,nl,!g\\I.,!,t;)~'41 Service Included $117.00 $ 21.00 $55.00 L $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 . '10.00 Expiration Date c. . Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 $ 55.00 $ 76.00 $110.00 ~::;yeJ}~-/J/~d-' . ^ NO'rICE: . {' THIS PERMIT SHAll EXPIRE IF THE WORK Inspection.w.1HQBI4GRJlhi~ER THIS PERMIT IS NOT Ctl'1~tlVJtNCt'(:j OR IS ABANDONED FOR ANY 180 DAY PERIOD. 'New Alteration or Extension Per Panel One Circuil . .. ~fHl'OO Eac~Iilllti10dft9@1W\m'V r"~lJ.lIGS ,OII. , . -"~n~~.[\ ,\\MJ' \\ 1\\ \l)\~j~...';..~;;;:~i.:.~..~ii:~:~I',ellilt&t!t:...~ ~~~1~\~~r~2:;i:;~~~~~"~'''' OWNER ~TALLA}ION Limited EnergylResidential $ 28.00 The installation is being made on property I own which Limited Energy/Commercial $ 50.00 is not intended for sale, lease or rent. :nimum Electric Permit Inspection Fee is $50.00 + sUf)O~oL? ~~() UU r :~U fA.ao 12% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)lBuilding FonnsIElectrical Permit Application l-QS.dOc ., . , -. . . . . . . . . " .' ... ." Construction Contractors Board 700 Summer St NE Suite 300 PO Box'14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: /~ ~ -{('O~ \, . Address: ,--, 0~ Q L) I \ \ CL. LUtcv I;sued bA I ~ i Date: f -Ct.PJ -D?) Statement: Information Notice to. Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed 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 licensing 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: ~L o 2. I own, reside in, or will reside in the completed structure. . I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR . -e\e0mcecL M3B. I will be my own l!@ll.erRI contractor. ~ If! hire subcontractors, I will hire only subcontractors licensed with the Co~struction Contractors Board. Ifl change my mind and hire a general contractor, I will contract with a contractor who is licensed 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. ~ f(~!J. V~"2--- (Signature of permit applicant) (?(- 17- CJ'51 (Date) (White copy to issuing agency permit file, pink copy to applicant) Property_owner.doc 06-01-04 , ,.. - - A~ting :~s;Yo.itt~Owu General Contractor? '- \ \ ~ \ i " _ I I ~ j . \ ;- "- ~;'. \" - .' . -" ~ - _ J. J J -' - -INFORMATION NOTICE TO PROPERTY OWNERS ;~".J- ,-:-i J'- \ ABOUT CO~S:r:Rl!CTION RESPONSIBILITIES .\i ... . . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. .. If you are acting as your own contractor to construct a ncw ho~e or make a stibsumtial improvement 10 an existing structure, you can prevent many problems by being 'aware of.the following responsibilities and concerns. Employer Respo~sibilities . . Vou will, in mpst il)~tances, be ruled to be,an ".employer:'.and the;contractors you contract with will be "employees" if you use contractors not licensed with the Conspuction C;ontractors Boa~d to do labor.in constructing or to assist in the construction or improvemen~ of a ~esi4ential structure. As the employer, you must comply with the following: 4 .',' .,' .. .'..' ,. -, .' \~.r ..... ." ~".'.':" . . '. _ .' -. ,. Oregon's Withholding Tax Law: As an employer, y6i.lmtist withhold income taxes froin 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, cailthe Dbpartnient of Revenue at 50f378-4988.' '. . . .. . Unemployment Insurance Tax:As an employer, you'are required to pay a tax for unemployment insurance purposes. on Ihe wages of all employees. For more ,information, call the Oregon Employment Department at 503-947-1488. --- , . . ','. -..~ _ .~. I. ,~ r ;::"11 ' The Oregon Business. Identification Number (BIN) is a combined number for .bot1?- . Qt:l;gorr. Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.doLstate.or.uslformsnav.htmll for the appropriate forms. _" ... .;: Workers' 'Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, , and must obtajn workers' ~ompensation insurance for your employees, If you fail to obtain workers' compensation insurance, you could be' subject to penalties and be liable for' all claim costs if ori~ o{your eniployees is injured on the job. For more information, call the Workers' Compensation Divisf6n at the Department of Consumer arid Business Services at 503-947-7815. J' -.", , .-~../" - -~) I . f "i '7 . I,,' - ,_ U.S. Internal Revenne Service: As an employer, you must withhold "federalirrci:ime--Iax from 'employees' wages. Vou will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call th~\ IRS at 1:800.829-493-3 or visit-their web site at www)rs,Qov'. ' , f'" . ..i ".'" . ::'; .; _.~ i ~ .. . : Other Responsibilities aIDLd Areas of Cc"ncerlls .,' '- . .....'. Code Compliance: As the pcrmit holder for this project, you are responsible for resol'viiigany'f~il~re t6 meet code requirements thaI may be brought to your attention through insp~ctions, . " . \ Liability and Property Damage InslIrance: : Contact your iiisilrance agent to see if you have adequate insurance' coverage for accidents and omissions such as fal1ing tools, paint over spray, water damage from pipe punctures, fire or work that must be,redone. " -' ~ \\ ..... .."" .. , ? Time: Make sure you have sufficient time to supervise your employees. .Expertise: Make sure you have tii~ skills to act as your' own 'gb~eral c~ntractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate limes so they can perform the required inspeclions. If you have additional questionscall the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140,Salem, OR 97309-5052. Property_owner. doc 06-01-04 225 )Fiftli Street Sp~ingfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00081 COM2008-00081 COM2008-00081 COM2008-00081 Payments: Type of Payment Cred itCard cReceintl RECEIPT #: Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee . + 12% State Surcharge + 10% Administrative Fee Paid By KENNETH WEDMORE City of Springfield Official Receipt Development Services Department Public Works Department '2200800000000000073 Date: 01/18/2008 Item Total: Check Number Authorization Received By Batch Number Number How Received IIh 562522 562522 In Person , Payment Total: ) Page 1 of 1 2:58:27PM Amount Due 70.00 3.50 840 7.00 $88.90 Amount Paid . $88.90 $88.90 II] 8/2008