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Home My WebLink AboutPermit Electrical 1993-1-11 1 n, following prt'joct 00 submittoo ha- the following (fJlI zomng, and does not rsquire opacific land use ~.. approJal. P.LECTltICAL PlmHIT APPLICATION 97l . Zonin~ L f)R (7-:J.i-.Ar<]. n6-3{~.?e \ -11- OJ] Ci ty Job Number iuL U F I Authorized Signature 55. COHI'LP.TI'. PEE SCnEDULE D1'.LOV 1. ~\l.fl}:r~lN ~' STALLATIONA _\..I'l \ I 'Pf-'\ Q Q..""1\)\ ).\..J....D.l0Z\X.\U.!A-t--Ne\l Residential-Single or - ~ Hulti-Family per d\lelling unit. LEGAL~ESC~PTION (~CJv\O Service Included: \ '1 (Y:\01c::.:.:..J \ n ()(v Items Cost ~,. 225 1'11'1'11 5TREET SI'IUflGFIELll. OIII.:C:ON INSPI~CTlON REQUI'.5T: OI'I'ICF.: 726-3759 '''"' JpD DES91\CI.ION tv\ --"r""".~'~ \, M,\D\'~ \\\Q.,~ Permits are non-transferable and expire I( york is not started vithln 100 days o( issuance or if \lork is suspended for 100 days. 2. CONTRACTOR INSTALl.l\TION ONLY / / Elec~cal Con t rac tor Address~ City ~ I'hOne/ sup~rvi~or Lice~u~ EXplratlon Date ^ . ~.. ~ of Supervising F.lectric~ 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanu f' d 1I0me or Modular Dwelling Service or Feeder D. Services or Feeders Installation, Alterations or Relocation: Sum . $ 05.00 $ 15.00 $ /,0.00 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300.00 Reconnect Only I $ 1,0.00 ~ C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 201 amps to flOO amps $ 55.00 Over /,01 to 600 amps $ 00.00 Over 600 amps or 1000 volts see "B" above Ovners Nao~ ~ \=C\N1J\Qffi D. Address \rm-- M(J1JJn)Lidn~ C it y 2ft- (f1 Phone Jt.lrr ~q J- OVNr.R IN~TALLATION The installation is being made on property I ovn vhich is not intended (or sale, ~~e or rent. Ovners Si~re:-1 ! i~~~------O:~----- , RECEIl'l.' A: ~ r,' HECETVEIJ nY: V)l Dranch Ci rcuits Nev, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limi ted Energy/Comm' One Ci.rcul t Each Additional Circuit or vith Service or Feeder Permit E. 5. SUBTOTAL OF ADOVE 5% State Sureharge TOTAl. $ 35.00 $ 2.00 not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 4/')CO (--)~ 4~j. ,- - -- ..., ,6,..-r ..... . . Pefmit No: q ~ Addfess: ~ () Q III J\ qd...tJe..,; Issued bcrt./}(J) Date: (.~) -, . FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Ofegon Law, ORS 701.055(4), requires residential construction permit applicants who are not registefed 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 pefmits. Licensed Architect and Engineer applicants, exempt from registfation undef 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 \v 1 I own, reside in, or will reside in the completed slructure. 2.,.J..::I; I understand 1hat I must register as a construction contractor if the structure is sold I or offered for sale before or upon comple1ion. 3. A.I I My general contrac1or is Contractor registra1ion number I will instruct my general contrac10r that all subcontractors who work on the struc- ture must be regis1ered wi1h the Cons1ruction Contrac10rs Board. OR ............:. /A '" n - ~ \ oOPCULtUli/ 3. B. I will be my own.....~1 contrac10r. If I hire subcontractors, I will hire only subcontrac10rs registered wi1h the Construc- lion Con1rac1ors Board. If I change my mind and do hire a general con1factor, I will con1ract with a contractor who is registered with 1he Construc1ion Con1ractofs Board and I will immediately notify the office issuing this building permit of the name of 1he con1ractor. I hereby certify that the above Information is correct and that I have read and understand the Inform:laion otice to Property Owners about Construction Responsibilities on the reverse side of t is f~ 4 111 ( i~~ j~S & sig\:..ure oft'ermit Applicant ____ Date ,/'IIf CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COpy TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFOIATlON NOTICE TO PROPERTY ~NERS ABOUT CONSTRUCTION RESPONSIBILITIES 1':' .s..... NOTE: T~is Information Notice to Property Owners About Construction Responsibilities Was developed by the Construc1ion Contractors Board in accordance with ORS 701.055(5), passed by' the 198~ Oregqn Legisla1ure. . I If you are acting as your own contractor to construct a new home or make a substantial improvemen1 to an existing structure, you can preven1 many problems by being aware of 1he following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons no1 registered with the Cons1ruction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most ins1ances, be ruled 10 be an "employer" and the people you hire will be "employees". As the employer, YO!J must comply with 1he following: Oregon's Withholding Tax Law: As an employer, you must wi1hhold income taxes from employee wages at 1he 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 Department 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 informa1ion, call the Oregon Employment Division DHR at 378-3224. . \^Jorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensa1ion Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensa1ion insurance, you may be subject to penal1ies and will be liable for all claim cos1s if one of your employees is injured on the job. For more information, call the Workers' Compensa1ion Division DIF at 373-7434. 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 lax. For more information, call 1he In1ernal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ~ode Compliance: As the permit holder for this project, you are responsible for resolving any failure 10 mee1 code requiremen1s 1hat may be brough1 to your allen1ion 1hrough inspections. Liabili1y 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 mus1 be re-done. Time to Supervise Employees: Make su~e 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 aDd finish 1rades, and to n01ify building officials a1 the appropria1e limes so 1hey can perform the requiredin,spections. " . .: . :. . . / '. .' . If you have additional ques1ions, write to: Construction Con1rac10rs Board 700 Summer SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89