The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1997-11-26 .... ... tl . SPRIFIELD ", "" ~... ,l. I.. lO:.c,Wlnl' ZO'IH,y, and does not requIre ap,,;-cI.lC Lnd U~,J ;.; approval. . Zonina L.d-- V Data_ll- 2.(" ~ c,-, 225 FIFTH STREET 97 ~7"'7horizod Signatu~ ~ ELECTRICAL PERKIT APPLICATION SPRINGFIELD, OREGON 4 " rrc ''/ INSPECTION REQUEST: 726-3769 ~^ ~^ ~"^ City Job Number q 7. .5 7 ~7 OFFICE: 726-3759 Cl_ ~~ ~ ,-, '* ~-o~ ~ ~., 3. COMPLETE FEE SCHEDULE BELO\l 1. LOCATION OF I STALLAT ~ ~ ~ _ f<;;)'4 t1 1i1 ~'^ ~~ ~,A. Nev Residential-Single or ~ '0 -~ ~ Multi-Family per dvelling unit. ' I LEGAL DESeR! ION ~..o 01> ~ ~ Service Included:, 7 () ~1, LJ ;J 16 ( 70 :v-- ~!.-G>l ~ ~<<' I,tv-ems, Cost Sum ~ ~ (jl ~~' 4- JOB DESCRIPTION I ( , ' ~ ,\1 sq. ft. or less $ 85.00 'ff''6<;. ~, 0... wcu...Q ~r-pt- ~ ~ ~dditional,500 - () I \J ~'~5i-@.A or porOon Permits are non-transferable and expire -Qt elff $ 15.00 if vork is not started vi thin 180 days ' ~c ~anuf'd Home, or of issuance or if vork is suspended for Modular'Dvelling 180 days, Service or Feeder $ 40.00 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders Installation, Alterations or Relocation: Electrical Contractor , ,', , I Ii I City Phone 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to' 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Address Supervisor License Number Expi ra t ion Da te Constr Contr. Number C. Temporary Services or Feeders Installation, Alteration or Relocation Expiration Date 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts see "B" above Signature of Supervising Electrician Ovners Name, Oetll/Yl!;.. ,,)(dIe I1r .::rOh1160~ Address_ f:z t/ frJlJl-l 'L. V rv C. T, Ci ty s;: (J F i D , Phone '7 '-17- 7'fi1r Branch Circuits .' Nev, Alteration or Extension Per Panel O\INER INSTALLATION One Circuit Each Addi tional Circuit or vith Service or Feeder Permit $ 35.00 $ 2.00 The installation is being made on property I ovn vhich is not intended for sale, lease or rent, ovn~s~gnature: ~::~ DATE~-;(%-- '/tf7-------------------- RECEIPT'#: d~. ,1)0 RECEIVED BY: < E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE ~ cgS, -, 5% State Surcharge ~.rl~--=- 3% Administrative Fee ';>,5'-5 TOTAL n. q J, In:> il Permit #: Issued by: ~Z.4 YYlM~ (Vj), ~ Date: Address: 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: ~ I. 1 own, reside in, or will reside in the completed structure. ~2, 1136' 3A. My general contractor is I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, LL':L2!:b- (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. ,T=t- ~ e. '(; III <. -r OR D 38. 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~ crti 'that the above information is correct and that I have read and do understand the Information Notice to P p rty Owners about Construction Responsibilities on the reverse side of this form. I A1;f/17i~~ 10&/97- /'- '~ture of permit applicant) .(bate) ( (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners About Construction Responsibilities , ~ \ , . " ' \ Note,! This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction 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 aware of the following responsibilities and areas of concern, EIIIlPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing 01' 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 th'e following:' , Oregon's withholding tax law: Asan employer, you must withhold income taxes from employee wages at thetimeemployees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more infonnation, call the qregon Dep!. of Revenue at 945-8091. 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 infonnation, call the Oregon Employment Department 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, If you fail to obtain workers' compensation insurance, you may be subjectto penalties and will be liable forall claim costs if one of your employees is injured on the job, For more information. 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 forthe tax payment even if you didn't actually withhold the tax, For more information, call the Internal Revenue Service I at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: Asthe permit holder for this project. you are responsible for resolving any fai lureto meet code requirements that may be brought tq your attention through inspections, Liability and property damage insurance: Contact your insurance agentto see if you have adequate insurance coverage for accidents and omissio~s ~uch as falling tools, paint o\'erspray, 'yater damage from pipe punctures. fire, 01' work that must be re-done, Time to supervise ernployees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure fOU have theexpertisctoact as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify b1lilding officials at the appropriate times so they can perform the required inspections, i , , If you have additional ~uestions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621):' The Board:is located at 700 Summer St. NE Suite 300, in Salem, prop-own.pm4 1/94 .' ,.