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Home My WebLink AboutPermit Electrical 1996-7-31 .j , J " The following project as aubmirt sea IOWln zoning, and does not requIre specific land use approval. ' Zoning 4\ ~ Dote~ , 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 'I. LOCATION OF INSTALLATION _!4tJ2S ~, 9 7 41>~hol1zad Slgnatur. 726-3769 LEGAL DESCRIPTION /? ~~"2. -~c./-'":?"3 . LV/a:> " JOB DESCRJPTION /If? / L/~/',,",/r- ,. Permits are non-transferable' and expire if york is not started'vithin 180 days of issuance or if york is suspended for 180 days; 2.' CONTRACTOR INSTALLATION ONLY Electrical contracto~~~~~ Address City Phone ~upervisor License Number Expiration Date Constr Contr. Number' Expiration Date Signature'of Supervising Electrician Ovners Name.v.4nUe- c:;,~..s. /l?t2.U1 - &f- Phone 91/1-7g-// Address /~O 2.5:" City_<-,.,t:'(rf. , OYNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sale, lease or'rent. Ovners Signature: . ' ~K~ ~~~~. --~~-~~-~O~&;----------------- . RECEIPT #: ?? c..P1"fJ RECEIVED BY: ' //~ // ~ ELECTkICAL PERMIT'APPLICATION City Job Number 3. COMPLETE FEE SCllEDULE BELOII A. Nev Residential-Single or Multi-Family per dvelling Service Included: Items 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dvelling 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 t9' 1000 amps Over 1000 amps/volts Reconnect Only ?.6/~~~ * uni t. Cost Sum $ 85.00 $ 15.00' $ 40.00 S 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 "Circui ts $ 40.00 $ 55.00 $ 80.00 see.IIB" above , " Nev, Alteration or Extension P~r Panel One Circuit / Each Additional Circuit or vith Service or Feeder Permi~ J $ 35.00 ~... $ 2.00 60 "2. 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 5% State Surcharge 3% Administrative Fee TOTAL -:>7. ~ /: 85"" . . ~ -'" 1.1/ ?"7 fC.:'">-, . . '?9 .'1~ -"'1--'~ ." --". J ?~ ~,; , ,1'" . . Permit #: 96/~"3 ~ Address: ~ <::>.:?5h?#/~ ~;7 - Issued by:r-. Date: 7 -76-~ 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: [ZI o 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D 3A. My general contractor i~ (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. OR ~ 3B. 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 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 the reverse side of this form. C)~ HP~ , 7<46--% ~gnature of Pem.;it applicant) (Date) (White copy to issuing agency permitfile, pink copy to applicant) ..' , . . "\ , ][U1J~iOl?M~~aOlIl"U N@~~cs ~~ ~L':IlJ~e!J\(Y OWTieTS . Afo)@(.'~ iC@Til$~fi!l~~[ildJWil ~e$~:OIJ'1SJ~[Q)D~~~E~~ Note: This Information Notice to Property Owners about Construction Responsibilities .. '. ... \vas deveLoped by the COllstruction COlltractors Board ill accordance with ORS 70/,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. IEMP~.O'fIEPJ ~IESPCNSlBiUVi~S: If 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 peoplc you hire will be employees. As the employer, you must comply with the following: Oregon's wit.'iliold!r.g tax !llW: 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 t:u from your employees. For more information, call the Oregon Dept. of Revenue at 945-809 I. Unemployn:2:lt insun:nce tllx: 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 Division at the Department of Human Res('urc~s at 378-3524. Wod,ers' compel'.sation il'.5~mmce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your cmployees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be I iable 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 945-7888. V.S. Inwrnal RevenGe Service: As an employer. you must withhold federal income tax from employees' wages. You will he liable for the tax payment even ifyoo didn't actually withhold the tax. For more information, call the Internal Revenue Servic~ at 1-800-829-1040. OY;-iIER RIESPONS!B!LIT~:ES AND AREAS Of" CONC!EiRl\l: Code compJ:ance: As the permit holder forthis project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liabili~y and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time :0 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 work of rough-in and finish trades. and to notify building officials at the appropriate times so they can perform the required inspections. ._ . '. ....,.. 1 If you have additional qu~stions, write or call the Construction Contracters. Board (pO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in S~lem. '. prop-own.pm4 1/94