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Home My WebLink AboutPermit Electrical 1999-7-27 Th. following project as submitteO has the following :-:vnlng. and does not require specific land use dpproval. Zoning Li>{L-- 225 FIFTH STREET SPRINGFIELD, OREGON 97'llh INSPECTION REQUEST: J2t1iei&1.6'.l;ignalUre OFFICE: 726-3759 " f -~ -, - C; <; ~ ELECTRICAL PERMIT APPLICATION rity Job Number 99 O~2-<6' LO~TION JU;:~;I~ /. ' . LEGAL DESCRIPTION /7a:J 2.'7 .;( ~ t'J1J fhO ' hl~~B DES~~TION ,/ ~lR~ Rl!>nJMI- OF I ;/'[Pte/. ~ Aftfl/i(.16 ~,X!? I Permits are non-trans erable and expire :J if york is not started yithin 180.days of issuance or if york is suspended for 180 days. 1. 2. CONTRACTOR INSTALLATION ONLY El~ical Contractor AddresA "" Phone Supervisor Lic~ Number Expiration Date ~ Constr Contr. Number ~ "" City Expiration Date " Signature of Supervising Electrician Oyners Name .k(,.M \i0\\\~a. Address \4cl~ ~\~ \)~, CitAi{r\~\d Phon~_J4\'::"/.rF()4 OlINER ~TALLATION The installation is being made on " property I oyn yhich is not intended for s~e:tllea~e 0 rent, o s S1 a tre: J _ _________l____ DA1 RE( BIIT ~: RECBIVED BY: --~~~~~----- .-z ~ Ell- "1 I . -" A(:ft'yI.;-l 3 . COHPLETE FEE SCHEDULE BELOI/ A. Ney Residential-Single or Hulti-Family per dvelling unit. Service Included: 1000 sq.ft, or less Each additional 500 sq. ft or portion thereof Each Hanuf'd" Home, or Modular. 'Dvelling Service or "Feeder" ~. Items Cos t Sum .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 S 85.00 S 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 D. 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 10QU volts Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above .' , Nev, Alteration" or Extension Per Panel ~~ One Circuit ~ $ 35.00 ~a-o Each Addi tional Circuit or yith Service IJ(l~ or Feeder Permi t '7 $ 2.00 .J::::tJ- Miscellaneous (Service/feeder not include~) -Each installation Pump or irrigation . Sign/Outline Lightin~ Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 1'1oSta te Surcharge 37. Administrative Fee TOTAL $ 40.00 $ 40,00 $ 20,00 $ 36,00 .4-<7.00 I !.~J 7.~r c- --'J.<O. " JI - '---, . Permit #: q ~1J'2..9, , Address: --L.4-17V R A J~h~u } Issued by: ~~ Date: 7h. 745' ~~/ r J 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 permils. 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 I and 2, and either box 3A or 3B: g I. I own, reside in, or will reside in the completed structure. l'\;;r 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale p, 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 bc registered with the Construction Contractors Board, OR N 3B, I will be my own general contractor. 1ft 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. ve in rmation is correct and that I have rcad and do understand thc Information abou Construction Responsibilities on the revcrsc sidc of this form. Ov\ v . at re of it applicant) 7/2-/ )~'1 (Date) L \ (White copy to issuing agency permit file, pink copy to applicant) . . .-' iij?oi'm$l~OOI1'll i\loftice io [?>ll'opell'~Y OWi"iell's Aro()!,o~ ~ollilsftll'lUIctiOIl'l Res[Ool1'isiroi~ifties ~ , 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 RIESPO~SIBllITIES: , 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 10 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 Ocpt. of Revenue at 945-8091. Unemployment insu'llnce tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees, For more infonnation, call the Oregon Employment Department at 378-3524, Worker's compensation insurance: As an employer, you are subject to the Oregon Worker.;' Compensation Law, and must obtain worker.;' 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 costs if one of your employees is injured on the job. For more infornlation, 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 evcn if you didn't actually withhold the I.'\X, For more infonnation, call the Internal Revenue Servicc at 1 -800-829-1 040, OTHER RESPONSIBILITiES AND AREAS OIF CONCERN: Code compliance: As the pennit 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 iosurance: Contact your insurance agent 10 see if you have adequate insnnUlce 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 trades, and .to notify building officials at the appropriate times so they can perfonn the required inspections. If you have additional questions, write or call the Construction Contractors Board (pO Box 141f10, Salem, OR 97309-5052, 503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem . prop-own.pm4 1/94 SP-001