HomeMy WebLinkAboutPermit Electrical 1997-09-105r.GFIELT)
approval.
,rnrQ -V'\-Tl NOTICE:
PERMIT SHALL EXPIRE IFT#d'$ffiH*CAL PERHIT APPLICATION
SPRINGFIELD oREGoN 97477 RIZED UNDER THIS PEHMfjlSflCfbb Nunber q1
INSPECTION REQIIEST 726-
COMMENCED SCEEDULE BELOV
1 ON OF dilNY r8o DAY
oR rs+BAI\tD&UEBfPEm
PERIOD.
OFFICE: 7 26-3759
T A. Nev Resi dential-Single or
MuI t i-Fam iIy per dvelling unit.
Ll oo Service I ncluded Items Cost
3TEUTHO
t3q1
z 1000 sq'ft' or less $ 85'00
, 'n;/- rach additional 5oo
Sum
La14 l"5i
8,,.,0,
ON
sq. ft or Portlon
thereo f
Each Manuf'd Home' or
Modular Dvelling
Service or Feeder
Permits are non-transferablg "19 expire
ii-;;;k is not started vithin 1Bo daYs
of issuance or
''
i-'ottt is suspended f or
180 daYs.
2. COMRACTOR INSTALLATION ONLY 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 1OO0 amPs/vo1ts
-i,""o"n".t o"iv ----v-
Temporarv Services or Feeders
ilti.ii"iiot, Alteration or Relocation
'Electrical Con tractor
Address
Ci tY ne
B
C
$ 15.00
s 40.00
$ s0.00
s 60.00
sr.00.00
$130.00
s300.00
s 40.00 @-Supervisor Lice
Expiration Date
Constr Contr. Number
Expiration Date
I
Signature of SuPe rvising Electrician
Ovners Name
Add res s rL ,LT
200 amps"or less $ 40'
,oi ;*;" to 4oo amps
-
t ::'
Over 401 to 600 amPS
-
b uu'
0ver 600 amPs or 1000 volts see "
c Number
00
00
00
Brt
OIINER TALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Orrners Signature:
aEoVe
D Branch Circui ts
Nev, Alteration or Extension Per Panel'
One Ci rcui. t $ 35 . 00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0utIine Lighting_
Limi ted EnergylRes
Limi ted Energy/Comn
hll
I
Ci phone 1 )-l
I I 'iA-:--
s 40.00
s 40.00
s 20.00
$ 36.00
/y'a'oo5SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Admini.s t ra t i ve Fee
TOTAL
DATE:
RECETVED B
o
c)
tL+4.9
Permit#"l
Address t3 1o n 7 rLt- l-
Issued by Date:
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: oregon Law, oRS 701.055(1), requires restdential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement U"Qoru a building permit can be issued' This statement is required
"for resiiential buildiig, 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 1 and2, and either box 34 or 38
1. 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.
3,A'. My general contractor is
Qrlame) 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 certiff that the above information is correct and that I have read and do understand the Information
about C n Responsibilities on the reverse side of this form.
7-tt)47
of permit applicant)
(TVhite copy to issuing qgency permit file,
pink copy to applicant)
Notice to Property
(Date)
T
K
Informatloh Ndtiae to'Pfoireity Owners
-1 ) i\ r L@1, Ggnltluction Responsibilities
n,lp:' Tlti.s ltrfortntrtiorr .\rNkt:'Icr I'ro1tt,x1y'(htncr.s .thetil,('uttstrtt,-'liott Rasptm.sihilitit',s
'uloitrleve toprirt b1, tho tltltn.srritction ('nnt)tamu,:, Ri,i,,r,i itt rtrt:ttrdttttct tt'ith t )llS -l] L{)55(51
you can prcvcrlt rttarry prr:blcrns by be ing awart: qf.the foi.lorving;esponsibjlitt,Js and ar.eas ol.couccnr.
- ,i
. i', i:: i I , ,fffi1-OyE& RE$pOf,lSlBlLlTlE$:
constt't"lc'ion or inrprovernent o{'a reside.lial slrucfure^ v<lu rvill. in rriost in.'ru,,".r. r,,Jrri"a tn be an er.np}over.anii thc peopleltittltirerr'illhcelllpl()-\'ecs. Astheclrrplrrrer.-ttru:rrrrstiorn,lr *itt,,rt "f,rfilr,lr-,""
"': " " '- -"""'t'1"-''"
oregox'swithholdingtllllv: Asa,entplo'er.y'ornrustrvithholctincornetaxesfi.memployeervagcsatthetirrrsi:r.*pro"l.,ces
are paid Y*tr * iil be liable for the tax psy'ments even ify'or'don't *ctuafly ivirhhord the tax frorn your empr'.vecs. Fr:r rnoreinltrrmation. cail the Oreg.n [)ept. of Re'e,*e at 945-B0gl.
Unemplo;-ntent insurarce tar; As an e tnplo\ er. lou arc rcrFrirctl rr) pav a tax l*r unentpkr-v*rr:cnt insLll-ance pur.ilr,.)ses o, lhewtiges ol all etrlpir;\'*e s. Iror inorc infbnnation. cali rhe Oregon Hnrplovmenr l)epartrnen tat37|--3524.
ifiIffi:r,::ffi"TJ;il:,ffi;,l';;:fi::,:Jfrd,:Ifl,'-l;ffi,1t*kg:fii:3;i';::["j:;i:[ffilti:]lf[,X5,,Hilbt.?rY,,b,j,tillorg:l.t'li.t,u,?9w-illbeliable,forailclaim,costsifonei5'ouremployeesisiniuredorrtfeiob. Form.reinformario*-.
call the workers'Compensation DivTsibn at the Depdrtment of Consunier ano gudi?iits Sgr"ices'it 945:?'f gd: " ' ,
.
U'S' lnternal Revenue Sen'ice : As an emplcx cr. -\'\)u lrus[ \\ iihhold t-eclera] inconre tax &.o13r e nrplo.',ees,wages. you rvill be_liableforthetaxpayrnentevetl ifycudidn'lactuallyr.vithholdthctax. Forrnoreinlbrnratiorr.'eallthelnternalRevenueService
at l-800.829-1040: ,
OTHER RESPONSIBILITIES,AI{D AREAS OF OONCERNT, ,,,, , j. i
Codecompliance: Asthepermitholdorforthisproject.youarerespcxsibleforresolvingani taituretbinccrcoderequiremenls
tlrat ma;'be brought to your attention through inspections.
Liability and properlv damagc insurarcc: {lontact vour iuslrranca agenl 1o sec il'vou have a{equ:rle insurarice coverage for '
accidents apd ornissions such qs lalling tools. pailrt overspril-v, rvater ciamage tionr pipe pulctures. f-lrs, or rvork tl-r:it srust 5e
re-do11e.
:'I'irne to supervise ernploytcs: Make sure 3,c* have sxlficient time to sr.lpe r\ ise I our ernplovces.
trades. and to nbtiti tnrilding officials at the appropria{e tinres so the.v can perfon* the required inspections. ' : i
,i
If you have additional questions" rvrite or call the C*nstruc{ion C.ontrae tr:rs lloard (P() I}ox 1"} 140, Sa!*nr. OId 9730g-505:.
5031378-4621). 'Ihe Board is located at ?00 Surnnlr;r St" NIi Sili1e 300" in Salem.
prop-orvn.pm4
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