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Home My WebLink AboutPermit Electrical 1993-06-07225 PTYffi $NBBT SPRINGFIBID, ORBGON 97477 INSPBCilION REQUESTz 726-3769 oFPrcE: 726-3759 1. LOCATION OP I.,EGAL DESCRIPTIONl? oaav.+I Oot lrt JOB PTION Address ci ty-Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Blectrician 0vners Name Address 21)? \/ t ew^..r".t Ci Phone 1q L-SOI OI'NER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Ovners Signature: DATE: !iPRI,{GFIELO ELECTRICAL PERHIT APPLICATION City Job Number CO}IPLETB TBE'SCEBDT'LB BBLOS Nev Residential-Single orHulti-Family per dwelling unit. Service Included: Items Cost 1000 sq.ft. or Iess Each additional 500sq. ft or portion thereof Each Manuf'd Home or -Hodular Dvelling Service or Feeder $ 1s.00 s 40.00 Services or FeedersInstallation, Alterationsor Relocation: (,l,/it LOF ,L E % A Sum Permits are non-transferable and expireif vork is not started vithin 180 daysof lssuance or lf vork is suspended for 180 days. 2. COIITRACTOR INSTALI.ATION ONLY Electrical Contractor B 200 amps or less 201 arnps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps 0ver 1000 amps/volts Reconnect Only I $ s0.00 s 60.00 $100.00 $130.00 $300.00 $ 40.00 ...-:- 0r\ co C. Temporary Services or FeedersInstalIation, Alteratlon or Relocation 200 amps or less $201 amps to 400 amps - $over 401 to 600 amps - $ Over 600 amps or 1000E-rts s 40.00 55.00 80.00 ee rrBrr aSoF 35.00 .2.00 a_qo not included) 40.00 40.00 20.00 D. Branch Circuits Nev, Alteration or Extension Per Panel One Circuit $ Each Additional Circuit or vith Serviceor Feeder Permi t I $ Miscellaneous (Service/feeder -Each installation Pump or irrigation $ Sign/Outline Lighting- S Limited Energy/Res - S Limited Energy/Comm $ STIBTOTAL OT ABOVB 5Z State Surcharge TOTAL 5 RBCBIVBD u 01q) q s 8s.00 ) ,\)qb BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION SF.{T]{GFIELE! Offi ce: INSPECTION LINE: 726-3759 7 26-31 69225 Fifth Street Springfield, Oregon 97 477 OREGO'VCITY OF Job Locat'ion :a1 2f V^I f..r, fh-tL Assessors l,1ap lf : l..-) D3?l'tq I Tax Lot #: A Cl lO 0wner: Address: )-))2 u) v1.rw5y*It Phone #: 1 Stater dQ Zip:1 0,t t C'i ty : Backflow Permit is $15.00 + $0.75 State Surcharge Contractor:0 Phone #: City:State:z'i p: Construction Contractors Reg'istration #:Ex p'ires : By sign'ing this permit/app'lication, I agrgg to cal I for an inspection once the backfio* irevontion dev'ice has been'installed and is visible for inspection (726-3769). I also state that all informatjon on this app'licat'ion/permit is correct. -C/> S ure a e FOR OFFICE USE Date of Application: Rece i pt ll:5t ro Issued By: Total Amount Collected:?,eo.gS Job #: -Sotq 141 bl-\a 1 2 lssued by Date: OR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registration underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38: I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A My general contractor is , Contractor registration num I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 3.8 Q/*-lpt*"a I will be my own general dontiactor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understandthe lnformation Notice to Property Owners about Construction Responsibilities on thereverse side of this form. (. Signature it App t e CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 Permit No: Address:2-)2a Vre,'wwtt ilg Ll^,.13 WHITE COPY TO ISSUING AGENGY PERMIT FILE PINK COPY TO APPLICANT 3 OR R c)3o--tqa ( INFORMA. .JN NOTICE TO PROPERTY OWlr;RS ABOUT CONSTRUCTION RESPONSIBILITIES lf you are-acting a'S your own contractor to construct a new home or make a substantial imprwement to an existing structure, you can preve.qrt r.nany problems by being aware of the following responsibilities and areas of concern i EMPLOYERRESPONSIBILITIES.; . lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction"or ihplotliiment'of a residential structure, you will, in moSt instances, be iiteO to be an "employer" and th-e pe.6ple you hir:e Will.be "eqployees". As the qmployer, you must c6mply'with the following: ,il _ i''1,:l'. - Oregon's Wiiiilrq/ding t3x,l-ayv: As ?n empfoyer, you mr4st *itnnotd income taxes from emp-tqyee wages at uwillbe-Jiqb.le.for.thetaxpaymentsevenif.you{9nlt'actu.a.uywithholdthe tax from your employees. For more information, call the Oregon Departr.nent of flgvepue at 378-3390. Unemployment lnsurance 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 DHR at 578-3224. Workers' Compensation lnsurance: As an ernployer, fou dr€,sut{ectto the Oregon \Alorkers' Compensation ta,/v,;nd must obtain workers' compensation insurance for your employees. lf 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 DIF at gf3-7434. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax frpm employees' wages. Fer more information, call'1 i,You will b'e liable fo'r thb tax payment even if you d idn't actually withhold the tax the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCEFN: . . r Code Comptiance: ,As the permit holder for this proiect, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liabi and lnsurance: Contact your insurance agent to see if you have adequate insurance coverage accidents and omissions such as falling tools, paint oversprey, water damage from pipe punc- tures, 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 rougf'-in and finish irades, and to notify building officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 NOTE: This lnformation Noticeto Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. o24N 10124189