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Home My WebLink AboutPermit Electrical 1997-12-18 ; - , ..;,"C~ A&~ ,rb~ " y~!~ l ," ~-no'l i;~ "~Omia~d. ':~ 1M tollowlng e-::.~rO'/: l. qUj(.... t.;'...C..IC l:md u:o Zonina L AI ./ .J. _, uvr ,~~ D9!912d.&::J.'e"'1 ~fJ ~ 225 FIFTH STREET A' -, '^rW~<<" c..~O uthonzed Signature r ) A. ,";;> SPRINGFIELD, OREGON 97477 ( .~'" Q.. n ' INSPECTION REQUEST: 726-3769 <<.,~~v ~<<.,~'~'(tJ C1 ty Job Number '--1117 OFFICE: 726-3759 ~ ~~~ C~ , . ...,.,.~. ~'f- ~ ~ COMPLETE FEE SCIIEDULE BELOY 1. LOCATION OF INSTAL~,~. ~ r:o ~(;)~ ~'()'f- i I r11 k(!!'AAY"~O .,.,<<<j:-~ <,(;)YJ fJ'f:> ~fI. New Residential-Single or , ~~. ~r;. ~(;) ~fJ Mul t i-Family per dwelling uni t. LEGAL DESCRIPTION ~ ~~~fJ ~~G -A ~~ Service Included: JjO ~:;l.,!.\ U -OISOO'f- v;J~,+,,",L 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 days. 2. CONTRACTOR INSTALLATION ONLY Electrica~ontractor Address City / Supervisor " Expiration Date ELECTRICAL PERMIT APPLICATION wcj * Items 1000 sq.ft. or less Each additional 500 sq. f t or portion thereof Each Manuf'd Home, or Modular 'Dwelling Service or Feeder ,B. Services or Feeders Installation, Alterations or Relocation: Cost Sum 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 am~s to' 1000 amps Over 1000 amps/volts Reconnect Only $ 85.00 $ 15.00 $ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 5 40.00 41-60 . - C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'OT less a:t $ 40.00 201 amps to 400 amps $ 55.00 of Supervising Elec trician Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts see "B'! above ~;slpv2.- D. Branch Circuits Owners Name lJA-YI; e.. L LOI . Address 11 -11 i.. fl LlV-~ Ci ty<;"ot'Ll{\, L~l c( Phone 7dlP- I Dt:t I -, j-L' O\INER INSTALLATION The installation is being made on property I own whi~h is not intended for sale, lease or ren t. Owners Signature: --------------------------------------- DATE: 1;::),-1 ~- '17 RECEIPT jf: '::::)~30'r RECEIVED BY: -k0' New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE $60, - 5% State Surcharge -9,.~O 3% Administrative Fee $},<::::O TOTAL ''C;iJ. _ tI . .~ . Permit #: Address: Issued by: Date: 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 buildingpermit 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: , [K) [l(J \, \ 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 I ~I 3B, I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If! 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 ?5:Jni a!lstruction Responsibilities on the reverse s;~ o~ ~~o;~ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . It ., <, information Notice to Property Owners About Construction Responsibilities Note: This Informatioll Notice to Property Owners about Constmction Responsibilities was developed by the Constrllction 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 problcms by bcing aware of the following responsibilities and arcas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board 10 do labor in constructing or assisting in the construction or improvementofa residential structurc, you will. in most instances, be ruled to be an employer and the pcoplc you hire will be employees, As the employcr, you must comply with the following: Orcgon'switbbolding tax law: Asan employer, yon 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 infonnation. 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 Department at 378-3524, Workers' compensation insurance: Asan employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurancc for your employees. I fyou fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs ifone ofyouremployecs is injured on thejob. 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 forthc tax payment even if you didn't actually withhold the tax, Formore information, call the Internal Rcvcnue Servicc at ] -800-829.1 040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the perm it holder for this projcct. you are responsible for resolving any fai lureto meet code requirements that may be brought to your atlention through inspections. Liability and property damagc insurance: Contact your insurance agent to see if you have adequate insurance covcragc for accidents and omissions such as falling tools, paint ovcrspray, watcr damage from pipc punctures, fire, or work 1hat 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, tocoordinate the workofrough-in and finish trades. and to notify building officials at the appropriate times so they can perform the rcquired inspections-. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salcm, OR 97309-5052, 503/378.4621), The Board is locatcd at 700 Summcr SI. NE Suite 300, in Salem. prop-own.pm4 1/94