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Home My WebLink AboutPermit Electrical 1996-7-16 . . SPRINGFIELD 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 Zoning. L kxY . Dllle-1.J.Lo' q (p 9~~9"zed Slgnolure 'JV) 726-3769 1. LOCATION OF INSTALLATION C~~ "3 /vy cS? LEGAL DESCRIPTION J$'L:J.2.'~3-/V O?vOU JOB DESCRIPTION /..I4;py~ r~ 5p7;>~ , , Permits are non-transferable 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 Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners Name (/t.-AlkY0A'. n~~~.)IIf'" D. Address /2./$1 r ~r' City -;?/";?-"Z:> Phone '?Y6-7'7'7'~ OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. ;;: ~gna~~/ Ct ------------------------~------------ DATE: 7-/9-'56- RECEIPT 11: -22 ~B-/ RECEIVED BY: ~~ -:-.J--_ ELECTRICAL PERMIT APPLICATION City Job Number ~~ 7"5"0 3. COMPLETE FEE SCHEDULE BELOV A. Ne~ Residential-Single or Multi-Family per d~elling unit. Service Included: Items Cos t Sum 1000 sq.ft. or less ........ $ 85.00 ~ Each additional 500 sq. ft or portion q' thereof $ 15.00 ~ Each Manuf'd Home. or ModularD~elling Service or Feeder $ 40.00 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 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 0/.:::> $ 55.00 $ 80.00 see "Bft above Branch Circuits .' Ne~, Alteration or Extension Per Panel One Circuit Each Additional Circuit or ~ith Service or Feeder Permit $ 35.00 $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ $ $ $ 36.00 /8"';;:- ~~ ,~ .::: -;::- ~.~~-r- /~~- 40.00 40.00 20.00 . . Permit #: 76~.?.>~ Address: t::;g.::~ /y~ ~-- Issued by: ~~_ Oate: ~s-:. "":Y.: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction pennit 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 pennits. 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 pennit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: [Z] 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 W 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 Re/bilitieS on the reverse side of this form. /L- C ~!?>~~~ .{~ /S:Cf( V (Signature of permit appli€aiJt) (/ V (Date) (White copy to issuing agency permit file, pink copy to applicant) . . ][i1Iioi'maifon-i\\~tics ~c Propeiiy Owners , ~lbou~ iCon~~li"uc~ion Responsibiliiiss , . - -" -.) .', Note: This lnformo(ioll N.otice'to Property Owners aboUl COllstruction Responsibilities was developed by the COllstruction 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 problem, 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 constmcting or assisting in the construction or improvement of a residential structure, you will, in most instances, be mled 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: 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 Depl. of Revenue at 945-8091. Unemployment insui"3J1ce lax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more in[ormation, call the Oregon Employment Division at the Department of Human Resources at 378-3524. \ Worl,ers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensatio~ 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. finternal 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. O:-HIER RESPONSIB!L1TIES AND AREAS OF CONCERN: Corle 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 proJlcrty 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, or 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, tocoordinate 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 addition;il questio/ls, write or call the ConstmctionCoRtra~tors B~ard-lPO Bb-x 14140, Salem, OR 97309-5052, 503/378-4621), The Board is]ocated at 700 Summer Sl. NE Suite 300, in Salem, prop-own.pm4 1/94