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Home My WebLink AboutPermit Electrical 2008-11-26CITY OF SPRIN F'[ELD, OREGON E#ZON DATE SOURCE225FIFIHSTREET. SPRINGFIELD,OR97477 o PH:(541)726-3753 oFAX:(541)726-3689 E LE CTRI CAL P E RM IT AP P LI CATI ON City Job Number afi- - /a/ L/Date 1. I.OCATION OFINSTALI,A'I'ION: Z'lD'/ tt 16lt'/ <^',' "{;;ll ltl 3. COMPLETEFEESCIIBDULEBEI,OW LEGAL DESCRPTION. 7 7 '9 TTI A. New Residential - Single or Multi-Family per dwelling unit. JOB DESCRIPTION: Service Included 1000 sq. ft. or less - .Each additional 500 sq. ft. or L%Wthereof Each Manufact'd Home or Modular Dwelling Service or Feeder 2. 00NTRACTORTNSTALT'ATTONONLY B. Services or Feeders - Installation, Alterations or Relocation Permits are and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $121.00 822.00 $s7.00 Electrical Contractor \- Address Phone Supervisor License Number Expiration Date Consh. Conh. Number Expiration Date 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 601 Amps to I Over 1000 olts New Alteration or Extension Per One Circuit Each Additional Circuit or with Service or Feeder Permit City + $ 86.00 $143.00 $186.00 $426.00 $ s7.00 $ 50.00 $ s.00 5f-f"' Only C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less $ 57.00 201 Amps to 400 Amps $ 79.00 401 Amps to 600 Amps $114.00 Over 600 Amps or 1000 Volts see "8" above. D. llranch ('ircuitsSignature of Supervising Electrician Panel .1- Owners Name Address fi/E. Miscellaneous (Service/feeder not included) -Each Installation City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Phone 6ra-l Pump or irrigation $ s7.00 Sign/Outline Lighting $ 57.00 Limited Energy/Residential $ 29.00 Limited Energy/Commercial $ 52.00 Minimum Electric Permit Inspection Fee is $52.00 * Surcharges 4. sLrBT'O'.tAL OP- ABOW| l2oh State Surcharge l0% Administrative Fee 57o Technology Fee 7s5 55'u ?6u-9/qE -----------.---v ' 'l') Inspection Request: 726-3769 TOTAL Shared Drive(T:/Building FormVElectrical Permit Application 7-08.doc / f,u1 ru Construction Contractors Board Permit 700 Summer St I\E Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 lYeb Address; rvrvrv.ccb.state.or.us Address://" Issued by:(c Date:) Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 7 0 1 .0 1 0(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate btanks and initial boxes I and 2, and either box 3A or 38: Kt, 5(t, tu I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instruct my general conhactor that all subcontactors who work on the structure must be licensed with the Construction Confractors Board. OR 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the nzlme of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice io Property Owners about Construction Responsibilities on the reverse side of this form. &0 (Signature of permit applicant) (White copy to issuing agency peffnitfile, pink copy to applicant.) I Property_owner.doc 06-0 I -04 o Acting as hur Swn $eneral Cdfttractor? , '**,,r,,1 INFORMATION. NOTICE TO PROPHRTY OWNER$ ABOUT CON$TRucrIon ; RESFONSIBILITIES Ifyou are acting as your ccnskuct a nc\v home or rnake a substaxtial improv"ernmt to alt cxisting structure, you can prevent many problems by bein! aware of'the follmring respousibilities and concerns Emplaysr Re$ponsibilities You will, in most instanceq be ruled to be an "eurployeri' and the contractors you contract with will be "employees" if you rls€ conffactors not licensed witf $e Cqnstruction Contrac{ors Board to do labor,in conskuctrng or to 4ssist in the coastruction or iryprovempnt of a resi$ential strqeture. As the employer, you must comply witk the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid" Yor-r will be liable for tire tax payments even if you don't actually withhoid the tax *om your employees. For more information, call the Departrnent of Reveirue at 503-3784988. Unemployment Insurance Tax: As an employer, you are.teQuired topay a tax,f,or une'nrployment insurance purposes ' on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (Bff.D is a combined number {br bcth Oregonr Witrhholding andUnemp1oymentInsuranceTax.TofileforaBIN,call503-945'8091orforthe appropriate forms. , -l .-iWorkers' Compensatiop Ilrsuranee: As an employer, you are subject to the Oregcn Workers' Compensation Law, and must,o-bt1in workgrs' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties andbe liable for all clairn costs it'one of your empl*yees is'irijured on the job. F'or mcre information, call the Workers' Compensation Division at the Department of Consumm and Business Selices at 5A3-947 -7815. LI.S. trnternal Revenue liervice: As an empiayer, you must withhold &deral incorne tax lrom employees' wages.' You ivill be liable ftrr the tax payment even if you didn't actualiy withhold the tax. For a Federal EiN nur*ber, call the IRS.at I-800-82t4933 or vi*it their web site at..raElvw.irs,coy. Other Responsibilities and Areas of Ca:rcerns Coc&e Complixnee: ,{.s th* per-mit h*}d*r tbr this pr*ject, yt>il are resp*nsible for r*solving *r:y traitrure t* rrreet c*de requirements that may be br*ught to )aom attention through inspections. Liability and Froperty Damage trnsuraice: Contact your insurance agent to see if you bave adequat* insurance coverage 1-or n**i*ients a*d *r:r:iis*lanx s**h as fatrling {*r:ls. paint over spr.}y, water d*miige {r*:x pip* pun*fures, fir* *r wrrk that must be redone. Time:Makesureyouhavesufficienttin:etosuperviseyouremployee$,]'...j Expertise: Make sure you hdvi t'*Uttt to act as your own g*iiaibonilactor, to'boordinate the work cf rough-in and finish trades, and to notify building officiais as the appropriate times so they can perform the required inspections" If you have tdditional questi*ns cali t-}re Constr-ucti*n Confraetors Board {503-iT846Zi) or write the agency at p0 Box 14tr40, Salem, OR 97309-5052. Properfy_owner. doc 06-0 1 -04 NOTE: This lnformation Notice to Propedy Awners about Construction Responsibilfres was devetoped by the Construction Conlraelors Baard in accordance with ARS 7fi.455{5), passed by the 1989 Aregan Legislature. 225 Fifth Street Spriugfieltl, Oregon 97 477 541-126-3759 Phone c'*v of Springfield Official Receipt ^ t,elopment Services Department Public Works Department RECEIPT #: 2200800000000001682 Date: 1112612008 1:25:23PM Job/Journal Number coM2008-01714 coM2008-01714 coM2008-01714 coM2008-017r4 coM2008-01714 coM2008-01714 Description Building Permit Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + lz%o State Surcharge + lUYo Administrative Fee Amount Due 52.00 50.00 5.00 5.35 12.84 10.70 Item Total:$13s.89 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check JEFFRY BOWLING cjc 4547 In Person Payment Total: $13s.89 -siB8E. cReceintl Page I of I 1U2612008 *FruH{IMNL$