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Home My WebLink AboutPermit Electrical 1998-4-13 . '""" Thelfollowtng ~Ject as ec~ ;". J has Ihofollowlne zon rig, end does not require epec/iIc lend uao epproveJ. l Zoning (lv 081...6..... \3.A1~ ELECTRICAL PERMIT APPLICATION 9~~E~n~--D-n1E ~ty Job NUJIJ.ber!1:iO-/2- 7- NOT\" : IFlHE WORK HIS f'EIW.\1' ~@muilf!I!IPfEE SCHEDIfuIt BELOIl 1. LOCATION OF INSTALLATION i FR iHIS f'ERMIl ,~ '.J..9L\ la.~-", 11l"1>O -srmUiHOP.\!EONlW"Re.~i..<l.Im\~ee~gle or \ . COMMENCE(/'Il)lllrl~l\I'Wl'1y per dwelling uni t. LEGAL/Dfo~r~21.. _03IOG,NY1BOOAY~W Included, Items 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 JOB DESCRIPTION Permits are non-transferable and expire if work is not'started within 180 days of issuance or if work is suspended for 180 day~. ~i-. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone. Supervisor License Number Expiration Date Cost Sum 1000 sq. ft. or less t $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home. or Modular Dwelling Service or Feeder .$ 40.00 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits ,B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less . I 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 C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name l \t"\A(\ \'\v1.<jp(f'n Address {~'-\ '\..cu:;<:r,~!'\. 11"'O~ Ci ty <;;' n Prl Phone :::rZ.y,.' R\'(l d- ~ . OIINER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners S'gnature: . ~~- D~TE~----ct ,~iC1'yr-=--------------~- RECEIPT II: Ii, () .L '1.-x:1 "f RECEIVED BY: "J-- . ftf/l//\.-' . $ 40.00 $ 55.00 $ 80.00 see lIBft above .' New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting . Limi ted Energy/Res Limited Energy/Comm One Circuit Each Additional Circuit or with Service or Feeder Permit ~ E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 35.00 $ 2.00 Co.OO not included) $ 40.00 $40.00 $ 20.00 $ 36.00 514. Q(J '. ~. '( '0 J.aJ~: 8L . Address: . q (j01.f2 7 7r'i - W/C\(YIeh Loot) 1..1t1LIA-- Date: tf/,s/9f . Permit #: .. 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 701.0 I 0(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: . ~ D 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 D 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 about Construction Responsibilities on the reverse side of this form. "- (Signature of permit applicant) 41\~J~ (bate) (White copy to issuing agency permit file, pink copy to applicant) . . llnformCll~ion Notice ~o Pmperty Owners About Construction Responsibilities ,. .. Note: This Information Notice to Property Owners about Constl'llction Responsibilities was developed by the Constrllction Contractors BOllrd in accordance with ORS 701.055(5). lfyou 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 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 ofa 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'swilhholding tax law: Asan employer. you must withhold income taxes from employee wagesatthetime employees are paid. Yon 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. Unempluyment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more infonnation, call the Oregon Employment pepartment 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 subjeet.to penalties and will be liable lorall claim costs ifoneofyouremployees is injured on thejob. For more information, eallthe Workers' Compensation Division at the Departinent of Consumer and Busin<;ss Services at945. 7888. U.S. Internal Revenue Service: Asan 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. eallthe Internal Revenue Service at 1.800.829. I 040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project. you are responsible for resolving any fa; lure to meet eode requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agentto see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. fire. or work that must be re.done. Time 10 supervise employees, Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have 1he expertise to act as your own general contractor, to coord inate the work of rough. in and finish trades, and to notify building of!icials at the appropriate times so they can perform the required inspections. If you have additional questions. write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309.5052, 503/378.4621). Tbe Board is located at 700 Summer St. NE Suite 300, iILSalem.' . .' . prop-own.pm4 1/94