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Home My WebLink AboutPermit Electrical 1993-9-7 , " ... . . SPRINGFIELD The followlnQ pro!ecl es submltleri hos the foilowi zoning, E'nr' . .~~ . !"'~-: ':re ..;" "";, rnd use 225 FIFTH STREET approve' ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 lcoing IA>\Z- I a /?,/ INSPBCTION REQUEST: 726-3769 f) ... -q-:>. City Job Number -/ 3 ~!!3:> OFFICE: 726-3759 Date "1- ,- :/ i . - "".uI!tQrized Signature ~3. COMPLETE FEE SCHEDULE BELOV 1. LOCATION OF INSTALLATION I 2/J97 F?e,W M/8. A. LEGAL DESqy:FTION J?IJ2, 2..S J .2.. f)"~ JOB DESCRIPTION rt'~r .FZM. //,T1b//~~- 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 City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date - Signature of Supervising Electrician 'r- Owners NameJhJ/ct:. .'5h?GZZr Address. 2L9"7? F/A!.~~ Phone 7~-53<j:S City <;".P1r=7) . . OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. . P::;::;;EL:d' ~ --------------------------------------- DATE: . <7 - 7- l' !:> Rt,,,t..l1'l' i: . - /A//- { RECEIvED BY: - ~~......... ne... New Residential-Single or Multi-Family per dwelling Service Included: Items 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: unit . Cost Sum $ 85.00 $ 15.00 $ 40.00 6""0-;- 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 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 volts D.' Branch Circui ts $ 40.00 $ 55.00 $ 80.00 see IIB" above New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit ~ $ 35.00 ..-~ $ 2.00 4.8D 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 b.{.<>O 5% State Surcharge 2.7'" TOTAL <,""", 710 , .... . . Permit No: 9__< / ,j~ ~ Address: ~~ 7hA='p ~ Issued by. ~~ Date: :fY/93 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 CDnstruction Contractors Board to sign the fDllowing statement before the building permit can be issued. This state- ment is required fDr residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registratiDn under ORS 701.010(7), need nDt submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial bDxes 1 and 2, and either box 3A or. 3B: 1. J"~r I Dwn, reside in, or will reside in the cDmpleted structure. 2. r-- ~ I understand that I must register as a constructiDn cDntractDr if the structure is sold or offered for sale befDre or upDn cDmpletiDn. 3. A.I I My general cDntractor is Contractor registration number I will instruct my general cDntractor that all subcDntractDrs WhD work on the struc- ture must be registered with the Construction ContractDrs Board. OR 3. B. i-~ l..! will be my own general contractDr. If I hire subcontractors, I will hire Dnly subcontractDrs registered with the Construc- tiDn Contractors BDard. If I change my mind and do hire a general cDntractDr, I will cDntract with a contractor who is registered with the CDnstruction Contractors Board and I will immediately nDtify the office issuing this building permit Df the. name Df the contractDr. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~~ Signature of Permit Applicant' ,1)'7 Seu {/ q 3 Date' ( 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 tD Property Owners About Construction Responsibilities was developed by the ConstructiDn CDntractDrs BDard in accordance with ORS 701.055(5), passed by the 1989 OregDn Legislature. If you are acting as YDur own contractor tD construct a new home Dr make a substantial improvement to an existing structure, YDU can prevent many problems by being aware Df the fDIIDwing respDnsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If YDU hire persDns nDt registered with the ConstructiDn CDntractDrs Board to dD labor in constructing Dr assisting in the constructiDn or improvement of a residential structure, you will, in mDst instances, be ruled tD be an "employer" and the people YDU hire will be "empIDyees". As the employer, you must cDmply with the fDllowing: OregDn's Withholding Tax Law: As an employer, you must withhold income taxes from emplDyee wages at the time emplDyees are paid. YDU will be liable for the tax payments even if you dDn't actually withhDld the tax frDm your emplDyees. FDr mDre informatiDn, call the OregDn Department of Revenue at 378-3390. Unemployment Insurance Tax: As an employer, YDU are required tD pay a tax fDr unemplDyment insurance purpDses Dn the wages of all employees, FDr mDre infDrmation, call the Oregon EmplDyment Division DHR at 378-3224. - WDrkers' CDmpensation Insurance: As an employer, YDU are subject tD the OregDn Workers' CDmpensatiDn Law, and must Dbtain wor/(ers' compensation insurance fDr YDur emplDyees. If YDU fail to obtain workers' compensation insurance, YDU may be subject to penalties and will be liable fDr all claim CDStS if Dne Df your emplDyees is injured on the job. For more infDrmation, call the Workers' Compensation DivisiDn 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 fDr the tax payment even if you didn't actually withhold the tax. For mDre infDrmatiDn, call the Internal Revenue Service at 221-3960. 07:-:ER RESPONSIBILITIES AND AREAS OF CONCERN: Code Compliance: As the permit holder for this project, you are responsible fDr resolving any failure to meet code ~requirements that may be brought tD YDur attentiDn through inspections. Liability and Property Damage Insurance: CDntact YDur insurance agent tD see if YDU have adequate insurance coverage fDr accidents and DmissiDns such as falling tDols, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise EmplDvees: Make sure you have sufficient time to'supervise YDur employees. Expertise: Make sure YDU have the expertise tD act as YDur Dwn general cDntractor, to coordinate the work of rough-in and fini;:;h trades, and to notify building Dfficials at the apprDpriate times so they can perfDrm the required inspections. If you have additiDnal questiDns, write to: Construction CDntractDrs BDard 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89