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Home My WebLink AboutPermit Electrical 2004-10-3 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps .'1 601 Amps to 1000 Amps Phone 14 \ .\., $(.,0 Over 1000 AmpsIVolts Rec=~~ ' , 'on lalllfeClUII"" If~t ' E~\"ION:O~9 ""- -""""=-,,,,' A.TT '''', _ ~(\ted b'l ."em ,8.. ces>.pr~F~aer tollo'H ~ enter. ,."ose,:nt\.O~~_~52'0 Expiration Date ",o\~I~~ ~<'l1..QQ10 \h1O~~~Dion or Relocation ~OA.'" ~",.. w- obtain COP~~~\lQfi\e S 50.00 Constr. Contr. Number / Q09O. '(OU\~:~n!er. ~Not~.~ i\i{'fllWtili4lllt~ps S 69.00 / call"'" r'~tneQregon \.~tp6ooAmPS SIOO.oo E . . D nUl'lIberto. 800' i!.. xpll'3l1on ate :l!~.~5 ,- Over 600 Amps or 1000 Volts see "B" above. Signature~ervisingElectriCian D.~~~~r~.~~~~A~ New Alteration or Extension Per Panel One Circuit I S 43.00 Each Additional Circuit or with Service or Feeder Permit 1. ~Ve;rTION:'OB1:Ns~TI6N_~ ~...~",_,.-~.;:.t'"",~~_",M'.~" ,...-..t~~~ 52. \ M ,4-l,..uNl.. ~ /tV iF LEGAL DESCRIPTION 1/03"2."2.13 0") l{OC\ JOB DESCRIPTION IIb\'> C. l a.L-'-A.;- +- . 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 ~eoNTiOC, -crO,IDIN., '~'SL,~ONE~ . ~k~~~~~ ~ ,- ~~.~ Electrical Contractor Y,ooo..r -\.-.1. 0 IN Y\ C"'- Address S'2 I VV\ (J... \ ,,^-r ci ~v<L. City 'Sp.f-\ cL Supervisor License Number Owners Name [; S A (v/Ete. qE'^- Address 5 z.l 1M ,4-[(.Art-d . Ave City Sf>r=-", Phone 7'-1/- btbO OWNER INST ALLA TION The installation is being made on property I own which is not intended for sale, lease or rent. ;sr;:m~ Inspection Request: 726-3769 Date, 3. -'COMPi;;:.Ic.EEEiSl.nwdLE:f.8Et(tfwi~. ,. " ." .' . _, '. . . . _,~ ~ .'" - ..~ "I A.g~~~~~~~nit; ~tWf{~aded t 1~t WOR\{ ~k,.\-I~llt'k?IRtl ~~600 El~~ltt'J1ia doa\~~~01\-1IS \,cnil.\1 ~R . .",,j<,.. - 0 OR IS ~BM~f\O~tO t S 19.00 ~h\~U~.&tffi~dU~~~O . M~I;r~II~lSel'Vlce or Feeder S50.oo B. ~~~,J:.VI, '~..~~ri~Wfft~r~~l~ ~""'"".~.~ Mi~1I7',;:.~i~......t:l~~"~"~~'~"~~~ . -', ^ S 63.00 S 75.00 S125.OO S163.00 S375.00 S 50.00 '-13 S 3.00 E l'i~>h'llii-:.~~ve:~-~~(S;~,'~r;'ke:l~,"~~,'-t':.._i.~"l-'" d,-j~"J')'\i-:;'~,,~~~,~~,,~, . . . ce !leo~w ~.~Ct:HeeU.er:\n~",j~!=.a"eu ~J!i~,~'~llD~.at10I Pump or irrigation S 50.00 Sign/Outline Lighting S 50.00 Limited EnergylResidential S 25.00 Limited Energy/Commercial S 45.00 _ Minimum Electric Permit Inspection Fe~ Surcharges 4. m;;'~;Ar;,""':#Or,ABOVE~,' . ',.- ~~~~""..:..~~r"..."-.1:;"~. _ _ '. L() 7% State Surcharge ":3 I r 10010 Administrative Fee '1 )0 r~~) TOTAL Shared OrivdT:)lBuildim;r; FonnslEIcctrical Permit Application 1-o3.doc -; .... l '. " ", ." . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit#:COI41l-0_- o-G-/7 r Address: S Z ( j/I'1,4-l.(,.A,(Lh Issued by: '""h (f Date: /O-J-<:-:, )~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed 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 licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the "pp.up.;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: W'l. @ 2. 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. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR W 3B. I will be my own general contractor. If! 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 notifY the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to, Property Owners about Construction Responsibilities on tbe reverse side of tbis form. /~0I7k'~ _ v (Signature of permit applicant) L-J . 2 S- oS- (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 A(Ctnmig' ~~ ~ INFORMATION NOTICE TO.PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES <<1\llJi"'OWllll <GtellllteJr~ll C!tJr~(Ct~])Jlo? , - . ,: t' " NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. 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. t' Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if :;' you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the foUowing: 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 for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpose's- . on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htrnll for the appropriate forms. 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 could be subject to penalties and be liable for all 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 503-947-7815. 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 actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. , Otllner lResjpOlll.silbiRWies 2D'lldl Areas of Concerllls Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adcquate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. ' Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills io act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 06-01-04 225 Fifth Street . ." . , . Springfield, Oregon 97477 541-726-3759 Phone . ~! """'ity of Springfield Official Receipt .ve1opment Services Department Public Works Department Job/Journal Number COM2005-00478 COM2005-00478 COM2005-00478 . COM2005-00478 COM2005-00478 Payments: Type of Payment CreditCard , 'l " 'J ': ( . 10/3/2005 RECEIPT #: 2200500000000001365 Date: 10/03/2005 Description Building Permit Add, Alter, Extend Circ Minimum/Adjustment Electrical + 7% State Surcharge + 10% Administrative Fee Paid By LISA METZGER Item Total: Check Number Autborlzation Received By Batcb Numher Number How Received djb 891291 In Person Payment Total: '. . . _t I . .. ~ ... Page 1 of I 10:38:50AM Amount Due 52.80 43.00 2.00 6.85 9.78 $114.43 Amount Paid $114.43 $114.43