HomeMy WebLinkAboutPermit Electrical 1996-11-12
I
.
.
. The, following project llS r.LJbmfH'f'lcI h..... h '
zoning, and doe" "of r . ~ '. ......t.o ~0r;(~V.
approval. oj " sqUire speCifIC bnc! :.i'::C
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
, Zoning L tJ V
97477 .
72653169/J.. - L~ Y
AUlnorlwd Slgnatu/s tV 'M
3.
1. !,o{~TIM. OF. INSTJ\L!.l\TION .I.-
lC)lo Q,LV'\ 'J*,l(f_e--",
LEGAL DESCRIPTION
J/~"5-~~--~j/.. 6e,/7b 2
r
, JOB' DESCRIPTION '
/~?'W~ ~ ,/]-tt-rc, ,4wji '--:0;.:
. ""',..l,.l"
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
Address
City
Phone
Supervisor License Number
Expiration Date
ELECTRICAL'PERHIT APPLICATION
City Job Number qlpl/)lti1 ),
G<lHP-[ 1<1'1< Ff.E SCHEDULE BELOII ~
New Resi4ential-Single or ~
Multi-Family per dwelling ~nit.
Service Included:
A.
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
Items
Sum
Cost
$ 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
Constr Contr. Number
Expiratio~ D~te '
Signature of Supervising Electrician
Owners NameC1'l\.v \p~A-7(h,UC\.AJ~
,Address,~~;3\ ) p$ '. f2tDCo...~f' (,~"
'City~ \ V\~~\~\~hone1~lPc.7 \~ 0
O\INER INSTALLATION
The installation is being made on
property'I own whi~h is not intended'
for sale, lease or rent.
~~~:~~-~--------------
DATE:_ //./~--9t::.
RECEIPT #: '2'37~~
RECEIVED BY: /j~;~#'
200 amps' 'or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 am'ps $ 80.00
Over 600 amps or 1000 volts see "B" above
D. 'Branch Circuits
"
New,. Alteration or Extension Per Panel oQ
" $. 35.00 1f5 'Y
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
. One Circui t
Each Additional
Circuit or with Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative F~e
TOTAL
$
2.00
not included)
. $ 40.00
$ 40.00
$ 20.00
$ 36.00
~5.@
1.1"'1,
.~'
T
.
.
Permit #: q/ /0"'7"''9-
Address: /'!>" ~A/
Issued by: ~~
'/p?,r'
~,?'- .
,
Date:
P-p-~L
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction penn it appli-
cants who are not registered with the Construction Contraclors Board to sign the
following statement before a building pennit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing penn its. 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 pennit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
I.~eside in, or will reside in the completed structure.
[I]
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.
D
3A. My general contractor is
(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 cerf that the above information is correct and that I have read and do understand the Information
N.dre .. p, brly J ""1 Co~ln"d.. "'po~;b,"d~ .. tb. re~~ ,id. of tbi, '..m.
Jd lA \ ).;'(} m 0 A _ J (- ) 2 57 (~
, - .
~ ignature of permit applicant) (Date)
(White copy to issuing agency pennitfile,
pink copy to applicant)
.
.
~
][1I'1!~iOI~mEl~itOi1l NiOI~DiCS to Puoopefity Owneuos
A~~~~ (Cl!:);lI'1!s~mc~Dm'il Respoi"isobilities
"
Note: This Information Notice to Property Owners aboul Construction Responsibilities
\Vas developed by the Construction Contractors Board in accordance with 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.
EMPLOVIEPl ~ESPONSIBllPJlES:
If you hire persons not registered with the Construction Contractors Board to do labor in constmcting or assisting in the
constructipn or improvement (,r 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:
~rego,! 's with:'0!t::illg tax (ew: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You v. ill be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unem;Jloyment ::-s:mmce t~m: As an employer, you are rcquired 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 Resources
at 378-3524.
Wo:-;,ers' campcfisation im!Crance: 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 may
be subject to penalties and wiil he liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensadon Division at the Department of Consumer and Business Services at 945-7888.
U.S. !ntc:oIul Rcycnue Serv;c:l: 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 more information. call the Internal Revenue Service
at 1-800-829-1040,
ml';:EPI ~IESPONSIBI!LITIES AND AREAS OF CONCEc:lN:
Code com;>;iance: 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.
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, 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 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