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Home My WebLink AboutPermit Electrical 1997-6-27 :. .- . . The following project as f;ub!"rrttcd h....s th~ zonIng, and does not raCp..iir3 U;J':'O:"~ L .,111 approval. Zoni~ Ld.f2/ 225 FIFTH STREET Dm.(lln/~ SPRINGFIELD, OREGON 97477 AuthortzodSignalur. fJ Nt. INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF INSTALLATION 912.. ~c/~~ ~r LEGAL DESCRIPT~OI'} )703 2-3 4-~ 0.<:;;"C;0-0, JOB DESCRIPTION ,P,q..,2L ~ ~~.M?J ~~..o. Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY ,B. Electrical Contract~tJ.t'<f\Y\9( S\Qtt Address \ ~() '<-\me., 't1Hl_~ City f~"QQn~, p~one1~~.1t1~ Supervisor L~cense Number '?JC\~~ Expiration Date \ \). \. CVl Constr Contr. Number C\\o';if\~ Expiration Date \. ~~ .C\f! Signature of Supervising Electrician ?iJJtJ,~ Ovners Name ,Fz/.??...,IAPb- L'":<. Address City Phone 4~) - <'LZG ~ -, OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: ----------------~-- -;-~-------------- DATE: ?/ '77 RECEIPTli: 2." .s '" ( , RECEIVED BY: ..........- ....-.:- ....-.n-, ELECTRICAL PERMIT APPLICATION Ci ty Job Number ,9 7/J?'P-.,2- COMPLETE FEE SCHEDULE BELO\I . Nev Residential-Single or Multi-Family per dvelling unit. ' Service Included: 3. A. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dvelling Service or Feeder 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 1000 amps/volts Reconnect Only C. Items Cost Sum S 85.00 $ 15.00 $ 40.00 $ 50.00 ~6C:l $ 60.00 $100.00 $130.00 $300.00 $ 40.00 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 100u volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above Nev, Alteration or Extension Per Panel " Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightinv Limited Energy/Res Limited Energy/Comm One Circuit Each Additional Circuit or vith Service or Feeder Permit E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAl. - , $ 35.00 $ 2.00 not included) 'S 40.00 $ 40.00 $ 20.00 $ 36.00 50,&c A'/ z..&"'r> tr.:::J.~ _~-1:::~ VI r S"FIELD .. '." ,...... zon!n(!. U,11l,., U.....~:.> .1......'- .\.....--r "pprOVJ~o;;[r <J_W c~,Up]j-1- Authorized Signa\um~GAh-PERMIT 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF WSTALLATI.\lN Y Q'b, '~'1~ti~~' " JOB DESCRIPTIO/i j.l /JalL,r ,IV lJ D.A!--I'A.{/~ lloacl!-/1J Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. APPLICATION City Job Number 9'7 1)1- ~ t-- l COMPLETE FEE SCHEDULE BELOII ~ New Residential-Single or Multi-Family per dwelling unlt Service Included: Items . ~ost Sum 3. A. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dwelling Service or Feeder 2. CONTRACTOR INSTALIffION ONLY -r Elec trical Contrac torUi!JJt) j),A 1?4 Address 10, i~ "1/ h Ci ty _(/; 'J1~ Phone - O~, Supervisor License Number B. Services or Feeders I h (\ Ins talIa t ion, Al tera t ions ,1f.:f9 ~, or Reloca t ion: 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 Cf?(1 j(7" Expiration Date The installation is being made on property I own which is not intended for sale, lease or rent. Ovners Signature: ------------w- -- ---.---------------- DATE: 97- RECEIPT 11:. (Yl/l/ RECEIVED BY: - I- J1.1.-..UA.. $ 85.00 $ 15.00 $ 40.00 $ 50.00 $ 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 Constr Contr. Number () Expiration Date~!l let..- Signature~upervisin~el1rician JIAj kA(>--f({/,~ Owners Na:e .fFtlfure ~ Addres~SC!?::; ~i{V Pf>;f1r"" L ;\tL.--New, Alteration City E;u~Phone t,f<l~-3/7v O\INER ~STALLATION D. Branch Circuits or Extension Per Panel $ 35.00, One Circuit Each Additional Circuit or with Service or Feeder'Permit E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res --L-. Limited Energy/Comm 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 S 55.00 $ 80.00 see "B" above $ 2.00 not included) $ $ $ $ "2f).60 f- ()() ;) ;.'ffb 40.00 40.00 20.00 36.00 /' Toe fol/owing , ;",l/OJ anO"dProJ&ct as submitted h ',Jprov~1 oee not require .n~fflca., thde fol/owinS '( I"'^' nn Uso 225 FIFTH STREET Zoning tl( ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 917L42764__3/ -lktr1_ Q702 CJ ""':> INSPECTION REQUEST: ~~, City Job Number J' ~ ~ OFFICE: 726-3759 Aurhorizc'd Signature~ ~ 1,." LOCATION OF J;NSTALLATIOfh . _. I i'I. . =z..7~ J.1A<:!"