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Home My WebLink AboutPermit Building 2010-10-13 , Ele'ctrical Permit Application , 'tv - , 1..:"4V,' .~~ ~:{" k:,,~~ _, ClT}\~OF; S~RIN~Ji}IECJ},J,!@EEO~~ . ~ \ "",,~l;"iJ' "" ~ '""N> t, __A." 'O;)~""'" ''ff:_ 225 Fifth Street. SpriDgfield, OR 97477+ PH(541 )726-3753+FAX(541 )726-3689 /C',;.::<,'..'::';/", '-.:-::T-.i"."'00-'... -.-."_. " ..... .... ,.~.."'; ,~, "DEPARTMENTUSE'ONL Y 7>?f>ftiW'''-<'''i'_'~'T<ih',<<_ .. *..~,.-"t~.-+"',;", ,_0._.. :.;p~,.-:;_ '>' Penn it no.: -n3' Date: ID This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. ";",;;,-..,~"'LOCAL ,GOVERNMENT,;'APPROVAL;},)1R' ,-;:::;" Zoning approval verified? 0 Yes 0 No 'CATEGORY'OF;CONSJRUCTION: , Name:lno,"'....<" ~""-,\ Address: I::'} ,'<- S7 City: S cG State: CJ Phone:S"ff-'1lfS- b9 D Fax: E-mail: b",,--, """'''' \e"",, @> '-'6\' This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479. 0(1). Signature: . ,', ,F':CONTAACJORINSJAIILiATION,;j +, Business name: ~ Address: City: Phone: E-mail: CCB license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ZIP: Fax: BCD license no.: ~\) ~.~ ~~ 44O-2584-J (9/08/COM) ::,~;:7,:r;~~' ::,,:FEE;S,cHEDULE';' ' ~ 7 ,c,~ 'N~';;h~~6fiiis~~Ctions.~~r'ii~",d,:; Qty; Cost Total ;, .. ';'..~>;;.;N",,':;'-" ," ',<:',.:::- '>::" ....;:.. ......' ':'"" .....;:,......' ea. ' ~ost Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwemng service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ 20 I to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a. Fee .for branch circuits with purchase of a service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) I $ 55.00 $'S"5' Each additional branch circuit I $ 6.00 $~ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ ~ <.>,' (A) Enter subtotal of above fees $(, {~.. (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [A)) $ '1 J:::' (C) Technology Fee (5% of [A)) $14$ TOTAL fees and surcharges (A through C): $ 1711~ S~~~N. G. '::EL~ ~.~ ,",,~ : \ OREGON TRANSACTION RECEIPT 811-SPR2010-00503 1378 . OLYMPIC ST' www.cLspringfield.or.us CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000562 RECORD NO: 811-SPR2010-00503 DATE: 10/13/2010 [DESCRIPTION ',. ,,~ Branch circuits without service or feeder - 1 st circuit Branch circuits without service or feeder - each additional State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) "" ',,- ,6.G~C9J!I-l:U:9RI;~. 224-00000-426102 224-00000-426102 821-00000-215004 100-00000-425605 TOTAL DUE: PAYMENT TYPE PAYOR CASHIER,'CCARPENTER CQM!','I!'!'U_S Credit Card . 111692 .. . .. .. BARTO THOMAS EARL ;-AMO~UNLPUE . $55.00 $6.00 $7.32 $3.05 $71.37 .AMOUNT.PAID $71.37 $71.37 ~ '. " Information Notice to Owners About .Construction Responsibilities (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: . Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: . Oregon's Withholding Tax Law: Employers 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 Department of Revenue at 503-378-4988. . Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to htto://www.oreoon.oovIDOR/BUS/docs/211-055 odf for the appropriate forms. . Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. . Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages: You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.oov. Other Responsibilities of Homeowners: . Code Compliance: As the permifholder for a construction project, the homeowner is responsible . for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. .. Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. .. Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. f/property_owner adopted 12-04-07 CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300. PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 - Fax: 503-373-2007 Website Address: www.oreoon.oov/ccb This Copy for Permit Applicant ~ " Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit.. Please check the appropriate box: ~eJn,.er~<!e.in.the'coffijileted structure ~y'-general'contractor is: Name CCB# Expiration Date D I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ~I will be performing work on property I own, a residence that I reside in,or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowne'rs About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. MO/hP1S E If c,y/D Print Name of Penni! Applicant :: ---~ ~ - Signature of Penni! Applicant ~~//O Date Permit#: S 10 - $C) 3 Address: /7("76 ot... Y M"'L .s..Prt; #.J~ fieLD O~ C;'Z't"lf) IssuedbY:~ Date: /()//~'/IO r r This Copy for Permit Offices