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Home My WebLink AboutPermit Electrical 1995-8-16 71~-- " -,..-,0 f. IJrW" 9 ,",' t b ,,: ,,: :' "',' , ,,; ope as su mltf{'l' I1a$ the I vii " . Idl~:, "n,~ .'O':H ,o,;.t r.'ou fa ...,.,"It:. far",. ~lr)~)r:.:.,'a; . .... -~ dS Zori;r""LV~ ~~,~- I ~~~F?'" '--. -, / ..u.lP . .' ELECTRICAL PERMIT APPLICATION 97477 A.Mlc,t!:~d Signaturl1_:~ " , , 726-3769 " "--'" ~-Cl:.ty~b Number ~ f'.t:: 3. COMPLETE FEE SCHEDULE BELOV 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 1. LOCATION OF. INSTALLA~IO~: _ ~ /5l&J~ ~~ie'~ ~. LEGAL DESCRIPTION /7"'V>3<2~-~;Z, -/~/~ - / - , , 'JOB DES~ION ' , ~ r~ .~c~..)A~ ~ Permits are non-transferable and expire if work is not started within 180 days of issuan~e or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor ,~~~ C./ ,kn-/ -'. Address City Phone Supervisor L{cense Number Expiration Date Constr Contr. Number Expiration Date ~ignature of Supervising Electrician Owners Name ,7---?1l~VE ,~~ ~~ Address /~ey ~" ~ " City ~~. Phone~~/"~~ -,.' . OVNER INSTALLATION The installation is being made ~n property I own which is not intended for sale, lease or rent. (Ovners=t'\. ~ ~ . ~-~--------------------~---------- DATE: Ry~..~ RECEIPT #: /~?~ RECEIVED BY: /. ~~V.-.~ / . "/? A.Ne~ Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum , 1000 sq.ft. 6r less' $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home. or Modular Dwelling Service or Feeder $ 40.00 "....-- $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ ,40.00 ?~4P B. Services or Feeders Installation, Alterations or Relocation: ' C. Temporary Services or Feeders InstallationlAlteration or Relocation 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 am~s to 1000 amps Over 1000 amps/volts Reconnect Only " ~ 200 amps' 'or less $ 40.00 201 amps to 400,amps $ 55.00 Over 401 to 6,00 amps $ 80.00 Over 600 amps ' or 1000 volts see "B" above D. Branch Circuits New, Alt~ration or Extension Per Panel ,. One Circuit $ 35.00 Each Additional Circuit or w,ith Service or Feeder Permit ~,$ 2.00 ~' not included) Miscellaneous (Service/feeder -Each installation Pump o~'itrigatio~ Sign/Outlin~ Lighting Limited Energy/Res Li'mited Energy/,Comm E. 5. SUBTOTAL OF ABOVE' , 5% State Surcharge 3% Administrative Fee TOTAL $ $ $ $ ~~~ - ~...~ L.~2. 5~ -~2 40.00 40 . 00 / 20.00 36.00 # Permit#: ~~~ Address: /~ Y ~ L~ ~ Issued by: ~ ~---- Date: JB~"'~Y- ~~~~~ - ~ 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: 11 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 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 (White copy to issuing agency permit file, pink copy to applicant) .. '. -,~~,,,...., ,'~ -" . Infornuitiorr Notice to Property Owners co. :' ',,_ ,A.Qout C~~~ruction Responsibilities . "," ,,;. _'. _.,' 'i:", ~ , . :. ~~ .:. '?: -:" -0" '<.,Note: This Informatipn Notice to Propf;,rty Owners about Construction Responsibilities, .. - ". ,'-. :::~ ;V~s...:.d.eveloped by the Cdh~truc"tloli-r:ont-"actors 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 ~pe following responsibilities a~d ar~as of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not re~istered with the Construction Contra9tors ~oard to do labor in c(mstructing or assisting in the construction or improvement of a res.idential structure, yot! will, in most instances, be ruled to be an employer and the people you hire will be employees, A~ 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'1iable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. 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 DGPartm~nt of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and riiust obtain workers' cpmpensati,on insurance for your employ~es: Xf you fail to obtain. wQrkers' compensation insurance, you may be subject to penalties arid wili be liable for all c1aimcosts if one ofyo~r employees is jnjured on the job. For ~ore information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal RevenueService: 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 1-800-829-1040. 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 prop~rty da~age insurance: Contact your iflsuraJ:I,ce agent to see if you have adequate insurance coverage for acci~ents and omissions suc~ as fallingJ?ols, paintoverspray, water d~mage from pipepunctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to s~pe!"ise your employees. Expertise; Make sure you have the expertise to 'act as your own gene~ai contractor,-to coordinate the ~9rk of rbligh~in and finish trades, and to notify building officials at the appropriate timer~o they can perform th,e/required inspections. "-..., \ , . . \ . . .' . If you have additional questions, write or call the ConstructionC;~mtractors.Boatd (PO Box 14140, Salem, OR 973.09-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite J"OO~ in Salem.. ' prop-own.pm4 1/94 \..