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Home My WebLink AboutPermit Electrical 1998-2-3 " ." ~t l,tG-P.> 1. LOCATION OF INSTALLATION n 3~loO L!.tl.L-'r1.....C~ 2Yvld",.l- IUlJ I <.i LEGAL DESCRIPTION lIn.:f-1 ql-/ \ OOdO J JOB DESCRIPTION . Mfi.j-i-]'~ (i)r8L.u.:L City Supervisor Owners Name 'RA-LP~( E ~ !Z:.H?- F--Y2...D. Address'?1fGO H4.)J~ 1jVI')4!- (Q), Ci tY-4ff(i~ ~l'eD Phone 7 i..f- 7-1- 266 OYNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~\ @~gn~ ----1T--~------------------------------ DATE: 01-3-") 't RECEIPT 11: 1<:;( l,q I RECEIVED BY: -+<w , , A. ELECTRICAL PERMIT APPLICATION Ci ty Job Number q {' I () (p 0. 3. COMPLETE FEE SCHEDULE BELOV Cost Sum , . - '., The followfng toning, and ~ asreq~ltted he. th<? IIpproval, SPecific land .."" ZonJ~V 225 FIFTH STREET O"'e,;J~2,-y~"6. SPRINGFIELD, OREGON 97477 ~~~ INSPECTION REQUEST: 726-3769 ure tJM OFFICE: 726-3759 1000 sQ.ft. or less Each additional 500 sq, ft or portion Permi ts are non-transferable and expire IV" thereof if work is not started within 180 days h ~~ Each Manuf'd Home or of issuance or if work is suspended f~~~,o, ~~Modular Dwelling 180 days. (/~ c:-~~ -Service or Feeder C'Q V~,~ ''7/?- 2. CONTRACTOR INSTALLATION ONLY -11')- ~~~~'B:"'~O ~ices or Feeders 'c90 V~O Qn.sr(lJJati~n, Alterations 0-1)- 0-9;r9~i~~tlOn: ,o~ <9 ~ ~tc- ~d~~mil'lD~or ~ss ~~i ~~~~~~~ 601 amps ~'~mps Over 1000 a s ~lts Reconnect Only New Residential-Single or Multi-Family per dwelling unit. Service Included: Items $ 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' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts 8ranch Circuits $ 40.00 $ 55.00 $ 80,00 see "Bit above .' New, Alteration or Extension Per Panel One Circui t $ 35.00$~.- Each Additional Circuit or with Service h or Feeder Permit ~ $ 2.00 P ~, -- 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 4> t..J.1. - 5% State Surcharge .;2.oS 3% Administrative Fee 1.2.~ TOTAL -f-Y-Ll-.,u .i.., . . .. . . . . .. . . . . . 275011.96 Permit #: Address: 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: o o 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 N 3B. I will be my own general contractor. If 1 hire subcontractors, 1 will hire only subcontractors registered with the Construction Contractors Board. If [ 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 propw rr~rs a~ostruct n Responsibilities on the reverse ~4.t; f~5? ~Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . . . . .. . e . . .. . . .... 'e Kn~ormal~ioi1 Notice to Property Owners About Construction Responsibilities Note: This Injimnation Notice to Property Owners about Construction Responsibilities was developed by the Construe/ion Contractors Board ill 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 existiug structurc. 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 constructiug or assisting in the construction or improvementofa residential structure. you will. in most instances. be ruled to be an employer and the people you hire will be employees, As thc employer. you must comply with the following: Oregon's withholding tax law: Asan employer; you must withhold income taxes from employee wages atthetimecmployees 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 thc Oregon pmployment Department at 378-3524, Workers' compensation insurance: As an employer. you a~e subject tot he Oregon Workers' Compensation Law. and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subjectto pcnaltiesand will be liable for all claim costs ifoneofyouremployees is injured on the job. Formoreinformation. 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 incomc tax from employees' wages, You will be liable fonhe tax payment even if you didn't actually withhold the tax. Formore information. call the Internal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder forthis project. you are responsible for resolving any failureto 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 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 coord inate thc work of rough-in and finish trades, and to notify building officials at the appropriatc 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 1t94