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Home My WebLink AboutPermit Electrical 1999-1-20 (2) The following project as submitted has the following zoning, and does not require specific land use 225 FIFTH STREET approvaL J...p (2.... EL.<:CTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 Zoning Cf~ ~~~i~~IO~2~~~~T: 72~::;:d Signatur~ - ~O -M ,,~'ty Job Number 005 cf 3. COMPLETE FEE SCHEDULE BELOV LOCATION OF IN]1'ALLATIOlj" Ljt::lq("" rorsdlll,,,-- I rffJ ::Ft!fffrJ~ 00 jJ~DJS~~N~MO C(t~ I Permits are non-transferable and expire if work is not started within 180.days of issuance or if work is suspended for 180 days. 1. 2. wULMCTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date . Signature of Supervising Electrician Owners Name '-J,m C,',-kr h,/S 'lilt, ~ ( Phone 7'11 ~ 2. 2"2'" Address ~9b Ci ty . ?~f-Jr) OVNER INSTALLATION The installation is. being made on property lawn which is not intended for sale, lease or rent. Gk Owners signature:--J~ rn -..J~ IV\ (' ~ --------------------------------------- DATE: 1-zI)-99 _ _ .., ~...//' RECEIPT 11: ,1 I 17. -S d-...S D - f RECEIVED BY: Y" i 1/1 JJ ~ , A. New Residential-Single .or Multi-Family per dwelling unit. Service Included: Items Cost Sum $ 85.00 1000 sq.ft. or less Each ad1ftIQ~_500 sq . 1;..~ 1C/k>"fJRIii'fBIiOregon . ther~(HtifiCatio s adoptPrj b law r~u~5. 00 Each M!i\rti~ ;d.:'Jl6lnIDtQ.c ih Ylhe Ore es You to Moductq'tO:~~t\g.ooio thOse rU{e~ gOn Utility Servi€e"i?Jg t~~e1iefltai rOUCl.h O'A';f0 ~f)fOrtl nUmber ~ e Center Ii ~oPies .Of 952-001' .B. Services or, o/e~@Tii (Note: the the rUles b . Ins talla t i~li?tE'J\:l:,-t~~'tliol!li;ty ~el~Phone Y or Relocation: 00-332_23 otlfication 44), 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to. 600 amps $100.00 601 amps to 1000 amps $130.00 NCOVer,..1000 amps/vol ts $300.00 I i'w.r- ~ Tf1/SReconnec t Only $ 40.00 . , PERMIT SI-I C(IiI-;T~ITlP.~Iary41Se'i.ljtjo.'ffl?ItJ. Feeders Cc ,,,InstaiJ!:J:i1\t[ie.ll 'r' Al tera i!'iIOltIC9WKReloca t ion 'v/"'ENC{:D 'HIS PERMI j; I'IY 112.0.04 i1-1I!~S8 'bc;,~llel?MNF= TIS NOT $ 40.00 20t ampsl/ito 400 ampg r-UR $ 55.00 Over 401 'to' 600 amps $ 80.00 Over 600 amps or 1000 volts see "B" above D. Branch Circuits " E. New, Alteration or Extension Per Panel One Circuit )\ $ 35.00 ~ Each Additional Circuit or with Service or Feeder Permit $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting----- Limited Energy/Res Limited Energy/Comm 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 40.00 $ 40.00 $ 20.00 $ 36.00 2,C) .()() ..( /.::j (-) .,,/ .. . Permit#: 019 oo~ Address:33q(~ Fo~~/~ Issued by: ~. /ly)f Ifer- Date: / / /q /1' r 7 . (' I 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) and 2, and either box 3A or 3B: g D ), ) 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, 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 D. 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 building permit ofthe name of the contractor. I hereby certify that the above information is correct and that I have read and do understand thc Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. '\.f~ I'VI WW (Signature of permit applicant) /-2.0~9q (Date) (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 Colllractors Board in accordance with ORS 701,055(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 the following responsibilities and areas of concern, EMPLOYER l=IESPONSIBILlTIES: 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 payments even if you don't actually withhold the tax from your employees, For more infonnation, call the Oregon Dept. of Revenue at 945-8091, Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurancc purposes on the wages of all employees, For more infonnation, call the Oregon Employment Depanment at 378-3524" Worker's 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 cost.~ 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. 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 infonnation, call the Internal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code requirement, 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 punctures, fire, or work that must be re-done, Time to supervise employees: Make sure you have sufficient time to supervise our employees, Expertise: Make sure you have the expertise to act as your own general contractor. to coordinate the work of rough-in and finish trndes, and to notify building officials at the GI'I',vl',;ate times so they can perfonnthe required inSpections, . , If you havc additional questions, write or call the Construction Contractors Board (pO Box 14140, Salem. OR 97309-5052, 503/378-4621), The Board is located at 700 Summcr St. NE Suite 300, in Salem prop-own. pm4 1/94 SP-001