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Home My WebLink AboutPermit Electrical 1994-9-6 'i .,' ~- .~ SPRINGFIELD The following project as submitted has the folio zoning, and dOGS not requira speciflci land.use epprovaL . 225 FIFTH STREET SPRINGFIELD, OREGON 97477 Zonln~ LDfl_ 726-~9 4-1~ Authortzed Signature 1. LOCATION OF INSTALLATION ~ 1_<: /A) L^"L:J (~^11 LEGAL DESCRIPTION J'il>I"'J.":t 192. >.s, o'7'7~. INSPECTION REQUEST: OFFICE: 726-3759 City Job Number , . ~~ COMPLETE FEE SCHEDULE BELOY JOB DESCRIPTION .th~~L'J.()~ JC"~ c.CIJ;V~J ( .J 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 Electrical 'Contractor Address City Phone Supervisor License Number Expiration Date A. New Residential-Single or Multi-Family per dwelling Service Included: uni t. It ems Sum Cost 1000 sq.ft. or less $ 85.00. Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home or Modular: 'Dwelling Service or Feeder -1L $ 40.00 /I.c;~' 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 Reconne,c t Only $ 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 D. Owners Name-->2..lq""../-:;'U )/~ .q~ Address :2.~/3 /" )L-/brJ) Wv:t Phone 74 (-3~/r',) City <)"v'.r5) ,; I - OYNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners'Signature: ~ dlL:~~_~~?_~}~~!-~~~--- RECEIPT 11:_ ;, /~--/!(? RECEIVED BY: ~~~_ 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600.amps or 100U volts Branch Circuits $ 40.00 $ 55.00 $ 80.00 see liB" above ." New, Alteration or Extension Per Panel.' Miscellaneous (Service/feeder not included) -E~ch installation Pump or irrigation $ Sign/Outline Lighting $ Limited Energy/Res $ Limited Energy/Comm $ MbO 2~ I :>.e> .d:2 2.(0 - ( .,. One Circuit Each Additional Circuit or with Service or Feeder Permit E. . 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 35.00 $ 2.00 40.00 40.00 r 20.00 36.00 J" - . Permit#: 94/ S~ <) Address: 2e1' 3 /A.l&b,~A /ff/lv Issued by: ~~ Date: 7/cyf1' 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: g ~ 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. 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 JS2l 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. !/?J.- '1{/ "---?77 n "v'77';:> J., "",( /- L99V / - (Sign~ture of p~rmit applicant) , (Date) (White copy to issuing agency permit file, pink copy to applicant) " ,\ '.\, '':'''''. :--..J. .e. -. > ',\.. '. \,~ \.j . 'iril'Vi .,.atiOrid\lotice" to Property Owners ~\",:~~.s>\~t C;~ns!~l.!ction Re~ponsibilities . .-:J ,~, \~ .- - "-, '. ., . .'N~tfi: This Informati(mfV..tJtice '(0. Property OW/lers about Construction Responsibilities .-.-"",, ,~,~,. . was'developed by the Constructio/l-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 awm:e of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registe~ed 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 emp'loyer, 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 945-809 I. 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, andniust 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 informatid~ 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 requirervents 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 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 yo~'5:V?'ad".it\jmai>que~ions, write or call the Construction Co'ritfacWrs"B~~(POBoX}4140;,Sillem<QR-97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. . prop-own. pm4 1/94