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Home My WebLink AboutPermit Electrical 1994-12-5 ,--. The following project as Gubmittad hoe the tol oWing 225 FIFTH STREET ~~~;;:,~"~nd doe. not require .pecnlc Iani~CAL PERMIT APPLICATION ~~~~~i~::REg~~~~ 9~;~~3769 Zonina 1.- pe. City Job Number Q40R'I2- OFFICE: 726-3759 Dale J 2,.-5 - q'f 3;J COMPLETE FEE SCHEDULE BELOIl 1. ,L~C~,!I,70N~F~. ti5J~ho,Or~Signature I'\A ' \~J~ ~~ t-"\~ ~ A. Nev Residential-Single or Multi-Family per dvelling unit. \~~~ O~ Service Included: Items h~\~4a- 30.~~O Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. CONTRACTOR INSTALLATION ONLY / / City ~ Supervisor Expiration Date umber "" "" of Supervising Elec~ ....ovners Nam;\~~ - D. Address \7 <'fA.. ~ "'\ l ~ill..i' , Ci ty ~d--Phone"i1-l. (d\-S 3 OIINER IN ALLATION The installation is being made on property I own vhich is not intended for sale, lease or rent. ~Ovn~A:- /r DATE~-~-~~-~l~-;.{--------- RECEIPT tI: /~...,- RECEIVED BY: 7/Yr--'9 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder B. 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 \ B Cost Sum $ 85.00 Rs $ 15.00 ~ $ 40.00 $ 50.00 $ 60.00 $100.00 5130.00 $300.00 5 40.00 Temporary Services or Feeders ~Ar Installation, Alteratioj' or Relocation ' ~ 200 amps or less ~ 5 40.00 v\ 201 amp~, to 400 amps " - $ 55.00 \; Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts see "B" above C. Branch Circuits Nev, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm One Circuit Each Additional Circuit or vith Service or Feeder Permit E. 5. SUBTOTAL OF ABOVE~ 5% State Surcharge ~ 3% Administrative Fee TOTAL $ 35.00 $ 2.00 not included) 5 40.00 5 40.00 5 20.00 $ 36.00 ~ Yr:: .;: '" ?./~ ~o /60.(10 :b~1 .f.~ - . 172..,8:0 --- ---- '. Address: -- CJ,,/o g 72- 0'23 C~~ lJPR /~ Date: Iypl 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 701.010(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: ~ EJ I. 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. I I 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 about Construction Responsibilities on the reverse side of this form. ~; ..LIL.9.di~A-7-'/d~ / =%:s-/ <1 ~ (Siin~ of permit applicant) , , (Date) (White copy to issuing agency permit file, pink copy to applicant) . . . .', -- . - , , " " ",,,-,,, . " .........~ --.J \ ~nformation Notice to Property Owners y. ') \ J",~~~ut~CQ~tr.~ction Resp'onsibilities ~ ';>..'\:- .1._...... I "., , ,>,,,-,,' 'N-.;:le,: This Injormntion. Notife tf!!:operty .owners about Construction Responsibilities , , ' wtis 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 thefollowing 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~ 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 Depl. 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 hi~st obtain workers' compensation insurance for your employees. If.you fail to obtain workers' compensation insurance, you m!ly, 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 requiremen\s that may be brought to your attention through inspections, X. 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, 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 have the expertise to act as your own general contractor. lU 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, If you have additional questions. write or call the Construction Contractors Board,(PO Box ,14140. Salem. OR 97309-5052, 503/378-4621), The Board is located at 700 Summer SI. NE Suite 300, in Salem, prop-own.pm4 1/94