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HomeMy WebLinkAboutPermit Electrical 1994-12-7 , . . , .' . .' SPRINGFIELD Tho followIng project c.s ~ubmttted. ryas tho zoning. and does not requiro SpeCIfiC land approve!. 225 FIITIl STREET SPRINGFIELD, O'REGO'N 97477 INSPECTIO'N REQUEST: 726-3768m O'FFICE: 726-3759 9 Zonlno AUlholiIcd Signaturo ~ 1. LO'CATIO'N O'F INSTALLATI~ h? / ~G!:>..w-~ L;P.? A. LEGAL DESCRIPTION 17..." '?-/~-.::::'>o::::=>_ ~~ '5""~ /' , ELECTRICAL PERMIT APPLICATIO'N City Job Number r9Mr~~E FEE ~~HEDULE BELO'V "7 '7"'/~ Ney Residential-Single or Multi-Family per dyelling unit. Service Included: JOB DESCRIPTION /_ 10'0'0' sq.ft. or less E/,-:zr. ~~e;.-rr-~~""'<.:2/Each additional 50'0' .. . " sq. ft or portion Permits are non-transferable and expire thereof if york is not started 'Yithin 180' days Each Manuf'd Home or of issuance or if. york is suspenaed for Modular Dyelling 180' days. Service or Feeder 2..- CO'NTRACTOR INSTALLATIO'N O'NLY Electrical Contractor ..&~1"""G"~ Address City Phone Supervisor License Number Expiration Date B. Services or Feeders Installation, Alterations or Relocation: 20'0' amps or less 20'1 amps to 40'0' amps 40'1 amps to 60'0' amps 60'1 amps to 10'0'0' amps O'ver 10'0'0' amps/volts Reconnect Only It ems Cos t Sum $ 85.0'0' $ 15.0'0' $ 40'.0'0' $ 50'.0'0' $ 60'.0'0' $10'0'.0'0' $130'.0'0' $30'0'.0'0' $ 40'.0'0' C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number Expiration Date Signature of Supervising Electrician . , / D. Oyners Nam~?;>-~e:~/~/~ Address ~~df!;' , Ci ty -?~~~hone? V/~ /~ . ~)~ . O'YNER INStALLATIO'N The installation is being made on property I oyn yhich is not intended for sale, lease or rent. . D\tllers Signa mr . , ,1 '" , --~ ~---------------------- DATE: (/~-"7 '''''7CT' . RECF.II'T 'j,: /~ 4' RECEIVED !JY: //jf~__ 20'0' amps or less 20'1 amps to 40'0' amps Dver 40'1 to 60'0' amps Over 60'0' amps or 10'0'0' volts Branch Circuits $ 40'.0'0'. $ 55.0'0 .' $ 80'.0'0' see "BIt above Ney, Alteration or Extension Per Panel Dne Circuit ~35.DD ~ Each Additional Circuit or yith Service or Feeder Permit $ 2.0'0' Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTDTAL DF ABDVE 5% State Surcharge 3% Administrative Fee TDTAL not included) $ 40'.0'0' $ 40'.0'0' $ 20'.0'0' $ 36.0'0' ....>>';,- I. /"1.... /,eP~ ~ '"2 tZe> .... . / , . Permit #: . ~y/~ tb 3'/' ~~.PF/A'-<- 2>? ~ Address: IssuedbY:,~~ Date: /2-::>~"5'Y / 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 I and 2, and either box 3A or 3B: ~ D 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 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 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 ab t Construction Responsibilities on the reverse side of this form. I )-7-7Y- (Date) (White copy to issuing agency permit file, pink copy to applicant) '''. . . " , . . JlnformationNotice to Property Owners About Construction Responsibilities ," . - -~.... - . ~ '- ~~.: Note: This Information Notice to Property OWMrs aboUl Construction Responsibilities ~.. . -., .. . , ....... . . 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 ilfeas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with 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 comply with the following: Oregon's withholdhig 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 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 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 Business 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 permit 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 property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, o~ work that must be re-done. Time to supervise 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 questions, write or call the Construction Contractors' Board (PO ~ox i 41~0: Salem, OR'97309-5052. 503/378-4621). The Board is located at 700 Summer SI. NE Suite 300, in Salem. ,...'. prop-own.pm4 1/94