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Home My WebLink AboutPermit Electrical 1994-8-24 ',' I, / }.... . e SPRINGFIELD Tho following project as submitted has the following zoning, and does not requiro specific land use 225 FIFTH STREET approval. l-~ ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 Zoning q~/2- 5 ~ ~~~i~gIO~2~~~'~T: 7&e~s37(Jl'2f1,q'f' City Job Number . L _ Authorized Signature {l f'i\. 3. COMPLETE FEE SCHEDULE BELOV 1. LOCATION Qf INSTALLATION S-1 ~ \ I)/h<;~ ~/3 2... A. New Residential-Single or . ( Multi-Family per dwelling unit. LEGAL DESCRIPTION Service Included: /7(/2.. "1 LTP,;> tC)/3/TO -- .' JOB DESCRIPTION /:YJ / #. r-/?nr~ r , Items Cost Sum Permits are non-transferable and expire if work is not started within 180 days of issuance or if. work is suspenaed for 180 day~. 2. CONTRACTOR INSTALLATION ONLY ~. Electrical Contractor ~~~~~ Address 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 t..--, $ 40.00 ' 'flJpo 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 Supervisor License Number Expiration Date C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number 200 amps or less 201 amps to 400 amps Signature of Supervising Electrician Over 401 to 600 amps . . Over 600 amps or 1000 volts 7'-';><:-. \ ... D. Branch Circui ts Owners NameS'~7Roo ~~hl/LA ~ +1' ./---'~ #~ /~ -- r ~ New, Alteration or Extension Per Panel Address .? 3 ,:) AI c / /W('7~7b:2 ~z City~{ Phone 7)"2.g4;</ ( Expiration Date $ 40.00 $ 55.00 $ 80.00 see "B" above OVNER INSTALLATION One Circuit Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 >-f L.___ ~//~ ~ -" ...' ~ / -------------------,------------------- DATE: B.2~... '9 Y . RECEIPT #: /~/~ RECEIVED BY: ~.;'~7-' 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 d/J ~(J 5% State Surcharge ( "2..O?D 3% Administrative Fee 1,'2.0 TOTAL d 2 2.0 ( -, The installation is being made on property I own which is not intended for sale, lease or rent. Ovners Signature: ,. ,i . e Permit#: 9~/2~ Address: ~y~ L//9-./?7-'"#/f:< , - - -.. Issued by: ~ 4.A-":M' ..., ..-- ~ - Date: S'<~"7'y , 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: lKJ U 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. u 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 b.uilding 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. {l~,~~ ~ /l (Signature of permit applicant) q- 2?-7~ (Date) (White copy to issuing agency permit file, pink copy to applicant) .... . . " ", TI[(i)~@fi"malft~@fiil 'U\fl(QJ~~~~ ~@ '[Pfi"(Q)IP~ult1f OW[(i)~fi"$ . '. ~lo)(Q)M~ 'ZC(Q)[(i)$~fi"M~ft~(Q)[(i) ~~$IP(Q)[(i)$~lo)~~~~~~$ ~.... ...- ~" .~.. '" .-..... .:...... .....~ '"". . " " ..:. Note.: This Information Noti~e to' Property Owners about Construction Responsibilities ... ...', . '.. , was developed by the Construction-Cqntractors Board in accordance with ORS 70I.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 ~he following responsibilities and areas of concern. !EM IP'IL(QJV!EIRlIRl!E5)IP'(QJ[i\I]S~ 18l~ UT~!ES:. 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 mled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: , Oregmll. 's WJiallnllnolldDll1I.g aax llaw: 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 Dep1. of Revenue at 945-8091. Ull1l.emJPilloymell1l.a nll1l.summce 1I:ax: As an employer, you are required 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. Workers' comJPiell1l.saanmll. Dll1I.SUnrall1l.ce: 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 at the Department of Consumer and Business Services at 945-7888. u.s. ][ll1I.aerHllall lRevemJle SerVlice: 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: OTlHIlE1Rl IRlIESIP'OlNlS~I8l~lLnr~lES AlNlfC>> AIRlIEAS OIF COlNlC!EIRl[i\l]: Code COmJPillDaHllce: 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. lLfi~1l>DnJiay aHlld JPill'OJPieray damage DHllsuram;e: 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. nme ao sUllJlllerVlise emJPinoyees: Make sure you have sufficient time to supervise your employees. IExpemse: Make sure you have the expertise to act as your own general contracto,r, 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 14l40,Salem,.OR 97309-5052, 503/378-4621). The Board is located at 700 Summer S1. NE Suite 300, in Salem. prop-own,pm4 1/94