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Home My WebLink AboutPermit Electrical 5-2-2 ;<. r ,~ 225 FIFTH STREET Zonin~ /G fD f2- SPRINGFIELD, OREGON 97477 Qat Q/b--6J:; INSPECTION REQUEST: ,726-37b~ '-" OFFICE: 726-3759 Authorized Signature 1. LOCATION OF INSTALLATION 1'1-;<5' _~f7./~ ,~?! .A'2). LEGAL DESCRIPTION /?~ ~'"";:? 5'-~ 2 ~ ~P?4> "2- I' JOB DESCRIP'!.lON ~,5 ~--f/r/c~ .~~_c:::::::/~ c-/~;r. ~~~<:&--. . 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 Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Namet~?3 ~~~~ Address ?~~ ' , , City ~c..l> Phone/~h...6/// '" ,. OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~. /~)y/U?u' ---------------------------------~----- ':<'.2/~7 RECEIPT #: /~? RECEIVED BY: ;::;1;U,,,,.~. .;;j c9..1 ~ . DATE: ELECTRICAL PERMIT APPLICATION Ci ty Job Number 9?'&177 NIV\. 3_ COMPLETE FEE SCHEDULE BELOV A. New Residential~Single or Multi-Family per dwelling unit. Service Included: Items Cos t Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling Service or Feeder $ 85.00 $ 15.00 $ 40.00 ' 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 $ 40.00 $ 55.00 $ 80.00 volts see "B" above D. Branch Circuits " New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 35.00 $2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 S. SUBTOTAL OF ABOVE ~~. ~ 5% State Surcharge . ~.?p 3% Administrative Fee /.-~~ TOTAL "1Y'.~G> .' Permit#:$ ~. 7~t:)/77 Address:./~'2~/&~~~~ ~"'~ .' ISSU~dbY:,'/ /~ Date: 2---=4:' .~-- , //7~ , 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 Const~uction 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 mid 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: KJ U 1. I own, reside in, or will reside in the completed structure. 2, I understand that I mustregister as a construction contractor if the structure is sold or offered for sale before or upon completion, ~ 3A. My general cQntractor 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 I hereby certify that the above information is correct and that I have read and do understand the Informat.on Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~J~) aJ~~ J (Signature of permit applicant) d.UJ! /1S (Date) (White copy to issuing agency permit file, pink copy to applicant) '. ..~ .~~. Iflfot~~-tiori~Notice'to 'Property Owners ,), .,~.,,/~~~,~t C_~nst~ucti911 ~esponsibmties -. - >,<,.-..,,, > .' - ,. - ~.~:. ~ - Note: This Information NQtice to Property Owner.s abqut Construction Responsibilities' , ' , wiii ?Jevel~ped by thi'Con~~tru~tio'iL1::'()iitracto~s B~ard 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 t}!C following r~sponsi~~~ti~s and areas of concern., - EMPLOYER ,RESPONSIBILITIES:' If you hire persons not registered wit~ the Construction Contractors ~oard, to do labor. in constructing. or assisting in the construction or improvement'of aresi.dentlal structure, YO,U will,,in )1Jost instanc.es, beruleQ to ,be an ~mployer and the people you hire will be employees. As the ymployet;, you must comply :vith the.following: . Oregon's withholding tax law: As an employer, you must withhold income taxes fronI' erriploye~ wages at the time employees are paid. You will be liable for the tax payments even if you don't actuiilly withhold the tax from your employees. For more information, call the OregoriDept. 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 aU employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mll'st obtain workers' compensation insurance for your employees. If you fail to obt,ain workers' compensation insurance, you may be subject to penalties and wi"II be liable for alldaim costs if one of your employees is ii1jured'on the job. For more information, call the Workers' Compensation Diyision 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 froin errtployees' 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. ' OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this 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 in~urance agent to see if you bave adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc,tures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your empl;yee's. Expertise: Make sure you have the expertise to act as your own general contractor/to co<?rdinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can 'perform the required inspections. ILyou have additi6Qahqu~~tions, write or call the Construction Contractors Boardc:(PO Bbx 14.]'4Q~.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