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Home My WebLink AboutPermit Electrical 1995-12-18 . ~~~ rOir,J.....t~a project C~ submttt',~j ~~3:~). ;h,.~ t<<~'.Y~l L.\..11.nf1, cna doc$ roc: ~qult'Q &POC~;iQ '\'~n...l ~'I.'Ul' npprovof. \. ""It" Tn:"'l::' 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 '-' Dn Zcninp .<-- Dcte I ') -11.: l(s ~ 9747-7thcfizGd Slgnslure 726-3769 l. LOCATIqN/ OF INSTALLATION 4~,r~~~rr A. LEGAL DESCRIPTION J~2.. 6)2. 3 '3 /O?7tn/ JOB DESCRIPTION ....k. A7. M) /77 /)j, ) Permits are non-transferable and expire if vork is not staL'ted vi thin' 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date ELECTRICAL PERMIT APPLICATION (.).ty' Job Number 3. " COMPLETE FEE SCHEDULE BELOV '95"/7/7 4lV unit. ~ Cost Sum Nev Residential-Single or Multi-Family per dvelling Service Included: Items 1000 sQ.ft. or less Each additional 500 SQ. ft or portion thereof Each Manuf'd Home. or Modular, 'Dvelling Servic~ or Feeder .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 $ 85.00 " $ 15.00 $ 40.00 $ 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 --- Owners Name iA.LV)/, eLae -P-/; _ .. Address .,i? K'A7c/:1:?h.JT City_ ,~;:7) Phone '72td-f!;SO"j OVNER INSTALLATION " The installation is being made on property I ovn vhich is not intended for sale, lease or rent. ~:a:Latuh~ -----~~-~--~-----~-~-------------- DATE: J)... //8~./ . RECEIPT 11: '(' 1/C! a.:U:;... RECEIVED BY: .' ~.n,..., , 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above .' .' Nev, Alteration or Extension Per Panel One Circui t V Each Additional Circuit or vith Service or Feeder Permit $ 35.00 .?,')PO " $ 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 . !. $ 40.00 $ 40.00 $ 20.00 $ 36.00 , ?S:OO j.7J' /,04 ~.z 7140 Address: . c::p/s/ 7/7 ~'Y /~b;??I}t7('-- . Permit #: Issued by: Date: 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. 3A. My general contractor is '. I (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. I 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 :; to ~~Lwne#:; Construction Responsibilities on the reverse side of this form. r . f' (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . , . Information Notice to Property Owners About Construction Responsibilities . . . .1 / ,,', ., Note: This Information Notice to Property Owners about 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 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: 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.mus\ obtain workers' compensation insurance for your e!TIployees. 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 J that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agentto 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, 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 Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. p,....t-' ........'n.pm4 1/94 -ADDRESS- 47 KREMONT WAY ... BUILDING DIVISION JOB# 941f17 -LEGAL- LOT BLOCK ACTIVE DESCR:LIVING RM & DECK ADDIT URBAN GROWTH BOUNDARY -OWNER- PHYLIS ELCE 726-8501 47 KREMONT SPRINGFIELD, OREGON 97477 1803023303700 -VALUE- 7536 951030 / 951219 -ENERGY- HEAT1- H20- RANGE- INSULATION PATH- -STATS- BLDG ZONE STORIES FLOODPLAIN BEDRM OCC GRP UNITS SQ FEET 119 CONST TYPE -CONTRACTORS- GENL-R BENSON CONSTR CONTRACTOR PHONE-747-4783 PLMB- ELECT- MECH- DESGN- 2- -INFO- ADDITION RESIDENTIAL 1150 QUAD AREA 5RSW SEQ-REQUIRED pERMITS----------------FEE--SURcHARGE--DATE~-RECPT--CAT-------VALUE 001-061-RES PLAN CHECK 002-002-BUILDING PERMIT 003-004-ELECTRICAL 004-005-PLUMBING 44.53 68.50 35.00 25.00 0.00 951027 19425 3.43 951201 19715 601 1.75 951218 19836 500 1.25 951201 19715 510 o 7,536 o o SEQ-MINIMUM INSPECTIONS + REQUIREMENTS--------------------EXP DATE---ACT DATE- 001-002-FOOTING 002-003-FOUNDATION 003-005-POST & BEAM 004-009-INSULATION FLOOR 005-042-ROUGH ELECTRIC 006-006-FRAMING 007-009-INSULATION 008-011-DRYWALL 009-049-FINAL ELECTRICAL 010-027-STORM SEWER 011-019-FINAL BUILDING 951206 951206 951218 951219 951219 951219 SEQ--INSPECTIONS---------COMMENTS----------------------------DATE---RSLT--INSP 001-002-FOOTING 002-002-FOOTING 003-003-FOUNDATION 004-006-FRAMING 005-005-POST & BEAM 006-006-FRAMING 007-042-ROUGH ELECTRIC 008-011-DRYWALL 009-009-INSULATION C/N 951206 WIR 38 951206 OK 38 951206 OK 38 951218 NOTOK 38 951218 OK 38 951219 OK 38 951219 POK 61 951219 OK 38 951219 OK 38 SUB. ELECT. APPL. C/N OK TO INSULATE&SHEETROCKEND WALLS ~