HomeMy WebLinkAboutPermit Electrical 1993-12-1
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SPRINGFIELD
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225 FIFTH STREET we'C:"0~";;;'o'cGO~(\0'
SPRINGFIELD, OREGON 97;.7,;?ai: d') - q)
INSPECfION REQUEST: "726-31~?n\l' d- ~V'
OFFIC~: . 726-3759 )y \1\ )
1., LOCATION OF INSTAIfUT ON , S'.\)\";;.\'.l,e
/.,e" ; I; . 0 ' 0('200
rx.J W.:2""'- ~,'r\f'~.A.J r.'~\r,-'
LEGAL DESCRIPTION
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JOB DESCRIPTION
f~c'l se.rlfitl!. 4- a..".. !
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Permits are non-transferable and expire
if .work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACfOR INSTALLATION ONLY
Electrical Contractor ~~~~~
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
ELECTRICAL PERMIT APPLICATION
C' Y Job Number
COMPLETE FEE SCHEDULE BELOV
A.
New Residential-Single or
Multi~Family per dwelling
Service Included:
~~,:s<w
uni t.
Items
Cost
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
~. 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
$ 85.00
$ 15.00
$ 40.00
-- $ 50.00 .:;;:;;2
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
Expiration Date
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Signature of Supervising Electrician
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 Circui ts
Owners Name ~L #At-S5~;~
.. , ' New, Alteration or Extension Per Panel
Address~~6 ~/~~jqW~. '
, . One Circuit $ 35.00
City ~~~Phone '7~'1SZ2r' Each Additional
- - .' Circui t or IIi th Service
OVNER INSTALLATION or Feeder Permi t $ 2.00
The installation is being made on
property I own IIhich is not intended
for sale, lease or rent.
Owners s~a ture:
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RECEIPT II: //~
RECEIvED BY: ,/ -- "'""'1,
./7~
DATE:
a _.
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5._
SUBTOTAL OF ABOVE
5% 'State Surcharge
TOTAL
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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Permit No: ~3"~D
Address: .t:t;~ ./';l9-.fl5>>V/"~ , ~ '
Issued b . Date: /~ y-,.:r
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 in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. I Y
I own, reside in, or will reside in the completed structure.
2..1
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3, A.I
I My general contractor i<:
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
3, B, I/.. I I will be my own general contractor,
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If 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 of the name of
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.
t:t~gr~r7;Ji Applicant
11~ Co I ~
Date '
CONSTRUCTION CONTRAClORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPUCANT
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NOTE: Thislnformat.ipn Notice ,to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
, pass~<l by,the 1989 Oregon Legislature,
.. ."" ,:', '. ' . ,
, If you are acting as your own contractor to construct a new home or make a substantlallhlprovement to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
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 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 iime 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 information, call the Oregon DepartlT!ent of Revenue at 378,3390,
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 Employmel'1l Division DHR
at 378-3224.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' 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 information, call the Workers' Compensation Division DIF at 373-7434.
U,S. Internal Reven,ue Service: As an el)1ployer, you must withhpld 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 221-3960,
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 Property Damage Insurance: Contact your insurance 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,
Time to Supervise Employees: Make sure you. have sufficient time to .supervise your employees.
Expertise: Make sure you hav!l the expertise to act as your own general contractor, to coordinate the work
of rough-in and finisn tr\ides. and to notify building officials at the appropriate times 'so th~y can perform
the required inspeciions:, ',\ ' . '~ , ,
" you have additional questions, write to:
Construction Contractors Board
700 Summer S\, NE, Suite 300
Salem; OR 97310-0151
Phone 503-378-4621
, 0244J 10/24/89
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