HomeMy WebLinkAboutPermit Electrical 1994-7-22
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The followIng project as iubmittad has the f
225 FIFTH STREET zoning, and does not require specific 1~~etRICAL
SPRINGFIELD, OREGON 97477 approvel.
INSPECTION REQUEST: 726-3769 Zonina L-j)e.,.
OFFICE: 726-3759 ~
Qeta<-r-2.'2: . l-( 3. COMPLETE FEE SCHEDULE BELOV
1 LOCj}TIJlli.., OF INSTALLATI~utho'r~ed~~.?atYl'e (\ fV\- '
b'h:3 (:~Y1lel1l1la ( 5r~d Ot( Iff'/7? A. New Residential-Single or
I Multi-Family per dwelling unit.
LEGAL DESCRIPTJON Service Included:
/'7[) '3 2C; -4.'3 (J/?A:50 Items Cost
JOB DESCRIPTION ) 1000 sq.ft. or less $ 85.00
/P8?C~/3 5~eo I~cs/ Each additional 500
.... , ,. -./ sq. ft or portion
Permits are non-transferable and expire thereof
if work is not started within 180 ~ays Each Manuf'dHome or
~of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder
2. CONTRACTOR INSTALLATION ONLY
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Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date .
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name l?\c6vcl Ih $rC"nSe v\
Addr,ess <JbO [1e/1!eVH? 14 (
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Ci ty5pr, 'jBe d Phone 7lf'&CqS-<l
OVNER INSTALLATION
The installation is b~ing made on E.
property I own which is not intended
for sale, lease or rent.'
Ovn~/Signjture: .
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______________________________________~ . 5
DATE: ;7~.:2 Z -11, .
RECEIPT #: / fcl"f-n
RECEIVED BY: " ~ ~ ~.:.-
PERMIT APPLICATION
CJ~I/2/
City Job Number
Sum
$ 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 amps
Over 1000 amps/volts
Reconnect Only
//
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
S-D,~
C. Temporary Services o~ 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 "B" above
D.
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
Each Additional
.Circuit or with Service
,or Feeder Permit
$ 35.00
$ 2.00
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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Permit #:
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d~l Date: '7/;;22-//~
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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 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:
'M 1.
~,2:
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
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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
l hereby certify that the above information is correct and that I have read and do unders~and the Information
Notice to ~y 0;". ers ~t C, onstruction Responsibilities on the reverse side of this for~.
, ~/4/~. , " . ?-.,A2~<?Y
(Sig~ature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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Information 'Notice to' Property Owners
" . ~ , .- " About qonstructiQn .Responsibilities
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Note: This]nformationjNotic'e. to Property Owners about Construction Responsibilities.
'was cle'velopCd by the 'consir~d[ont;o'ntractors Board in accordance with ORS 701.055(5).
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If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prev~nt man~ problems.by being a~Yar~ofthe f~llowil1g responsibilities and areas of concel!l: .
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EMPLOYER 'RESPONSIBILITIES:.
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If you hire persons not regi&tered wit.h the Cdnstruction Contractors ~oard, to do-labor in C\mstructi~g or assisting in the
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construction orirnprovement ofa residential structure, you will, in most instances" b~ ruled to be an employer and the people
you hire will be einpk,Yees. As"the employer, you ~ust cOmply with the following: , "
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Oregon's withholding tax law: As ail employ~r,yoii must withhold income taxes from eJ:Iiploy~~ wages at the time employees
are paid. You will be liable for the tax paymenJs even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept.of Revenue\al 945~8091.
Unemployment insurance tax: As an employ~r, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, pall the Oregon Employment Division at the DepartmentofHuman Resources
at 378~3524. !
Workers' compensation insurance: As an eITlployer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for YOl-Jr 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. Formor~ information;
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 fotthe tax payment even if you didn't actqally withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-104'0.. t . , .- - ; ,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
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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 ipspections.
Liabili.ty and property damage insurance: C6ntact your insurance agent to see ,if you have !ldequa,te insurahce coverage for
accidents and.omissions such as falling tools, p~int overspray, water damage from pipe punctures, fire, or work that must be
re-done. '
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Time to supervise employees: Make sure you: have sufficient time to supervise your employees.
Expertise: Make s~re you havethe expertise to ~ct as your ~wn gene~al contractor, to coordinate the wo~k of rough-in and finish
trades, and to notify building officials at the-appropriate times so tliey can 'perform the required inspections.
If you have additio~al questions, write or call the Construction Contractors Board (PO-B'ox'14140, Smem,.OR 97309-5052,
503/378-4621). The.Board is located at 700 Svmmer S1. NE Suite 300; in Salem.
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