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Home My WebLink AboutPermit Electrical 1996-8-1 \ .' -. . The following project as submitted has the folio zoning, and dOGS not require specific land use approvaL ZOning--1-~ 225 FIFTH STREET Dclej.' I. tilL SPRINGFIELD, OREGON 97477 " " INSPECTION REQUEST: 726_:fYll"9",zed Signature OFFICE: 726-3759 1. LOCATION OF INSTALLATION <,I7~ P/Hd=P.Al'~tF' AtV6: . LEGAL DESCRIPTION I ?"It!?~'"2 2..- c,I~ _ o':::,:;,!e'2.. JOB DESCRIPTION E.r~Dd)":l #a:> :2 c:/~/?""5 Permits are non-transferable and expire if york is not started yithin 180 days of issuance or if york is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor 4....;..; ~ . c,....--~. , - . Address City Phone Supervisor License Number Expiration Date CanstI' ContI'. Number Expiration Date Signature of Supervising Electrician Oyners Name l)~s-' ~ Address )/'/6 lP/A/tS.I?A~ ~e . City ~_(!)7?Phone / OVNER INSTALLATION The installation is being made on property I oyn Yhich is not intended for sale, lease or rent. ~zaff~~~_______~__ RECEIPT jl: 'it ::l?6 Y ./1 -n~ ELEcrRICAL PERMIT APPLICATION ~ :i t) Jab Number 9b~::::>-:::> 3. COMPLETE FEE SCHEDULE BELOV A. Ney Residential-Single or Multi-Family per dyelling unit. Service Included: Items Cost Sum 1000 sQ.ft. or less Each additional 500 sQ. ft or portion thereof Each Manuf'd Home, or Modular 'Dyelling Service or Feeder $ 85.00 $ 15.00 $ 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 $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ "80.00 Over 600 amps or 1000 volts see "B" above D. Branch Circuits Ney, Alteration or Extension Per Panel One Circui t / Each Additional Circuit or yith Service or Feeder Permit / $ 35.00 ?~ $ 2.00 "'2. E. Miscellaneous (Service/feeder -Each installation - Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee $ 40.00 $ 40.00 $ 20.00 $ 36.00 ~,?pe> /.~S / .// ~q.9~ 'T'()I'T"^T , , . . Permit #: 9~~7 '/ Address: y::>c. h#'EZ)~~ ~ ~~ate: B-/'~ Issued by: 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: [K] D 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 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 ill 3B. I will be my own general contractor. E'LC'-//'I/~ ~~ . 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. ~~~__ 57-/- 76' (Signature of permit applicant) (Date) (White copy to issuing agency permitfile. pink copy to applicant) f . . " ][U'iJ~((j)G'm~~i@tt'i ~@~n(C~ ~@ ~m[Ql~~l' OWU'DSIi'$ t\fOJ@:!.ii~ <<:;@1I15~W~~[@U'D ~~$[Ql@In~~St~Jn~kl')$ Note: This Information Notice to Property Owners about Conj'/ruction Responsibilities was 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 makc a substantial improvement to an existing s.ruelure, you can prevent many problems by being aware of the following responsibilities and ~reas of concern. EML"'WV[;~ ~1t:~LoONS~k.mJ':i':}:S: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisli~g i~ the construction or improven\ent of a residential structure, you will, in most instances, be ruled to be an cmployer and thc people you hire will be employees. As the employer, you must comply with the following: O;-egon's Wi~t3ldiilg tzx law: As an employer, you must withhold income taxes from employee wages at the time em!,loyecs are paid, Y Oll will be liable for thc tax payments even if you don't actually withhold the tax from your employees. Fm ,11(1"e infonnation, call the Oregon Depl. of Revenue at 945-8091. Ur:emp!oy::!2nt ins:Jral'\ce mll: As an employer, you are required to pay a tax for unemployment insurance p~rrr"~' l1~ ::',' wages of all employees. For more information, call the Oregon Employrr.ent Division at the Department of I:llr:1ar :~c";'m:,,,' at 378-3524, Wor"e,'s' com:;:eO'sl;.:on :r~ura:Jce: As an employer, you are subject to the Oregon Workers' Compcns;:tion l..::v.. :'OC! lClJ,t obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation inSllli1nee. y"" may be subjcct to penalties an:! will be liable for all claim costs if one of your emplo)ees is injured on the job. For more inr"IT Iltion. call the Workers' Compensation Division at the Department of Consumer and Business Sero.'iccs at 945-7888. 0.5, :nternzl Revem.:e Se,-v:ee: As an employer, YOll must withhold federal income tax from employces' wag.:-s_ Y n~1 v, ill b: liable forthe tax payment even if you didn't actually withhold the tax. For mo'c information. call the Intcmal Revenue Scn ;c,: at 1-800.829-1040_ OT~[E}"1 R,:S~C[l!Sjf3l~lnr;[:S !-\;C1 !-\c::iF.f\!3 C~: c:m]c:~.'J~I;: Codeco!11:;Ii:mce: As the pennit holderforthis project, YOll are responsible forresolving any failure to meet code rcquirc'ments 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 accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must bc 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 re9u!red inspections. If you have additional questions, write or call the Construction Contractors Board (pO Box' 14{40. 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