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Home My WebLink AboutPermit Electrical 1993-11-15 (2) I , , .......-.~ '. .' . . ,~ SPRINGFIELD " ' ~ The followIng project ' 225' FIFTH STREET zoning, and does not ~:;~;:Itt!Kl'f~as the fo"o~CTRICAL PERKIT APPLICATIO~.:,) SPRINGFIELD, OREGON 971Jff!oval. ,speCt IC land use., I -i 3/72-9 INSPECTION REQUEST: 726-37~~ina L, DR CIty Job N\imbeL.7! )-i.!:~ :}l~ OFFICE: "726-3759 1 " . _ Datf;J IltsJ.:'8 /9- -dd ~COHPLETE FEE SCHEDULE BELOV . 1. LOCATION OF I~T~;ym, , ., S<::: '1] 53 3S. D ~ . FfJ~9ftture ~ ) A. New Residential-Single or , ' ~' , ' hultl~ramily per d~elling unit. LEGAL DESCRIPTION Service Included: 1J 0 2. ~ 3 ClO 0 I 3 00 Items Cos t Sum JOB DESCRIPTION t.' ~" If ('/~Q~ 4".vvt) 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 . Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I 2. CONTRACTOR INSTALLATION ONLY ~ $ 15.00 J $ 40,00 ~fO Electrical Contractor B. Services or Feeders Installation, Alterations or Relocation: City Phone 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 Address Supervisor License Number Expiration Date Constr Contr. Number C. Temporary Services or'Feeders Installation, Alteration or Relocation Signature of Supervising Electrician 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 $ 55.00 $ 80,00 see "B" above Expiration Date -, D. Branch Circuits \- Owners Name G~~"f3I.1~ , q Address~5" $.. ~..c:$v..sr: Sp # 9 Cit~ Phone7~&'''597J OVNER IN TALLATION New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Ser~ice or FeederPe,rmi t $ 35,00 $ 2.00 The installatiori is beirig made on property I own which is not intended for ~ale,lease or rent. 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 5,. SUBTOTAL OF ABOVE 4n CJ.O 5% 'State Surcharge t' -;;;zPO TOTAL ' 4. 2- '!'0 ( Owners Signature: ;:<'A9/)tt;~r3L1.fL1.X)' , DATE~--~------~/-jjT;~ ;'~3---~------ RECEIPT, I: ( /~ lP1 91 RECEIVED BY: -.;:-~ '( , ' \. ... ~ ""f... . . . , Permit No: 93(172-7 Address: 5'-7< c.1.kfl,('(./{I!:.f3 7 / Issued by: -{~ Date: WJ FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ',' ABOUT CONSTRUCTION RESPONSIBiliTIES Note: Oregon law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state. , ment is required for residential building, electri,cal, mechanical', and plumbing permits. Licensed Architect and Engineer,applicants"exempt from registration under ORS 701.010(7), need no.t .submit this statement. This statement will be filed with the permit. Fill, in the applicable blanks,' and initial boxes 1 and 2, and either box 3A or 3B: 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: ' 3. A.,I I My general contractor is ,Contractor'registration number , I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR '. 3. ~:Q will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board . and.l 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 understand. the Information Notice to Property Owners about Co'nstruction Responsibilities on the reverse side of this form. ~:1.~ t1ltJUxJ Signatyre of Permit ApfPicant J~//S:/73 DateI (' CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 . , . WHITE COPY TO ISSUING AGENCY PERMIT'FILE PINK COPY TO APPLICANT , , .. . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . .,.-.. NOTE:, This Information Notice to Property Owners About Construction Responsibilities was.developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by. t,he 1989 Oregon Legislature. ' 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. EMPLOYER RESPONSir8'l~lL.rnE$:. If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the constr~ction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and th~ people you hire will be "e~ployees". As the'employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from emp!oyee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the .4' . tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all,emplqyees. For more information, call the Oregon Employment Division DHR at 378-3224. Workers' Compensation Insurance: 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 will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434. , ' U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the fax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 221-3960.' , OT~lER RIES~ONS~[8)~Ul~!ES fQ\N[f) &.lRlfE&.S orr CONClE~li\j: 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 insurance agent to see if you have 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 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 to: Construction Contractors Board 700 Summer S1. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89 . -,.-