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Home My WebLink AboutPermit Electrical 1991-12-16 (3) '#'0" .' / 'r:'~ !' ,'>. 225 FIFTH STREET" , , ' , ,",. '. ".,. SPRINGFIELD, OREGON 97477 - INSPECTION REQUEST: 726-3769 OFFICE: i26~3j59 , " " 1.' LOCATION OF INSTALLATION ~ SS..s " 7>K/S ~ # / /.s ( LEGAL ,DESCRIPTION / /; if; i._~ ~ "~ ' ',6:/$. 6f-o' , JOB DESCRIPTION ' h1~., tf;rc:;. eU!z.T Cbf/;fJ. . -,., ,",' . P~rmit~are non-transferable and expire if york is not startedvithin 180 days, of issuance or if york ,is suspended for 180 days. " 2. CONTRActOR 'INSTALLATION ONLY , , Eie,ctricalC()n:~racior ' , : Address' Ci ty .'" 'Phone Supervisor License N~mber ' Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners NanieV ti l.t~ <N,(l.JlJcJ orrj \) Addressn,~AC:S \"")o.LC\ IIJ Phone f\ (' fYl Q City '~f\-bc1 - OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: X _HJ1A~ WlldrQ/l-4! ~ATE~---~/~~/(p;ftf-~-~~-~-----~~~--- RECEIPT #: ( ~ 3/9 RECEIVED BY: ~71'~ 3. A. SP'"NCr-'I!LO t;, ' '," '. ELECTRICAL, P'ERMIT APPLICATION . ~ " ' " , . " ." .. ' ,.", "'City J~b' Number' q / /<1'/1- . \ "',": t " COMPLETE FEE SCHEDULE BELOV : , ,. ",; ", ,.:..', .' '. ' Nev Residential-Single or , Mu~ti~Fam~iy 'perd.',ielling 'unit.' Servi'ce,,' Included:' "', " , , , ' , - " 'Items 'Co's t , , ' ',Sum ".' , ",.,1, '"'. ,toO " ,1000 sq. ft. Qr less Each a'dcli tional 500 sq. '~t orp,ortion , , thereof " , ,'.' " Each Manuf'd Home or Modular Dwelling . ' ," ,ServIce or Feeder , $ 85.00 , ' '$15.00 " ,'; I:., ,11' $ 40.00 .::Io.6ftI " ":'\ 200am'ps or 'less '," , 201 a~p~ to' 400 a~ps 401 amps to 600 ,amps 601 amp's to 1000 am'ps 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 201 amps to 400 amps Over 401 to 600 amps Over 600 amps~r 1000 volts $ 40.00 $ 55.00 $ 80.00 see "B" above D. Branch Circuits New, Alteration or Extension Per Panel One Ci.rcui t 'Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 E. Miscell~neous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Li~ited Energy/Comm not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 5. 4-0.tH "7.._~ 4. 2. ,#'0 SUBTOTAL OF ABOVE 5% State Surcharge TOTAL . '-.'.- , ... ~ , , Permit No: 9/ /4/4- . " Address:' ~'}?("' //i1;../fC4 ~ //S- ..Jssued by: - <~~ bate: /~1/1>,: I FOR OFFICE USE ONLY , " ST A TEM ENT: 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- mentis 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 applicable blanks, and initial. boxes 1 and ,2, and, either box 3A or 3B: '. , ,0 , 1. l'""::-.....e::I",- I own, reside in, or will reside in the completed structure: ~ . ,. .. ~ 2."~1 r, -- I understand that I must register ,as a construction contract6r ifthe structure is sold or offered for sale before or upon completion::- ...' -r,.,: 3. Ail 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. B :r'>-~ I will be my own .general contractor. ' , , " , " " .If I hire subcontractors; I will hire only subcontractors.fegistered.with the Construc~. '.tionContractors Board. If I change my mind ,and do hire a genera~ contractor, "will" contract with a contractor who.is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. . " . , .. " T'.t . .~.& ~ .. . : . , ' '. , ',- o I hereby certify that the above information is cor:rect and that I have' read and understand , " the Information Notice to Property Owners about 'Construction Responsibilities on the.. , reverse side of this form.' xl0 n / tV (f /lfJtl /l /It t 'S'ignature of Permit Applicant ',-"'. " 1?1/(p/fJ/ Date (, '/ . CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT !..- , f' .. INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Prope~ty Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), , passed by the 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 RESPONSIBILITIES: 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 p~yments even if you don't actually withhold the 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 employees. For more information, call the Oreg~n 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 pe,nalties 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 tax payment even if you didn',t.actually Withhold the tax. For more information, call the Internal Revenue Service at 221-3960. :,.. ,'" " , , :-' . OTHER RESPONSIBILITIES AND AREAS OF CONCERN: : ,~. c. Code Compliance: ..As the permit ho/derfor thi~ proj!3ct, ypu are responsible for r.esolving any failure to meet code requirements that inay be brought to your attention throug~ .inspe,ctions. " .. . , . Liability.and Property Damage Insurance: Contac,t 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 official,s 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 "