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Home My WebLink AboutPermit Electrical 1996-11-26 . ..\ .,.:~. - r~;-. '~~"'': .~i.1 ..-, ,. i'''' , ,"" .-" \ ~ ..... I _ ' .' . t.\.IjHO".t..ol. 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 Zoninfb-D'~- 9010 I I ~ 2.(,r 'L.. 6 9747 - 726A~?6ged Signature ELECTRICAL PERMIT APPLICATION Ci tyJob NUIDber--3..h OCO 7?f' 3. COMPLETE FEE SCHEDULE BELOY tJ . tv' A. Nev Residential-Single or Multi-Family per dvel1ing LfLJ _07UJ6ervice Included: Items ~GAL ~~PTION '/131 -1!OO'7/76 Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork 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 '{I Ovners Name, AddressJ15k; (C,lb,AA,4 , City~'~~Pho~e]2h --q~1 O~~ STALLATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Il(.;'~;~~~~-------------- RECEIPT #:. ,'I;tal<l . RECEIVED BY: ,tV T - L.--- 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular .Dvel1ing Service or Feeder 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 amps Over 1000 amps/volts Reconnect Only uni t. Cost Sum $ 85.00 $ 15.00 :$ 40.00 $ 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 Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above .' Nev,. Alteration or Extension Per Panel One Circuit Each Additional Circuit or vith Service or Feeder Permit E. 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 $ 35.00 $ 2.00 not inc,luded) )( $ 40.00 $ 40.00 $ 20.00 $ 36.00 2f).{}V :w ,o-n 'tf); "l { . (ptJ . Permit #: . q(offK /7( t(3h e/VW 1Uw1/ JtJa1/ /iJ Date: j!~ 26 ~~ , .f .. 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 statemenl 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 nol submit lhis statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: I own, reside in, or will reside in the completed structure. understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D 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! 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 above information is correct and that I have read and do understand the Information Noticyeo roperty ~waers ou~ ~onslruction Responsibilities on the reverse side of this form. ~' tJi< J(A/L.., }j !)-'2t?-'l~ ( gna ure of permit applicant) (- (Date) (White copy to issuing agency permitfile, pink copy to applicant) . . . '\ [~~OIi'Ma1frkCiif( J\::Q)~:~iE) ~::t ~7@LG@~ ~1Jl7~~;'i&i 0. r..:..!f\\1 n\l' .~~~~'~r?~ ~'i~I',~rcV0' ~R<~~~TI"."'Q)~~~~~~(\=rA'\~) ~!!J;~\\I~", '0\oJ~ ~'<...d.L I..,.:.;~...\t:-,.. _ """"'-')~ ~>UI~ u... Jl0~""ll._"...." . Note: This Information Notice to.. Property Owners abolll Construclion Responsibilities was developed by the Conslructioll Contractors Board in accordance \Vith ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a sl'~1S\antial improvement to an existing stmclure, you can prevent many problems by being aware of the following responsibiUties and area., of concern. '-~r'D' ""~' .~ ""~"''''''''~'~"",,'' '"'... '" :::~,~_i.'.>J ~. :."(j n~U>ii\iji~\J~.J~~,l"J . ~l(:~: If you hire persons not registered with the Construction Contractors 'Board to do labor in constmcting or assisting in the construction or improvement of a residential structure, you "ill, in most instances, be ruled to be an employer and the p~opJe you hire will be employees. As the employer, you must comply with the following: C.ego~'s "l~;l~,C!:lL~g tel' ,a"l: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable forthe tax payments even if you don't acmally "ithhold the tax from your employees, For more information, call the Oregon Depl. of Revenue at 945-8091 . Unemj)!oy::!~nt fnsui"llnce tax: As an employer, you are required to pay a tax for unemployment insurance purposes O~ I)," wages of all employees. For more information, call the Oregon Employrrcnt Division at the Department of Human Resources at 378-3524, Workers' compensation insllI"ance: As an employer, you are subject to the Oregon Workers' Compensation Law, and i11u,t obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insmunc, ) 0" 'OU) be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more inform~lIn~, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. V.S. ~nternaI iRevellue Service: As an employer, you must withhold federal income tax from employees' wages. You IV ill b~ liable forthe tax payment even if you didn't actually withhold the tax, For more information, call the [ntema! Rc\ cnuc Sc" ice at 1-800-829-1040, OlJ'~IE~ ~iES~O~Si:a:U"j'HES tl.NiD tl.?li2tl.S 01= COf\:C:a~i\j: Cade compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirclT'ents that may be brought to your attention through inspections, Liability and pI"operty damage insurance: Contact your insurance agent to ~ee if you have adequate insurance coverage for accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must he re-done, Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can petform the required inspections. If you ha've 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 Summer 51. NE Suite 300, in Salem, prop-own.prn4 1/94