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Home My WebLink AboutPermit Electrical 1994-12-20 .t.... M......l.. "..... 1- The following project as si:ibm!tted.~asthe f~1I0 zoning, end does not require specific land use approval. ' JOB DESCRIPTION " " Q _ 1000 sq. ft. or less J1R~/~ ~ ~c-~~~Each additional 500 .. 11 .. -.. .r' ' .. I ~ - sq. ft or portion Permits are non-transferable' and expire thereof if work is not started 'wi thin 180 days Each Manui'd Home or of issuance or if. work is suspenoed for Modular Dwelling 180 days. Service or Feeder 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUE'ST: OFFICE: 726-3759 97477 Zonina I .-i)/0 :r726-tl~~~ W,"-r '1~ . 1. Authorized Signature LOCATION OF INSTALLATION , "2 / 2 ~,. ~?/!?,.a-~::>- -" , " r' LEGAL DESCRIPTION:, /?~ ~ ... =<~ -:?: V' d' /:::;;-t::$ /' r ( 2..' CONTRACTOR INSTAL~TION ONLY Electrical contra~tor'~~~ Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date ' Signature of Supervising Electrician . .. ~ D. Owners Name ~~ ry.</{r-:'/.YA:::...~~ Address???>>;::> ~, ?.:::?~ _~.. Ci ty _?~~,..Phone 7 9?-/,~ O\1NER INST2~~?' The installation is being made on property I own which is not intended for sale, lease or rent. , Owners Signature: )~it;}~~~~----~- RECEIPT 11: ., . /;? .....~ ...cpa qr RECEIVED BY: . ~~ ELECTRICAL PERMIT APPLICATION City Job Number q~/9~~ I . COMPLETE F~SCHEDULE BELOY A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum $ 85.00 $15.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 ~mps 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 $ 40.00, $ 55.00' " $ 80.00 see "BIl above Branch CircuHs New, Alteration or Extension Per Panel --- $ 35.00 ~~ One Circuit Each Additional Circuit or with Service or Feeder Permit ~ $ 2.00 /"~ ~ not included), E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm $ 40.00 $ 40.00 $ 20.00 $ 36.00 5. ~-. -..- ~ .2S:- , /. ':;'"5""" ~8 '~O SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL .. . Permit#: 9~/93>>.5~' Address: '"'2./2 Q Issued by: ~~_ \ h~ ,., 5'7' Date: /:;> '.2~Y7- Statement: Information Notice to Property Owners About Construction Responsibilities 'I Note: Oregon'ww, 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 ~ngineer applicants, exempt from registration under ORS 701.010(7), need not subm(t this statement. This statement will be filed with thepermit. ' Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: KJ U 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 o.r upon completion. ~ 3A. My general contr~ctor is , (Name) Contractor regis. # , I will instruct my general contractor that all subcontractors who work on the structure must be registered with th~ Construction Contractors Board. OR I YI 3B. I will be my own general contractor. If I hire subcontraqtors, 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 ~CB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners a~out Construction Responsibilities on the ~everse side of this form. rnl1u~~ 1~/U>/9t..p. · . ~n& '.,f ennit applicant) . tDate) ( I (White copy to issuing agency permit file, pink copy to applicant) -.0 .. " __....__ _ _. .1.. . >""'~_',.,......... .r" ,~~: - ,- , """" '. J'. ..~. ~ .! ~ ~ - In'formation- Notice'."tb ~Pr<bJ~erty Owners About Construction Responsibilities - - ...,'.....~ .- .~~ -. '~-' ".;.~ ""'. ,...-: ..' ......... , . -~ "'..... ". -.., ".... " '- !f.otf: This 1nformation)vot(ce:tQ Pr:operty"Qwnprs about Construction Responsibilities' .:-:;' . '- .. ~.. '-~~..... . . . . - . was-developed H)j the Construcilon~Contractors 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 iiriprovement to an existing structure, you can prevent maJly problems by being(iwar~ ,of the fdllqwing re.sponsibilities an~ areas of CC)llcern. c ..~ '~1 ,~ EMPLOYER RESP.ONSIBILlTIES: If you hire pers~:ms 110t .registered with the Con~truction Contractors. Boaro to do -labor ip constructing or assisting in the construction or impro~ement'Qf.~ residential structure, you:~~ll, in, most instances, be ruled to be an employer and tbe people you hire will be e,rnployees. 'As the employer,. you 'must c:omp'Iy with the follo,wing: ' . . Oregon 's withholdin~ tax I~w:' As an employer,. 'you must withhold incbme taxes from employee wages at the time employees are paid. You will be liable for the;tax: payments even if yoti clon't' actually withhold th~ tax from your employees. For more information, call tbe Oregon Dep( of Revenue 'at 945-8091. ". ': .'", 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 Oregon Employment Division at the Department of Human ResoUrces at 378-3524. , , Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' ,comPt?I:lsation insurance for your employees. If you fail to obtain workers' compensation i~surance, 'you may be subject to penalties and will be liable for all claim costs if one of your employees is ilJjured on the job. For more information, , 'i .' call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue~ervice: 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 1-800-82~9-,;l040'. . . .. . ~ J' ,~. OTHER RESPONSIBILITIES AND 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.' , 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 your employees. Exp~rtise: Ma~e sure you ha~c the expertise to act as your o,wn gener.al cQl).tract,or, to coordinate the work of rough-in and f~ish trades, and to notify building officials at the appropriate tirriesso they can pe~orm the required inspections. ~. , '. '. . ~ '.. , . .. ; . .~ ' Ifyouhav~''iidd'i~l'dnki ~uesti;;hs, write or call the ConstrucHon C6~tractors Board (PO Box 14140:.S'alem: OR 97309-5052, 503't378-4621).' TheB~ard is located at 700 Summer St. NE stille 300,in Salem:'j '.' prop-own.pm4 1/94