~k~)<12 LJr~,' A. New Residential-Single or v ::::~::m::: ::~:::l:::O:ni t. . _1-1'lJ3~~crj[r(J S(r;()(j Service Included: Items Cost Sum ~ i I' S,~~D/EJc:rPTION V- lA,;)t~~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY I, Electrical Contractor Address Ci tv Phone ) I i ,i Supervisor License Number Expiration Date ,: Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name ~II' , Address 2278 N... to Ci tYSl";lA.~G..4Cj Phone "J~f. OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Ovners Signature: Y-o ~1~ ~Dt\~, ----~~---------, DATE: If) 1 u I r RECEI PTJn Or!J./J 'JVr1 .1'": RECEIVED BY: - ~~ 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular. 'Dwelling Service or Feeder B. 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 1000 amps/volts Reconnect Only $ 85.00 $ 15.00 $ 40.00 $ 50.00 $ 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 D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see liB" above New, Alteration or Extension Per Panel One Circui t Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL ~ $ $ $ $ ~O.OO I.f}(j ') IlJn L./.RtJ 40.00 40.00 20.00 36.00 iH21--- ! ~ ''" . . Pennit #: 97nL 9 <: Addre~ Lf7~ )uL d&glo ('dR, Issued by: Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residenlial construclion permit appli- canis who are not registered with the Constmction Contractors Board to sign the following slalement before a building permil can be issued This slatement is required for residenlial building, electrical, mechanical, and plumbing permits, Licensed archilect and engineer applicants, exempl from registNllion under ORS 70/,0/0(7), need.not submit this slalement, This statement will be filed wilh Ihe permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~. ,I own, reside in, or will reside in the completed structure, D 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 k~ ~.t.~ (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, D OR I her.ebycertify that the above information is correct and that I have read and do understand the Information N,ti~ ';0:'" Ow,m ,"",' C'M'roct'" R"p",'bUi""" <bo ""'" ,ido ,hbi. C"m. .^_. ~~f.\(' /\. b-ID-?7 (Signature ofp~it applicant) (Date) (White copy 10 issuing agency permit file, pink copy 10 applicanl) . . r . \ ... Information Notice to Property Owners About Construction Responsibilities Nole: This lnforrnalioll NOlice 10 Propert)' Owners aboul Constl'l/clioll Responsibililies was developed by Ihe Conslruction Contractors Board in accord(rnce wilh 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. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential struciure. you will. in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, youl11ust coinply with the following: Oregon's withholding tax law': Asan employer, you must withhold income taxes from employee wagesatthetime employees are paid. You 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 Depl. of Revenue at 945-8091. Unemployment insnrance 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. I fyou fail to obtain workers' compensation insurance, you may be subjectto penalties and will be liable for all claim costs ifoneofyouremployees is injured on thejob, 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. y,?u must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actuallywithhold'the tax, For more information, call the Internal Revenue Service at 1-800-829-1040. . OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder fOl'-this project, you are responsible forresolving any failureto meet code requirements that may be brought to your attention through inspections. Liability and property damagc insurance: Contact your insurance agent 10 see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. 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 theexpertiseloact as your own general contractor, to coordinatethe workofrough-in and finish trades. and to notify building of~cials ai the appropriate times so Ihey can perform the required inspections. . If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309-5052, 503/378-4621). The Board is located at 700 Summer SI. NE Suite 300, in Salem. prop-own, pm4 t/94