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Home My WebLink AboutPermit Electrical 1998-6-15 . S~R.FIELD , . wning, and doee not require epecIlIc land use 'PPZ!stOVaJ. , ,iii 225 FIFTH STREET: dmdSlgrlldule (\~ ELECTRLQA1N<9~IT APPLICATION SPRINGFIELD, OREGON ':J'ffln, - :". f..,?I?''E. If \f''''' ~O\ INSPEcrION REQUEST: 726-3769 ~ i\ \\1 ?,WlI\ Sr\r>-\.\. 'C. C~~gflli\\NRJber qa () I..fLl- '3 OFFICE: 726-3759 \r\IS?C IINOt.?'\ ..."m,If'OfO?' oJ.O~'f.O eoMPLE:m..~' 'SCHEDULE BELOV 1. LOCATION OF INSTALLATION r>-\.I\ P C'f.O O?' I'::) 1""'" h:l<'ll~ I ULf ~+ /"nWlWl~. N\;'t~9i.dential-Single or /<:;'0 '0223 &/.cWl'{j)\l \)r>-Mun~-FamilY per d1Jelling uni t. LEGAL DESCRIPTION 0 ~ LJ'~ SerVlce Included: Lo1" 21 ..$,. !f-,,-/..-~ N ,r;1I.E73,~L;fJ6~ ",f/ IZO ' Items Llt7Jf; fUJ. (jREbf;Tr.J JOB DESCRIPTION ' 1000,sq.ft. or less ~ $ 85.00 taie;,/ (EAFT/1z-. _ J...I-O l-A-se: Each addi tional 500 sq. ft or portion ? ~ Permits are non-transferable and expire' thereof ~ ~ $ 15.00 if 1Jork is not started 1Jithin 180 days Each Manuf'd Home, or of issuance or if 1Jork is suspended for Modular, 'D1Jelling 180 days. Service or Feeder .-' 2. CONTRAcrOR INSTALLATION ONLY B. Services or Feeders Installation, Alterations or Relocation: Electrical Contractor Address 200 amps or less 201 amps to 400 amps 401 amps to, 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect oflly City Phone Supervisor License Number Expiration Date Cost Sum d'S. 00 i.f5.0D lJi;Jr.~ - ~ .$ 4().00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number Expiration Date , Signature of Supervising Electrician 200 amps' 'OT less . 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 100u voits 01Jners Name GG'~U~ rb"l.-I~ONJ Address, ~ C-t2..tJ~ LA! Ci ty "b-<19 ENb Phone 60 ?-b / c.f g OIINER INSTALLATION <11/"2..-1 q Cf'2.-- D. Branch Circuits Ne1J, Alteration or Extension Per Panel $ 35.00 One Circuit Each Additional Circuit or 1Jith Service or Feeder Permit $ 40.00 $ 55.00 $ 80.00 see "B" above " $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightin~ Limited Energy/Res Limited Energy/Comm The installation is being made on property I O1Jn 1Jhich is not intended for sale, lease or rent. . E. O&#A ~imre:. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL DATE: RECEIPT , , n.$,.O <.< &? RECEIVED BY: ^ . /111'\://\ ~ . $ 40.00 $ 40.00 $ 20.00 $ 36.00 L j.: 1..1::D r",,_ t30 ,OU t-f() . '-i () . . Permit #: q 't 0 Lfc.-f .s Address: ~~~R L Vf..,{".-- .~fy'~ Issued by: A. frJ.JJ;.!. Date: (~( IS (9 r . .' Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residenlial construction permit appli- cants who are nol 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 statemenl. 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: ~ ~ 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. o 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 D 38. I will be my own general contractor. IfI hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. IfI change my mind and hire a general contractor, 1 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 N"'" 'f~~~:t.:"""" R..po.,'b,""" '" .h. ....~ 'idr.'~ ';~f;~ '-' (Signature oh'ermit applicant) (Dale) (White copy to issuing agency permit file, pink copy to applicani) . . ~.\. \ . ~ j \ . \ '. nnl'o~ma~o"i1 No~iee ~o Pwpeiiy Owners Ab.ou~ Cons~ruc;~ion Responsibilities .~ , "' , , \ \ Note: This /njormatiouNoti'ie./o, Pr?pel:~1' Owners about Constructiol/ Responsibilities ll'~,s\developed by the Coii"tri,dion Conttactors Board in accordance with ORS 70/.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 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 withholding tax law: Asan employer. youmustwithhold 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 infomlation. 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 Department 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 employ~es. If you fail to obtain workers' compensation insurance, you may ~ besubjectto penalties and will be liable forall claim costs ifoneofyouremployees is injured on thejob. Formore information. \ call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U,S, Internal Revenue Service: Asan employer, you must withhold federal income tax from employees' wages. You will be liable forthe 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 holderforthis project. you are responsible for resolving any failuretomeet code requirements that may be brought to your attention through inspections. Liabilil)' 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 overs pray, 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 theexpertisetoactas yourown general contractor, to coord inate the work of rough-in and finish trades. and to notify building officials at the appropriate times so they can perfonn the required inspections. . If you have additional questions. write or call the Construction Contractors Boa~d (PO.Box 14140, Salem. OR 97309-5052, 5031378-4621').<Th"(:?i?ard i~\located at 700 Summer St. NE Suite300,in Salem. .. i : ,'_. : prop-own.pm4 1/94