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Home My WebLink AboutPermit 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