The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1999-3-3 1 c'"O 9;.: ~ ')0. q,~ ~~ ~ --~. 0" . ~~ '?g () ~~ 0'0:::.0"'0_ 225 FIFTH STREET "I~~:~: ~~'p "A:~~~~<l ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 9747'1'0' ~ . ~/~,,'?)1;,,0' ' /:. ~ INSPECTION REOUEST: 726-37~ ~"c/J~~~ City Job Number~9M~ OFFICE: 726-3759 ~~~" ~"/J~"'- 3. ~~TE ,FEE SCHEDULE BELOY 1, LOCATIqN OF INSTALLATIONA' ~~" 7~ -1.3../3 / h/-V""./a.l! ~ A, Ne\J Residential-Single or ~ 1 t i-Family per d\Jelling uni t, LEGAL DESCRIPTION Service Included: /7 t2!; :2<; 2..2- tJ'~ Items Cost Sum JOB DESCRIPTION 1000 sq, ft. or less $ 85,00 Each additional 500 'NOls~~<!:~ t or portion Permits are non-transferable and expire ~heveof $ 15,00 if \Jork is not started \Ji thin 180 days THle'1-'i..tmJ:l,'l'UlF~~ :H)?P'~IE?IfTHE WORK of issuance or if \Jork is suspended for Moaular D\Jelling 180 days, . AUTfS?!?'\i'fC'eU~\?EfeTJaIe'roERMIT IS NOS 40,00 CO:;. ~MEN,CI' ) 0R IS 1\8ANDONED FOR, 2. CONTRACTOR INSTALLATION ONLY ,B. Servlces'or Feeders A" Ins.t~l'la;t:{"')h),. Al tera tions Electrical Contractor or Relocation: ...J ;, Address Ci ty Phone Supervisor License Number Expiration Date Constr Contr, Number Expiration Date Signature of Supervising Electrician O\Jners NameJ, IY/. B/'<<dr..-l)ru/'? D. . /' Address J:;S /3 L.:cWv1/(k~ Ci ty ~ cI of.. Phone 7~ -j n I OYNER INSTALLATION The installation is being made on property I O\JP. \Jhich is not intended for sale, lease orerent, I ~\ - 200 amps or less ~ $ 50,OO~(J. 201 amps to 400 amps ~ 60,00 4.0J.Ei!mp~Nten9SlQl ~p'SlqUlr.." yvU,$.1'OO. 00 Ml a'hlll,'j, a'dopt.,0@9y<mIPSlregon Ut$lt'80. 00 lO~'r r,~oqoe.il[!jh~~tt~les are set$mlb , 00, N<Rj,!cO't\I'1'I1C1Q;oooYo through OAR 952$lQio, 00 In OAR 952-0 ~ht~in co,pies 01 the rules by C. OmempYrtlal!y'\Y::;erV1l<g,ie?t\illl\@lt~e I I)Bltia~l'alt ~al\~r'A\],'\:~eoMtl.q!jbt\l1C<llie~oca t i on number lor the uregon I ,y 200 amj)STlb'ti!i1fggO-332-2344), $ 40.00 201 amps to 400 amps $ 55,00 Over 401 to 600 amps $ 80.00 Over 600 amps OL' 1000 vol ts see "B" above' .' Branch Circuits .' Ne\J. Alteration or Extension Per Panel $ 35.00 One Circuit Each Addi lional Circuit or \Jith Service/.i or Feeder Permit ~ $ 2,00 10...... E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40,00 Sign/Outline Lighting $ 40,00 Limited Energy/Res $ 20,00 Limited Energy/Comm $ 36.00 5_ SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL ~{} - ~- I. <;(0 6:J VS'v 1 . . Permit #: q Cf 0 0 (o~ I (3 f 3 I Jl<<Jn (jd Cf -C ;q V L-- 'tVYd I t/ Date: 2W qO(_ Address: Issued by: .'9-.. , 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 1 and 2, and either box 3A or 3B: J2S] D I, 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 bc registered with the Construction Contractors Board. OR D. 3B, I will be my own general contractor. If! 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 Responsibilities on the reverse side of this form, m~~_ ~ ~ ~ (Sig~mitapPlicant) (White copy to issuing agency permit file, pink copy to applicant) '3'13/1 9 (Date) -~"''-. --,. ' . . i -. ,Information Notice to Property Owners About Construgtion Responsibilities Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction COlllractors Board in accordance with ORS 701.055(5). If you are acting as YOUt own contractot to construct a new home Ot 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 Department at 378-3524. Worker's 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 infornlation, 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, or work that must be rc-done. Time to supervise employees: Make sure you have sufficient time to supervise our 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 notifybu.ilding officials at the a"",v".:ate 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 prop.own.pm4 1/94 SP-001