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Home My WebLink AboutPermit Electrical 1998-3-2 c'4' ~ \ " M'-' approv . ~ f0't- Z~ UV ~~~ ~a ~o"\ Oaie~ (( . ~~~ {< ~~ ,COO~ Authorized Sl9nmure IJ. k.A ~'P '6 ~<() ~\) <( 225 FIFTH STREET .-.L. . -. ,b..\'\' - <I(,~ .n~ ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 9747~*\\\J # ":>' ~~""\" ~~~'" q , / '1 oS ,INSPECTION REQUEST: 7~\1j~~~ d,~\) \:S R-- 'CO 'f. ei ty Job Number7"L- , OFFIeE: 726-3759 "\~ o~ ('~\)a ~O\), . ...\.y..~ ~\J~ ~~~ 3. eOMPLETE FEE SeHEDULE BELOV 1. LoeATION OF INSTALLATI~ o~~~ 'Otf Z 4(:,5 Cn422A\.... D(l.CJ.\ \~~ ' A. , ~~, / ~~tlffF{rf~~\o D 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 JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if .work is suspended for 180 days. CONTRACTOR INSTALLATION ONLY iical eontractor / / eity Phone Supervisor Expiration Date ,'" '" e. eonstr eontr. of Supervising Electricl Owners Name ~Asok) B\.lSH Address 2 L\bS CoiL{L)\L {)t2... eity ~ pr:Lf:) Phone { li G,- 91 C} 3. OVNER INSTALLATION D. The installation is being made on property I own which is not intended for sale, lease or rent. E. Ow. ;;;;ature~~ . - E~-----j~~Jfq-~=:~-~------------- RECEIPT ~:. ().J" ~~~ 1 . ' REeElVED BY: Y!. - JlVC VV---- ' , 5. SP.FIELD / New Residential-Sfngle or Multi-Family per dwelling unit. Service Included: Items Sum eost 1000 sq.ft. or less Each additional 500 sq. ft or poition thereof Each Manuf'd Home, or Modular Dwelling Service or Feeder , $ 85.00 $ 15.00 $40.00 $ 50.0050.00 $ 60.,00 $100.00 $130.00 $300.00 $ 40.00 Temporary Services or Feeders Installation, Alteration or, Relocation 200 amps' 'OT less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 vQlts see "B" above Branch eircuits . , ,. New, Alteration or Extension Per Panel One eircuit Each Additional eircuit or with Service or Feeder Permit ~ $ 35.00 $ 2.00 lit? ,0 0 Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/eomm not included) SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 $ 40.00 $ 20.00 $ 36.00 (O~ -00 - .-/- - -/j.L'f . ...../ --- I , , J~ . . Permit #: 0/7 /2 OS Address: ;) l/ (p~ C o(r~ Issued by: X - /1M a:-- Dat~t:J--h r 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 ORS701.010(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 orJB: . , ~ I I ~ 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. ,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 ~ 3B. I will be my own general contractor. If I 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 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 P perty Owners about Constru ion Responsibilities on the reverse side of this form. 3/Z.Jq ~ (Signature of permit applicant) , I (D~te) (White copy to issuing agency permit file, pink copy to applicant) ~/ \ "...-/ . . n[(iJ~(Q)rrmca1tt~oU1l ~ott~c~ tt<Ol I?rrOlPeG11f OWU1leIT'S AlQ),<OllIJitt CC<Ol[(iJ~ttrr(]J)lCtt~(Q)[(iJ ~~~ IPOU1l~ U [b;u ~ utt~~!S) I ~ .' 0" - Note: This l1?formatioll Notice to Property Owners about Construction Re.\ponsibilities " , was developed by the Construction Contractors 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. IEITilllPlOYIE~ RlESPONS~B~Ul~ES: If you hire persons not registered with the Construction Contractors Board t~ 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 comply with the following: OJregon'swWnfi1ohllinng ~ax law: Asan employer, you mustwithhold income taxes from employee wages atthetimeemployees are paid. You will be I iable for the tax payment~ even if you don't actually withhold the tax from your employees. For more infornlation, call the Oregon Dep1. of Revenue at 945-8091. , lUll1lempRoymeud innsuJrall1lce 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.. WOJrkers' comlPell1lsatnonn nlllisvuannce: As an employer, you are subject to the Oregon Wprkers' Compensation Law, and must ,. , obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation 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' C0l11pensation Division 'at the Department ofConshmer and BUSiness Sel'vices at 945:. 7888.. " . UJ.S"llll1lte~mlln RevenHlle Sea-vnce: As an employer, you must withhold federal income tax from employees' wages. Y Oll will be liable forthe tax payment even if you didn't actually withhold the tax. FOI' more information, call the Interllal Revenue Service at 1-800~829-1 040. OTHER IRIESPOU\ES~B~UT~ES AND AREAS Of CONCERN: Code wmlPnn~llllce: As the permit holder forthis project, you are responsible for resolving any fai lureto meet code requirements that may be brought to your attention through inspections. ILnabiBity 2lll1ld pJrOpen"ty dlamage insaJIn'alllice: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, pa,int overspray,water damage.from pipe punctures, fire, or work that must be re-done, . Time to supeJrVnse employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate 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.que~tions, write or call the Construction Contractors Bq,ard (PO Box 14140, S~lem, OR 97309-5052, 503/378-4621), l'he Board, i~ iocated at 700 Summer S1. NE Suite 300, in Salem, ~' , , ':' ': " :': :. prop-own,pm4 1/94