HomeMy WebLinkAboutPermit Electrical 1993-10-22
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The followIng proJ ct ,.'
2oning, and does ~ot ~: s~~:sltted. ~as the followl
225' FIITH STREET' approvlifl.-", q . peclflc land ulltLECTRICAL
SPRINGFIELD, OREGON 974}7 ',Zonin ~ 0 ()
INSPECTION REQUEST: ' 726-3769 g, , ~
OFFICE: 72i>-3759,' 'Date Ib b.))~
1. L~tI,9t\ OF ANST~Tr8~ize~ S','gF\ure
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PERMIT APPLICATION
, CityJob Number c;(J> 1620
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3. COMPLETE FEE SCHEDULE BELOV
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V j) New Reside\1tial-Sirigle or
Hul ti-Fall!ily perdwelling uni t.
Service Included:
LE~ DES~ION
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~OB DESCRIPTION(\ Ot.. n)
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Perm~ts are non-transferable a~ ~xpire
if work is not started within 180 days
of issuance or if work is suspended f r
180 days.
CONTRACTOR INSTALLATION ONL
Contractor
Address
/
City
Supervisor
Expiration
~
ure of Supervisiug Elect'
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City F'l ~ Phone-rtto,..CT[tllp
OVNER I~ALLATION
The ins tallaJion 'is beirigJianF' o~
pro~~I-G-T,(f: 'A'l-i~ot in tended'
0i sale, lea~e or re~t.~~ " '
, Owners Signa ture: 'V~~
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RECEIPT .: 1\ iJ ,,\( )\ D'\!
RECEIVED BY: (7) lL){t).... ..J '
, I terns
Cost
Sum
1000 sq.ft~ or less
Each additional 500
~q. ft or portion
thereof
Each Hanuf'd Home or
Modular Dwelling'
Service ,or Feeder
$ 85.00
$ 15.00
$ 40.00
B. - Services or Feeders
Installation, Alterations
or, Relocation:
200 amps or less
201 amps to 400 amps
401 ~mps to 600 amps
601 amps to, 1000 ~mps
Over 1000 amps/volts
Reconnec t Only'
L $ 50. OO.eJ.)'
$ 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
, $ 40.00
$ 55.00
$ 80.00
volts see "B"
abo've
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
,Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
5.
Misc~llaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res' $ 20.00
Limited Energy/Camm $ 36.00
SUBTQTAL OF ABOVE c:::"~,\ ro
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5%' State Surcharge '-, ~O
TOTAL (~lJ .00
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Permit No: , CBl Co 20_
Address: 83q ~~Q 0 .
Issued bt:J((['J6-) Date: (O:JQft~
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FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued.This state-
ment 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 i,~ t1jra~pliCable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. I )( I I own, reside in, or will reside in the completed structure.
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2. I I understand that I must register as a construction contractor'if the structure is sold
or offered tor sale before or upon completion.
3. A.I
I My general contractor is
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Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR ..-A-::c I _ _ n
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3. B..I \/ I I will be my own 9"=11--n-! contractor.
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It I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. It I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit ot the name ot
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
~'ill ~ -P,~~~,
(!-nafU\e of Pem\J{APPllcant J
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
)0- Z- '2-' ~,3
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE~, This fnformati.on Notice toP.roperty Owners About Construction Respon~ibilities
was developed by the CO,nstruction Contractors Board in accordance with ORS 701;055(5), .
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passed by the 1989 Oregon Legislature.
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. If you -are acting" as your own COhfractor to construct a new home' or make a substantial improve~ent to an
existing structure, you can preve!1t many problems by being aware of the following responsibilities' and areas
of concern.---' <.'. . . '
EMPLOYER RESPONSIBILITIES:
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If you hire pe~sons not registered with the Construction Contractors Board to do labor in <:;onstructing or assisting
in the constructio'n or improveme.nt of a residential structure, you will, i.n most instances, be ruled to be an
, . '" . . . .. . 'il"" . ,', '
"employer" an.d (he p.eople yo~ hir~ wi,lI b~ "emproyees'.':.As tti.e empioyer:youml,.ll;lt c~mply with the following:
Oregon's With'h61ding Tax !l.,~\(V: As. an, eniploy~r, ypu must withhold inco~e taxes from' ~mployee wages at
the time employees. are paid,. 'You will be 1i~,ple.Jor- the tax payments even it ypu don't actually withhold the
tax from your employees. For more information, call the Oregon DepartmenJ of, R,evenue at 378-3390.
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Unemployment Insurance Tax: As an' employer, you are required to pay" a tax for unemployment insurance
purposes on the wages of all,emplo,yees. For mor.e informa!ioni~all the Oregon Employment Division DHR
at 378-3224.
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Workers' Compensation Insurance: As an employer, you are subject tothe Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fall 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 information, cal~ th~Workers' C~mp~nsatiOf) Qivision DIF at 373-7434.
U.S. Interna! Revenue Service: ,As an ,employer, you must I/I(ithhold federal income tax from employees' wages.
You will be liable for the tax paYl'J1ent even Wyou didn't actually withhold the. ta'x. 'FOr more information, call
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the Internal Revenue Service at 221~3960. ' "
OTHllER RESPONSIBllITDES AND AREAS OF CONCERN:
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Code Compliance: As the permit holder for this project; you'are respoosible for 'res0lving any failure to meet
code ,requirements that may be brought to your' attention through inspections.
Liability 'and Property Damage Irisurance:Contact yourinsurahce agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done.
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Time to Supervise Employees: Make sure you have sufficient tir:neto 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 perform
the required inspections.
If you have additional questions, write to:
Construction Contractors Board
700 Summer S1. Nf, Suite ;300
Salem,' OR 97310-0151
Phone 503-378-4621 ,
02'44j 10/24;89 '
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