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Home My WebLink AboutPermit Electrical 1994-9-22 } ,,I' f . . ^, " A , '\, 7')0, . ,~~ " . . The following project as su mea zoning, and does not require specific land use approval. 225 FIFTH STREET Zonina t-Df2, SPRINGFIELD, OREGON 97477 ' INSPECTION REQUEST: DJl2I;._~1.69 Cr/t?--fA.Lj ,,' OFFICE: 726-3?59 'Authorized Signature (l rI\ ::So 1. LOCATION OF INSTALLATION ~ ~'1~/ l?~/5t;~~$/ LEGAL DESCRIPTION //-b2 -~?--."' ... ""~~c..-J A. << - ~ JOB DES~ION ~ ~y?"~~ /O~~~-'i,..r-~;";:- 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 B. Electrical Contractor 0:' ,~~-~ ',' .,-~ ~ ' . Address City Phone Supervisor License Number Expiration Date ELECTRICAL PERMIT APPLICATION City Job Number qt//t;'? ~ COMPLETE FEE SCHEDULE BELOV New Residential~Single or Multi-Family per dwelling unit. Service Included: Items Cos t Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling Service or Feeder $ 85.00 $ 15.00 ~. $ 40.00 t/~~ Services or Feeders Installation, Alterations or Relocation: -200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to, 600 amps $100.00 601 amps to 1000 amps $130.00 . Over 1000 amps/volts $300.00 Reconnect Only $ 40.00 , Constr Contr. Number C. Temporary Services or Feeders Installation, Alteration or Relocation , D. Branch Circuits Owners Namel?~I''rf~A.~~~k'" . , New, Alteratlon or Extension Per Panel Address2?~~~~fr--P~ ~~/y" ., u I _ __ - . ~ One Clrcult Cit~/~~hone 6~;?-5:S'< > Each Additional ~~~ Circuit or with Service OVNER INSfALLA~InN or Feeder Permit Expiration Date Signature of Supervising Electrician The installation is being made on property I own which is not intended for sale, lease or rent. E. Owners Signa. ure: ---~--_:_~~~-----== DATE: ~-2<""7 ~ RECEIPT #: .---: ./ / V:;g ~? . , RECEIVED BY: ---I..... #I :Y ~~- 200 amps 201 amps Over,401 Over 600 or less to 400 amps to 600 amps amps or 1000 volts $ 40.00 $ 55.00 $ 80.00 see "B" above , ,. $ 35.00 $ 2.00 Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 $ 40.00 $ 20.00 $ 36.00 c/a. go.!!. (~_a;- yf:;~ . \." of' . .... . Permit#: ~ S't'fI ~;) Address:5;;':7::? ~_~ P6;> Date: ,....:::z.::?...'7 sr ~ . . , . "';,- Issued by: ' ,/ , 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: ~ U' 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, u 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 4J 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 Responsibilities on the reverse side of this form. ,~ -J~~~_ ~ature of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) ~ ~2.z.-iY (Date) ""',\ . . '\. , . ". \" , , JI~~(Q)fi'iIT(jJ~~O@~ ~(Q)tro~~ ~@ ~1f@[p)~lliW (Q)w~~IT'$ ". .' . , ~~~OJ]~~~@~~$RIT'OJ]~,~o@~~~~~@~$O~o~ofto~$ " .. .'\~ ...... ;;.'...... ......... ~~ _ . ''::' '-. ~,.... __ r .'. .. .. -~ .... ~.:....:' , , ' .. ....... Note;' Thi$ /nformation,Notlce to Property Owners about Construction Responsibilities . .....j ... . was developed by the ~onstruction Contractors 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. fEM[P>lOV[ElRllRlfE~JPlOU\ll~~I8l~Ul~fES: 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: OregGIlU'S wntll1lhlGllidlnllUg tID{ ll21w: 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. 1UllUemjplllGymellUt nllUSummce U!l1l:: 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. -I WGrlkers' CGIDjplellUSatiGIlU nllUSURr2llIll.ce: 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 at the Department of Consumer and Business Services at 945-7888. 1U.S.lfllUtemall lRevellUURe Servnce: 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. 01~[E!RllRlfE~~ONS~I8~Ul~IES AN[l) AIRHEAS OIF CONClEIRlN: r CGidle cGIDjpllluannce: 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. ' Ualbjllnty amll jpllwjplerty dlWllllage nllUSillll"21llUce: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, waterdam!lge from pipe punctures, fire, or work that must be re-done. ' 'lIlime tG sUIljplervnse eIDjplllGYees: 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 ~ontractors"Bo<ird '(PO-Box . 14140;,Salem,' OR 97309-5052, 503/378-4621). The Board is located at 700 Summer S1. NE Suite 300, in Salem. . ; , prop-own,pm4 1/94