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Home My WebLink AboutPermit Electrical 1994-9-26 " ':; #80GtJI7/rL -.....-ro-'/ 'I --.::."" ,{ 1,/ . 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST; O~fICE: 726-3759 . approllal. Zoning /-"j)tJ ./ 97'i4~' 4-Z{!!~((1" 7 ~FaJ~&aSignature ,. ;J j('A..-- 3. , . ' 1. LOCATION OF INSTALLATION \.~ 70 \-\ ~--\, ' LEGAL DESCRIPTION J?"/J; ~ I'n 2.. / ,) , e c> ~2~ . JOB DESCRIPTION .6?7.ec::- ~/.I(;c f e//ffC:C//'7T I Permits are non-transferable and expire if work is not started~ithin 180 days of issu~nceor if,work is suspenoed for 180 days. .. 2. CONTRACTOR INSTALLATION ONLY /,.... \ Electrical Contractor ~ '.'("';0 \10. ." " l Address Ililf! ~\. 5,,)- Ci ty_ ~P~'Q..~_O ~,R8~e '1~~)-;:fA\ . _.4"'',. "," Supervisor License>Numberr' ., Expiration Date Constr'Contr. Number f:'. Expiration Date / \ ";;'~. c { <.... ,",>:;~K-" I 5r.LJ:' '1:ners' N~~E:1iVW\ ,-(wlJ \>v,v~~ . ~ . \ Address \ ~ifl.(7 \--\. ~~' , Ci ty 0~, \~IG-:;\~i~_l-I1~hone 'l~,\ -.J(\L\ \ Signature of Supervising Electrician ", .. \J ,mINER INSTALLATION' The installation IS being made on . property I own which is not intended' for sale, lease or rent. , \. OVners Signa~ure: . ~)j~~~,~ lj&.,vvc\ ------LJ~---------7:~-----~------------ DATE: '. 5'j~/9ttf " RECEIPT #: - ( , /~2 ,<;"1 RECEIVED BY: . /J~-1..... . ~~.,.tl '.\;.. .. L .._~~ "~~ ELECTRICAL PERMIT APPLICATION !'~1;yJob Number 91/~71: COMPLETE FEE SCHEDULE BEL9V A. New R~sidential-Single or Multi-Family per dwelling unit: Service Included: 1000 sq. ft. or less Each additional 500 sq. .ft ~r portion ' , thereof" ~ach Manuf'dHomeor Modular Dwelling ~.",()j, Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: .,/ 200 a)1lp"~, or -less 20l ,'amps to 400 amps .401 amps to 600 amps . 601 amps to 1000 amps . Over 1000 a~ps/volts Reconnect Only Items Cost Suin $ 85:00 $ 15.00 . $ 40.00 V-s 50.00 $ 60.00 $100.00. $130.00 . 4.$300.00 "'$ 40.00 ~- -c ;::>.,,~ C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or l~ss 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 ,.' D. 'Branc~ Circuits $ 40.00 $ 55.00 , $ 80.00 volts see "B" above New, Alteration or Extension Per Panel ~ One Circuit Each Additional Ci rcui t or wi th Serv,i-ce--, or Feeder' Permi t / J If $ l..!!:!!!!l- Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 35.00 2.00 #~ not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 AsI',~ ~/o 2., ~ (b C:;~.~~ Permit #: 94l47?J v' . 1~7D J - ;?J~' '-- <::// Date: .7/~rL ( l' , Address: Issued by: 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: ~ ~ II 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. .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 )i 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 of the .. name of the contractor. I hereby certify that the abo.ve info.rmatio.n is co.rrect and that I have read and do. understand the Info.rmatio.n No.tice to. Pro.perty Owners about Co.nstructio.n Respo.nsibilities o.n the reverse side o.f this fo.rm. ..~ ~~~~CtS t/ -- (Signature ~ permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) ~; - Co. ,-'..., (. '-: .. , ..,'. -' \. '. . ..... ....... 1\ . ',', ..,' :JI1l'1l~(o)l1'm~~n(Q)ll'il~ N(O)~n<c~' ~(()). [pY[hO)[p1@~ . rDWll'1llel1'S A[b)(Q)~~ <C(Q)Il'1l$ftli':~~~n(Q?Il'il.IBi~~IP>(Q)Il'1l~n~n~ Dftn~$ - . -~ .....- -"-"-'.' .!. . \ . "- 'f' . }' :_1. . ~.;._ I . . .....;~.. ~ ",,;,.r. . . ", _' _'",' :'..,' ~.. _' : . , ' ':":.-'..' - - -" -i!o~e:' ThA~ InformatiqnNoti~e.to\~m~~riY,Qwn.ei-~:dbouit'on;truction Responsibilities. ",' .' . ' was developed by the Construction Contractors Board in accordance. with ORS 701.055(-:jJ/" ". If you are acting as your own contractor to construct a new home or make a su,,~stantial improvement to an existing structure, you can prevent many problems by being aware,of the following responsibilities and areas of concern. . '-' . '- " - ' ~~, .,,' - --"-. -. . . . If you hire persons not ~~gistered ~ith the Constructi~n CO(ltractors~pard to do 'labor i? c~mstructiJ:1gor assisting in the construction or improvement of ~ residential strocture, y:ou will,in mostinst{lnces,.be ruled to .be ~.empl~yer and the people you hire will be em~~oyee~. As the employer, ~ou must.comply ~it~ ~he follo,wing:.. ' . . Oregon 's withlln~Id!ing tax law: 'As an employer, you must withhold income taxes from employee wages at the time employees are paid., You will be 'llaole for the t~ payments ~ven if you don't actu~ly withhold the'tax from 'your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurmllce 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 Oregon Employment Di vision at the Departmentof Human Resources at 378-3524. i' Workers' compensation insmrall1lce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance fo~ your employees, If you fflil to obtain workers'compensation insurance, you may be subject to penalties and will be liable for all dai~ costs if one of your employees is injured on th~ j<;>b. For more informati~n, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. " U.S~ IntemallRevellllUe Sell'VJice: As an employer, you must withi:lold federal income tax.'from employees' wages. You will b~ 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. ..' , OTlHllER RlESPONS~B~UT~IES ANI[] AREAS OF CONCERN: Code compliance: 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. )< "- lLiabilitY.cand property d::unage insurance: Contact your insu(ah~e agent to see if you have adequate insurance coverage for accide~M anq 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 your employees. , '. Exp~rti~~:' Make stire you have the expertise t~ act ~s yo~r own g~neral c~ntractor, to coordin~t6 the work of r~ugh~.iri ~d fJ.l1isli . I' .... . - 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 1'4140, Salerri;. QR"97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite;300;jh Salem. : ' . prop-own.pm4 1/94 " .. ~- :.....' ~ .