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Home My WebLink AboutPermit Electrical 1999-10-11 Thafollowing project as submitted has the following lonmg. and does not require specific land use approval , L ,,<< Zonmg \ Ll- \ \ -<1 Ij' cr 225 FIFTH STREET SPRINGFIELD, OREGON 9"'411 INSPECTION REQUEST: ,3~&rz;}J~~neture OFFICE: 726-3759 1. LOCATION OF I~STALLATION -Sft,~ /'7~~/J)J/ 57, t LEGAL DESCRIPTIO~ /$6)2- dc::> /4 07>782) JOB DESCRIPTION <"F: /? e") 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 Constr Contr. Number, Expiration Date Signature of Supervising Electrician Owners Name_ uRe";"vZ1 ~<1)EA Address ./1)02 II. 'A /_~ r ' City ~#~ Phone .7M-Jt. ~ OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. f- ownerjJigna~ __~__l_____--~---------------~ DATE: le//~/'J ' RECEIPT 11:_ "'< S- fP. Z <i- ' RECEIVED BY: /J~_ At'" ELECTRICAL PERKIT APPLICATION Ci ty Job Num~er q ~ 0 -16 ~ 3. COMPLETE FEE SCHEDULE BELOV A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum 1000 sQ.ft. or less L--- ' $ 85.00 05 0'0 , Each addi tional 500 , SQ. ft or portion ] iSbV thereof $ 15.00 Each Manuf'd Home,or Modular 'Dwelling ,$ 40.00 'Service or Feeder ,B. Services or Feeders Installation, ,Alterations or Relocation: 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300.00 Reconnect Only $ 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 D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 volts see "B" above , . New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightinv Limited Energy/Res Limited Energy/Comm One Circuit Each Additional Circuit or with Service or Feeder Permit E. 5, SUBTOTAL OF ABOVE 7% State Surcharge 3% Administrative Fee TOTAL $ 35.00 $ 2.00 not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 /'<./J ~, ~ . (I'? 7(5'0 , 1B <Kl .1 ' - Issued by: 990"~f ?1S gJ .hA7~ j,fT, _ ~~ Date: /o;h;/i/ 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 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 1 and 2, and either box 3A or 3B: ~ ~ D I, 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, 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must bc registered with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. IfI 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 fJ9ners a:ut C st~uction Responsibilities on the reverse side of this form. ~ __ , _It) -113.'7 ~natufe (Date) (White copy to issuing agency permit file, pink copy to applicant) . e , ~111l~iDl~M~~niDll11l !I\J@UnciS ~O ~U'op~oiy OWl11liSU'S b'\.[iJI@!.!U !C@lJ'isUnncUnolJ'i ~teS~olJ'isilbinm~iSS Nore: This Information Notice to Property Owners aboUl Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 70J.(J55(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an exi~ting ,tructure, you can prevent many problems by being aware of the following responsibilities and areas of concern. IEM~lOV~~ ~IESP(Q)NlS~I8l~UTIIES: 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: 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 tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurancc purposcs on the wages of all employees. For more information, call the Oregon Employment Department at 378-3524. , Worker's compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must. obtain workers' cOplpensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more infomlation, , call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. I' US. Internal Revenue ~rvice: 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 inforrnation, call the Jmemal Revenue Service at 1-800-829-1040. OT~IER RIESPiONlS!raIUl~IES AND AREAS Olr: CONliClEiI:lN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirement~ that may be broul1ht to your attention through inspections. I' I.iability and p. ':"...., ;y 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 supervi~ employees: Make sure you have sufficient time to supervise our employees. Expertise: Make. ,:sure you have the expertise to act as your own general contractor, t~OOrdinate the work of rough-in and finish trades, and to notify building officials at the ""....vl'.:ate times so they can perfonn the uired inspections. ,- '\-- \ " \ '" '.- " \ \ ' ~ ' -- \ .. . \' \" . -" -.. -c,.- .';:,. , '. 'Mi -,~>--- If you have addi.ional questions, write or call the Construction Contracibrs Board (pO B'>l)( I<lM,<; Salem, OR 97309-5052, 503/378-4621 ). The Board is located at 700 Summer St. NE Suite 300, in Salem " prop.owl1.pm4 1/94 sP-oo,