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Home My WebLink AboutPermit Electrical 1996-2-15 r.~ , ubmmnd haO tho lolloWIOl Tho ~ollnwil:g pr~ec'~ ~~ulre op""nlc land uae ;,o:-lin(c, Dflu dOf.:.J nO approvc\. /' ELECTRICAL PERMIT APPLICATION r..i.ty_Job Number 5' ~~~4 225 FIFTH STREET SPRINGFIELD, OREGON 9747,.7c"o . :5 '1 4fJ' INSPECTION REQUEST: 72b~3769 OFFICE: 726-3759 ~.u\hori2od s\gnctur8 . 1. LOC4TIpN OF INSTALLATION 4S~t!J IVV ,1 r. , LEGAL DESCRIPTION /S2>02- 05/.3 m:l ?-~ JOB DESCRIPTION ~ / ~ An.- Adh'-. , I Permits are non-transferable and expire if ~ork is not started ~ithin 180 days of issuance or if ~ork is suspended for 180 days, 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Number Expiration Date Constr Contr, Number Expiration Date Signature of Supervising Electrician O~ners Name KCr'aJ &.I/.AJV.< Address Ch.. L9~5' ~~/~ Ci ty ~)~ ~Phone 'If?-/'!Il2i OVNER INSTALLATION The installation is being made on property I o~n ~hich is not intended for sale, lease or rent, Owners Signature: )( V C III ,I "J ( ijp,0 . ----~-~-------------------------------- DATE: J -I S- ~f RECEIPT 11:( ),-17) Lit ~ ' RECEIVED BY: II. /~ /~ 3. COMPLETE FEE SCHEDULE BELOII A. Ne~ Residential-Single or Multi-Family per d~elling unit. Service Included: " \ Sum Items Cost 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home, or Modular'D~elling Service or Feeder $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: ZOO amps or less 2- 201 amps to 400 amps 401 amps to 600 amps 601 amps to' 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 /[!;t).8'O $ 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 $ 40.00 $ 55.00 $ 80.00 see liB" above D. Branch Circuits " Ne~, Alteration or Extension Per Panel One Circuit Each Additional Circuit or ~ith Service or Feeder Permi t :z- $ 35.00 $ 2.00 16<) not included) E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 $ 40.00 $ 20.00 $ 36.'00.' 16-~(f"O "- "&.0 .,.. ~. 11- -LL'- S .( Permit #: . 7' 5/~,S-4- 4540 Ij/~ )7", f . Address: Issued by: Date: Statement: Information Notice to Property Owners About Construction Responsibilities Nofe: 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 pemlit, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: [g M 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 ~ 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. ~ /~AA/l . 7" v..-----? 2. - / s- C; L I (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . ~ lInVormaiion Notice io Property Owners '. . ,Aboui <<;,<?ns~r,:!ciioi'i Responsibiliiies " Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the COllstruction Contractors Board ill accordallce 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 stmcture, you can prevent many problems by being aware of the following responsibilities and areas of concern, EMPLOYER. RESPONSIBIUTCES: If you hire persons not registered with the Construction Contractor~ 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 mllst comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes I' tom employee wages at Ihe time employees are paid, Y Oll 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 Dep\. of Revenue at 945-8091, Unemployment insurance tr.x: As an employer, you are required to pay a lax 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, and must obtain workers' compensation insurance for your employees, ]1' you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for aU claim costs if one of your employees is injured on the job, For more informat~n, call Ihe Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888, U.S. Internal Revenue Sen,ice: 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 al 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for Ihis project, you are responsible for resolving any failure to meet code requirements that may be brought 10 your attention through inspections, ,/ "- Liability and'projlzrty damage insurance:, Contact your insurance agent to see if you have adequate insurance coverage for accidenls and omhsions such as falling tools, painl overspray, water damage from pipe punctures, fire, or work thaI must be re-done, Time to supervise employees: Make sure you have sufficient time 10 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 Irades, 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, Saleln, OR 97309-5052, 503/378-4621), The Board is located at 700 Summer S\. NE Suite 300, in Salem, prop-own. pm4 1/94