HomeMy WebLinkAboutPermit Electrical 1994-12-7
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SPRINGFIELD
Tho followIng project c.s ~ubmttted. ryas tho
zoning. and does not requiro SpeCIfiC land
approve!.
225 FIITIl STREET
SPRINGFIELD, O'REGO'N 97477
INSPECTIO'N REQUEST: 726-3768m
O'FFICE: 726-3759 9
Zonlno
AUlholiIcd Signaturo ~
1. LO'CATIO'N O'F INSTALLATI~
h? / ~G!:>..w-~ L;P.? A.
LEGAL DESCRIPTION
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ELECTRICAL PERMIT APPLICATIO'N
City Job Number
r9Mr~~E FEE ~~HEDULE BELO'V
"7 '7"'/~
Ney Residential-Single or
Multi-Family per dyelling unit.
Service Included:
JOB DESCRIPTION /_ 10'0'0' sq.ft. or less
E/,-:zr. ~~e;.-rr-~~""'<.:2/Each additional 50'0'
.. . " sq. ft or portion
Permits are non-transferable and expire thereof
if york is not started 'Yithin 180' days Each Manuf'd Home or
of issuance or if. york is suspenaed for Modular Dyelling
180' days. Service or Feeder
2..- CO'NTRACTOR INSTALLATIO'N O'NLY
Electrical Contractor ..&~1"""G"~
Address
City
Phone
Supervisor License Number
Expiration Date
B. Services or Feeders
Installation, Alterations
or Relocation:
20'0' amps or less
20'1 amps to 40'0' amps
40'1 amps to 60'0' amps
60'1 amps to 10'0'0' amps
O'ver 10'0'0' amps/volts
Reconnect Only
It ems Cos t
Sum
$ 85.0'0'
$ 15.0'0'
$ 40'.0'0'
$ 50'.0'0'
$ 60'.0'0'
$10'0'.0'0'
$130'.0'0'
$30'0'.0'0'
$ 40'.0'0'
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
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Oyners Nam~?;>-~e:~/~/~
Address ~~df!;' ,
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O'YNER INStALLATIO'N
The installation is being made on
property I oyn yhich is not intended
for sale, lease or rent.
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D\tllers Signa mr .
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DATE: (/~-"7 '''''7CT' .
RECF.II'T 'j,: /~ 4'
RECEIVED !JY: //jf~__
20'0' amps or less
20'1 amps to 40'0' amps
Dver 40'1 to 60'0' amps
Over 60'0' amps or 10'0'0' volts
Branch Circuits
$ 40'.0'0'.
$ 55.0'0 .'
$ 80'.0'0'
see "BIt above
Ney, Alteration or Extension Per Panel
Dne Circuit ~35.DD ~
Each Additional
Circuit or yith Service
or Feeder Permit $ 2.0'0'
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTDTAL DF ABDVE
5% State Surcharge
3% Administrative Fee
TDTAL
not included)
$ 40'.0'0'
$ 40'.0'0'
$ 20'.0'0'
$ 36.0'0'
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Permit #:
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Address:
IssuedbY:,~~ Date: /2-::>~"5'Y
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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 I and 2, and either box 3A or 3B:
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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.
D
. 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
~ 3B. I will be my own general contractor.
If I 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.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners ab t Construction Responsibilities on the reverse side of this form.
I )-7-7Y-
(Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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JlnformationNotice to Property Owners
About Construction Responsibilities
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Note: This Information Notice to Property OWMrs aboUl Construction Responsibilities
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was developed by the Construction,Contractors 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 ilfeas 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 withholdhig 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
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 Department of Human Resources
at 378-3524.
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 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 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 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 punctures, fire, o~ work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to 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.
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If you have additional questions, write or call the Construction Contractors' Board (PO ~ox i 41~0: Salem, OR'97309-5052.
503/378-4621). The Board is located at 700 Summer SI. NE Suite 300, in Salem. ,...'.
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