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Home My WebLink AboutPermit Electrical 1993-4-2 (2) 'ff ,,- " II 'r~...tlglO.IJ" ~ n'" r:-.Ij\1r:1:ttCCJ . ''''':-<:\. d U$3 t"n1e 'O\\OW\r.C\ '~~~~(>("~"I .l~"'i' 9~,'J(;'~'C 1-" 225 FIFTU STREET 'ZO!'~~J.;:C~' u".," Iii'j ELECTRICAL PEnHIT APPLICATION SPRINGFIELD, OREGON 91477 IV - Q INSPECTION REQUEST: 726-376 'n9. ~- Ci ty Job Number '7 _< CJ ?./Q "7 OFFICE: 726-3759 oataA I _ $' natura 3~Kl'LETE FEE SCIIEDULE BELOI/ 1. LO~TION OF ;rNSTAL'llAPflOrf 19 &::./ ~I /1/7 ,)"/, A. New Residential-Single or Hulti-Family per dwelling unit. LEGAL DESCRIPTION Service Included: /tfhttJ"2. 03 /4 2- 'k"o-D Items Cost Sum JOB DESCRIPTION -r-~ A e-T LZ:.-/ , Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Add~ ~ / / / City Phone Supervisor Expiration Date Expiration te Supervising Electr~ City The 'installation is being made on property I own which is not intended for sale, lease or rent. O~ers Si~~ture:, /J AM"Y <!!S.y ~..Y ~-------------~------\-~-------------- 9ATE:...:.q~..2"i'- 9~ r"R1/ CEIn 1I: L11. _ I ,t:J RECEIVED BY:[ 7l/~ 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Modular Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: S 85.00 $ 15.00 $ "0.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ "0.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to "00 amps "01 amps to 600 amps 601 amps to 1000-amps Over 1000 amps/volts Reconnect Only 200 amps or less 201 amps to "00 amps Over "01 to 600 amps Over 600 amps or 1000 D. Branch Circuits Owners Name ..J tLY /1 pt~~ J Address '2'2..77;.J I //Zi. ST~ Ll.tJJ. One Circu i t ,\' J1~ 'Phone T'-J ('-/5"'22... (I-c:>j Each Addi tional I Circuit or with Service OI/NER INSTALLATION or Feeder Permit s "0.00 40 $ 55.00 S 80.00 volts see "nO above New, Alteration or Extension Per Panel 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 TOTAL S 35,00 s 2,00 no t i neluded) s "0.00 S "0.00 S 20.00 $ 36.00 4/J.dJ -'A.W ~ :uJ ,~ , " . . Permit No: q2/J2..tr:Yt Address: liJ<?\ ~\-")I_~ Issued by:K~JJ1 ~ ) ~te: ~?_~) FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state, ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: :',~Q ( 3. A,I I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, I My general contractor is -Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3. B. ~ I will be my own general contractor. Ilf I hire subcontractors, I will hire only subcontractors registered with the Construe, tion Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ,"._.J/A-k~}l . Signature 6f PeriDit Applicant < ~2~-9.-"5 Date ' CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT r . I INFORMATION NOTICE TO PROPERTY OWN RS ABOUT CONSTRUCTION RESPONSIBILITIES P' NOTE: ' This Information Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passeq by the 1989 Oregon Legislature, 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 emQlPyer, '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 Department of Revenue at 378,3390, 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 Ore_gon Employment Division DHR at 378,3224, 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 DIF at 373-7434, 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'lax. For more information, call the Internal Revenue Service at 221-3960, ' " 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 punc- tures, 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, 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 to: Construction Contractors Board 700 Summer St. NE, Suite 300, Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89