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Home My WebLink AboutPermit Electrical 2003-7-8 ~ ~/~:~,l ;'" ';;"CrrY'OF S~JINtiFIELD? OREGON " "0' . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FM1~MJ,IJJ9r~li@llassubmittedhasthefollowing ELECTRICAHERftlIT APPLIC11ION zoning. and does nol require specific land use City .lob Number VJ m ()(fJ'?-Drf/lJO Date 1-- 0"-03 approvalzOning LD{L . .., -"l-O~ --r<vJ COMPLETE ~SC;-;EnULE bBLU W I. LOCATION OFINSTALLA110N .2:/0 10 ('(J c /{itJ UP. ?/JJ!.kf LEGAL DESCRIPTION --1-7 tJ 2.. '?'Lf-./ () 110/ .lOB DESCRIPTION 3. Authorized Signature A. New Residential - Singlc or Multi-Family pcr dwclling uuit Service Included /()6,d"O 76.()O 1000 sq. ft. or less Each additional 500 sq. ft. or ponion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106,00 l----" 4- r;rx (~/ilR~) Permits are non-transferable and expire If work is not started within 180 days of issuance or if work is Suspended for 180 days. $ 19.00 $50,00 CONTRACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: 2. $ 63.00 $ 75.00 $125.00 $163,00 $375,00 $ 50.00 Electrical Contractor 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpslV oIL. Reconnect Only .~ .~ ~OT'CE: ORK Addml'S g~QM'T SHALL EXPIRE IF THE 'foJ.. AUTHORIZED UNDER THIS I't15MI1 I;) "Jr CitYcm~~FNCEO OR IS A:lW@ONED FOR ANY 180 DAY PERIOD. . - c. Temporarv Sl'rvices or Feeders , J ~ " . Supervisor License Num r AI II-.'J !IUN:Ur 'gon law requIres you to EXpifll!ionrDate, a,'voted bv the Oregon Utility Noiitlc:';lion GC)nter. Those rules are set tort: G:oriSti, .Gon". umber:J1 0 throu~h OAR 952-001 009U. Y',u may obtflin copies at the rUles o~ Expirati' I Clare3 center. (Note: the telephone n~mbe~ for the Oreqon Utility Notification Signature of(Supet:\'lising Electrician.2344) . 'If""" 1<:' .-uvv-vv'"' . Installation, Alteration or Relocation 5"D~ v 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 Owners Name ~~a ~_lih flK&i~ AddressfJ n l.Xl.!/...-1oJJ ifl. . ,City ~fl- crL ~ 9iL?r JRE OWNER INST:tL~~{ON l~ J'I-r5Jir! $ 3.00 E. Miscellaneous (Service/feeder not inclnded) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited EnergylCommercial $ 50,00 $ 50.00 $ 25,00 $ 45.00 The installation is being made on propeny [ own which is not intended for sale, lease or rent. Minimum Elcctric Permit Inspection Fee is $45.00 + Surcharges ~~I!~ 4. SUBTOTAL OF ABOVE ,.X?? 00 10 }-r 2-~ ,2<:> 22/,14 7% State Surcharge 10% Administrative Fee Inspection Rcqucst: 726-3769 TOTAL Shnrcd Drivc(T:)/Building Fonns/EIl.'Ctric:11 Pcnnit Applicatioll j.OJ.doc · Ccfnstruction Contracttt Board e. , , . . . , . , " " , . 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 . , Web Address: www.ccb.state.or.us Penn it #: U 't ~a:?f~ Address: 7 (;,/D ,PIc.~.pi!/~ ~ Issued by: , /~:. Date: 'MAl 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 a building permit can be issued. This statement is requiredfor 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: ~l. X2. 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 On completion. ~ 3A. My general contractor is 11wi3- ./tu/CAAJ - (Name) 1/7{)''ft- (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 6/L=r: ~ 38. I will be my own geRer!l! contractor. IfI hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. IfI 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 he;A Y;:ify that the above information is correct and that I have read and do understand the Information Not(J&i:i7f ~ion Responsibilities on the reverse Sidl~y~}13 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) prop-own/f/3-99 . . ,...... .;. '\ Rnformatipn,:,Notice to Property Owners Ab<<;,uJ Co~~truction Responsibilities '. ., Note: This In/ormation No/ice 10 Property Owners about Constru('tion Responsibilities was developed by the Constrllction COlllractors Board;n accordance with ORS i(]/'()55(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 concerns. Employer Responsibilities I f you hire persons not registered with the Construction Contractors Board to do labor in constructing or 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 c~mply with the following: Oregon's withholding tax law: As an employer. you must withhold income taxes from employee wages at the time employees are'paid. You will be liable.forthe tax payments even if you don't actually withhold the tax from your employees. For more infonnation. call the Oregon Department of Revenue at 503-945-8091, 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 information, call the Oregon Employment Department at 503- 378-3524, .! Wnrkers' compensation insurance: As an employer, you are s~bjeC! 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 subject to penalties and will be liable fo~ all claim costs if one of your employees is injured on the job, For more information. ~all the Workers' Compensation Division at the Department of Consumer and Business Services at 50J":l4,7-7aI0. ". U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even,if you ,didn't actliall.y withhold the,tftx. For more information, call the Internal Revenue Service at 1-800-829-1040. Other Responsibilities and Areas of Concerns Code compliance: As the permit holder for this project. you are responsible for'resolving any failure to meet eode requirements that may be brought to YOllr attention through inspections. . . Liability and prnperty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray. water damage from pipe puncturcs, 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 wo~k of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required , . , 1I1spectJons. If you have additional questions, write or call the Construc.tion Contrac!ors 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/f/3-99