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Home My WebLink AboutPermit Electrical 1998-2-20 . Ilon'71 t .c, ~ 2b irl~ '-NO?\'- - 225 FIFTH STREET Aulhoroad SIgnaIu~nI\ 'C,f..pr. \~ - r .Rr.<I'R\1I~lr. PERMIT APPLICATION SPRINGFIELD, OREGON 97477 ~O ~\i SrliI-\.\. rllS ?~~~r""~ q ('J J Of INSPECTION REQUEST: 726-3769 irllS?1:.1'\ I:.OIi~O~~i ~O~~gOb Number l( 62 / OFFICE: 726-3759 liirlO~I! ~ IS iI-'OflI flI c~C~O ~. COMPLETE FEE SCHEDULE BELOII ~ 1. LOCATION OF INSTALLATION CO~~.. :'( ?~~IO\J, tJ, (l Q$ /lfR-.:,U &71; ~\>/ ,~QOP>. A. New Residential-Single or I ~ . Mul ti-Family per dl<elling uni t. ' ~~~P1'~tj,,~{)D Service Included: I -, U/-::>d-'i , U()j( Items Cost -Sum JOB D,ESCRIPTION, ....;... / ~ 1-!J41:{ri U)J-q.P /t::;Ya& .~~? 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 Electrical Contractor c:;,~LP , Address c:; Jtt Ue City Phone Supervisor License Number' Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician The installation is being made on E. property I oyn yhich is not intended for sale, lease or rent. Owners Signature: \ ~~ _______________________________________ 5. DATE: 0:2 -,J-o - r y RECEIPT 1I: 7ti~ ./7/ . ~ I.. RECEIVED BY: _ I~"-<<-L/ 1000 sq. ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home. or Modular 'DYelling Service or Feeder $ 40.00 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 $ 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 Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightin~ Limited Energy/Res Limited Energy/Comm SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 , $ 55.00 $ 80.00 see "B" above " Panel jS.o~ $ 2.00 D V I /L D. pranch Circui ts Owners Name rp...t?/~ /""'/ i]E..-h.t?\t:;;CflJ zt I /7- /: '~ Ney, Alteration or Extension Per Address f?/'?'-h uJ4./ 11./ -//. 7/ .. I' v/' One Circuit \ $ 35.00 Ci ty _~h t%:.C?-r-LPhone.:z~~- 27.6 &' Each Addi tional I' ~l Circuit or with Service o INSTALLATION or Feeder Permi t not included) 40.00 40.00 20.00 36.00 $ $ $ $ 3<;.60 /. r--, / 'IJ~ . '-< /. '6U ' . Issued by: . CJ 'i< OJ- / Cj L/ fDY rn~ 5tre;;t ~. m ~ Date: 2!d-qrj ~.-.... . Permit #: 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 Ihe Construction Contractors Board to sign the following statement before a building permit can be issued. This stalement is required for residential building, electrical, mechanical, and plumbing permits, Licensed architect and engineer applicants, exempt from regislration under ORS 701.010(7), need nol submit this slalement. 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: 8 D 1. I own, reside in, or will reside in the completed structure. o 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. My general contractor is _______ _ _~ _ """"-(Name) ~ctor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. 3A. 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! 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 Constructi n Responsibilities on the reverse side ofthis form. & ---' ~nature of permit applicant) (White copy /0 issuing agency permit file, pink copy to applicant) O:l-d/J --'1f (Date) . . .: ..~ rrru~oi'mill~ion Woi:ice ~o P~ope~ Owners .. Afqio"-'l\~ CO!l'Os~n.8c~iol1 Responsib~~Bi:ies NOIe: This [nforn/alion NOli,:-'e to Properly Owners ahou/ Conslruclion Responsibililies was developed hy the Cons/tuction ('on/rac/ors Board in accordance l1'ilh ORS 701,055(5;. If you are acting as your own contractorto 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 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 the following: Oregon's withholding tax law: Asan employer. you must withhold income taxes from employee wages atthetimeemployees 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 Dept. 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' compeusation 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 subject to penalties and will be liable for all claim costs ifone of your employees is injured on thejob. Formore infonnation. 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. Formore information. call the Internal Revenuc Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder forthis project. you are responsible for resolving any failureto 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 adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. tire. 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 work of rough- in and finish trades. and to notify building officials at the appropriate times so they 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 St. NE Suite 300, in Salem, prop-own. pm4 1/94