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Home My WebLink AboutPermit Electrical 1999-7-13 The, following projectes submi<<ed has the following zOning, and does not require specific land use approval. Zoning L iJ YL- 225 FIFTH STREET Date '1 0 '? - c,"'I , SPRINGFIELD, OREGON 9JJ(j,b~zed Signature 9'\uJ INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF INSTALLA~:rgij '~~D~~ LEGAL DESCRIPTION /7h 12-lfn O'f~o JOB DESCRIPTION City mINER INSTALLATION The installation is being made on property I oyn yhich is not intended for sale. lease or rent. -------;" ---------------------------- DATE: q I fjf ,',' RECEll"f * ~ 01<f'(;f'{ (I'_I f/ RECEIVED flY: IU' W~ ELECTRICAL PERMIT APPLICATION ..:i ty Job Number nO r Lf ~ 3. COKl'LETE FEE SCHEDULE BELO\I A. Ney Residential-Single or Multi-Family per dyelling unit. Service Included: Items Cost Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion Permits are non-transferable and expire thereof if work is not started within 180,days Each Manuf'd' Home. or of issuance or if wor~UTI~nded for Modular,'Dwelling 180 days. THISPER~ITSH PIREIF~~ or Feeder 2. CONTRACTOR INSTAI.LAOOl/ID~!fliID ERTHISfilER!flITJtlN.Q1 or Feeders , COMMENC ORISABANDONEtJ:f!G'Allati~n, Alterations Electrlcal Contractor or Relocatlon: ANY 1 tlytJf\ T t"toni0D:' 1 C.A 00 Address / ,200 amps or less $ 50.00 QU- / '201 amps to 400 amps $ 60.00 Phone 401 amps to 600 amps $100.00 mENTION'Ore 601 amps to 1000 amps $130.00 Supervi.sor L::2j' cense llum!>eru'M ~:.~_.~~'~ '''',': r"4~lre5 YOver 1000 amps/vol ts $300.00 :,"', . ---~._--, .,,~OrE'gonR'econnect Only $ 40.00 Expira tion Da t ~o~~<;.,a~~~ ~:~t~!',~hOSe rules a,6 set fortr 0...' -__ __' vv,~ ""uul,jl; 0<;8 g,Temjlorary Services or Feeders Cons tr Con tr. NumbQQ90:.~oumay obtam caples of 1116 roInst:alla tion, Al teration or Reloca tion . / .....o;.o.i'"l~ UIC'\lt:::lIU::tr. \I...ore;.t~e telephone .- Expi ra tl on Da t e number for the Oregon Ullhty Notificf,Q!:lnamps"oT less , / .. ' venIerlS l-Wl(1-332-2~44). 201 amps to 400 amps Signature of Supervising Electrician Over 401 to 600 amps ~ Over 600 amps or 100U volts ~ D. Branch Circuits Owners Name U:r~ue.HL-l)j Address QAI2e> fZANG14 Dfa. Ci ty ~PFLD Phone 11b ~ S 85.00 $ 15.00 . $ 40.00 $ 40.00 $ 55.00 $ 80.00 see "B" above " Ney, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation ' Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm orie Circuit Each Additional Circuit or with Servicf or Feeder Permi t :&. E. s. SUBTOTAL OF AflOVE 1'!oState Surcharge 37. Administrative Fee TOTAL $ 35.00 2.0..- $ 2.00 no t included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 r40 61 G9 l(.q (.r2. t7 U:> . Permit #: q9~9tff . Address: :2'12 ; U tJ~J t/ t:f Issued by: cf{JJ Date: 71 ~ /1J . 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 statemenl before a building permit can be issued. This slatement is required for residenlial building, electrical, mechanical, and plumbing permits, Licensed architecI and engineer applicants, exempt from regislration under ORS 701,010(7), need not submil Ihis slalemenl, This stalemenl will be filed with Ihe perm iI, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: c:m < I own, reside in, or will reside in the completed structure, ~ -i I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, .0 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 ~ ./ 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 t the above information is correct and that I have read and do understand the Information Notice t Property 'ners about Construction Responsibilities on the reverse side of this form, (Si~~\ure of permit applicant) (While copy 10 issuing agency permil file, pink copy 10 applicanl) \~ ,JUl.:-(. ~ (Date) / .--./ . . . , ijlJi)~OIli'Jl'iJ'ilal~OiOr.'Il lNJiO~ice ~iOi IJllrrC(OiSlliy OWli"iiSrrS A[Q)~l!.!~ tCiOiIJi)S~rrl!.!C~nOIJi) ~leslP1<<:msironmnles Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors' Board in accordance with ORS 701,055(5), If you are acting lIS your 6wn contractor to construct a new home or make a substantial improvement to '~"existing structure, you can prevent many pr6blems by being aware of the following responsibilities and area~ of concern, IEM[PllOVlE~ ~ES~ONS~lBliUlIIES: 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 strueture, 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 infomlation, call the Oregon Dept. of Revenue at 945-8091, I 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 Department at 378-3524, ,/"0) "L'" Worker's com~nsation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insuranee for your employees, If you fail to obtain workers' compensation insurance, you IlJJIJ') be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more infom1atIJn,~~ call the Workers' Compensation Division at the Department of Consumer and Business Setvices 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 Setvice at 1-800-829-1040, OT~IE~ f!IESIP'O~S~[2jiUl~IES AND AIFlEAS O~ CO~CEIFl\\J: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requireme~:\ that may be brought to your attention through inspections, .'\.. I Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents Md omissions such as falling tools, paint overspray, water damage from pipe punctures, fIre, or work that must bc re-done, Time to supervise employees: Make sure you have sufficient time to supetvise our employees, Ex~rtise: Make sure you have the expertise to act as your own genemI contractor, to coordinate the work of rough-in'Md fInish tradesr~ notify byildi~rfficialS at the ~l'l"Vl'.;ate times so they can perform the required inspections, :;,It"' :Y..JUV C, _ -:::;-...,. If you have 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 Sl. NE Suite 300, in Salem prop.own.pm4 1/94 SP-QO'