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Home My WebLink AboutPermit Electrical 1998-1-21 '1 . zoninQ, and does not requite opeclI1c land use !(} approval. ..J..<?~ ' <(;.i' "'<? Zoolna ~. :(.'t-'-'- ~~ C~~ ~\V _*," <a &:;J<(;.'?- ~~<;J - ~O r:r,,'?-'<" ~~ !O't-'O ~v.\'?:J <? _Q.~<(;.'i) ci" ~CTRICAL PERKIT APPLICATION \ ,<<-,<,'" ~<(;.'i) r:r,,~a 't-\)' ~~<(;.~ ~ <? Ci ty Job Number Q 7 I 7 d- 'i cP '?P'i) 't-~~". COMPLETE FEE SCHEDULE BELOV * . A. New Residential-Single or Multi-Family per dwelling unit. Service Included: It ems Cos t Sum Date 225 FIFTH S\rREE1OO Signature SPRINGFIELD, OREGON 974/1 INSPECTION REQUEST: 726-3769 OFPICE: 726-3759 1. LOCATION OF INSTALLATION ~::>'''1 L O~iIt.L.. L,.,...,., P LEGAL DESCRIPTION 1/ b ~2. ~ 1\ (') -:S(O 60 JOB DESCRIPTION Ad~ (l.lV'~5 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. ~ectrical Contractor Ad~S / City ~ Phone~ Supervisor Date of Supervising Ele~ian 0.Q5-RQ~I..). j-\v-rnA::;. D. Owners Name '?--..o...1'"6T...-c. :3), Q..-tno- ~ Address \..:;) ~"L lov~ lOo+=' City SpW Phone (<f70~S'7 OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~ Signature: ---\I. ~ ~ ) '-- ~- - ' - -.---.J DA~~~------T1:i1-!lJ~------=---------- RECEIPT -II: , (J J ~ ""'_<.. U RECEIVED -BY: ',P'. th .1-1",,-- 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular'Dwelling Service or Feeder '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 200 amps' 'OT less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above " New, Alteration or Extension Per Panel One Circuit L.li.- $ 35.00~ 3S: Each Add it iona1 Circuit or with Servic~ or Feeder Permit I, $ 2.00 10.00 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 Lf.".Q J I]' I \ --.!:i '1- 1.f.D rl . . Permit#: q 1/71- \( Address: J 2,~ ~ L-O( f\L Loop Issued by: ~__ Date: j /11/1'( -" :-....... 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: [ZJ ~ 1. 1 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 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 ofthe 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 ConsrctIon~ponsibiIities on the reverse side of this form. -=-"--. ~.,,~.'_~ .~~""->-~ 1/21 JqXl . (Signature of permit applIcant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . , Hnformation Notice to Property Owners About Construction Responsibilities ......--.. ..:-. Note: This Informatioll Notice to Property Owners abollt Constmcrion Responsibilities was developed by rhe Constmerion COlltractors Board in accordance wirh 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 ofa 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: Asan employer. you must withhold income taxes trom employee wages atthetime employees are paid. You will be liable for ihe 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. 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 ifoneofyouremployees is injured on thejob. Formore information, call the Workers' Compensatioli Division at the Department of Consumer and Business Services at 945-7888. I U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. Y 011 will be liable forthe 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 perm it holder for this project. you are responsible for resolving any fai lureto meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agenllo see if you have adequate insurance coverage for accidents and omissions sllch as falling tools, paint overspray, water damage from pipe punctures, fire. or work that mllst be re-done. Time to supervise employees: Make sure YOll have sufficient time to slIpervise your employ~es. 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. prop-o\'m. pm4 1/94