The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1997-6-2 ". .... Zonina L- D t2. DmeilJ ~-CcL . Authorized Signature IJ ~~ 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REOUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF INSTALLATION b"1 5 \ GI,u:,,:W /gO-1fJ;)..d-O"::::'WO LEGAL DESCRrPtfON U 3 "B\.Jc. b <{ 14>oM.-\\k Co'c~ ~l .--:'fOB DESCRIPWN ..;-- , /.hn tD. f/OuJ Q l' V 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 Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr Contr, Number Expiration Date Signature of Supervising Electrician Owners Name \Y\, ~ ~1.l"lJv\9-.(" Address Ll'6l ~ l()ik PL. Ci ty ~ lJn G\')'1?~ Phone jl!l-.'6'f-<!;/ OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: -----~- -- --- --.----.------------------ DATE: , ~ RECEI. _ '1'-1 { RECEIVED BY: . '// I.{ A_ ELECTRICAL PERMIT APPLICATION ---"I City Job NumberC( 7DSs... <, 3. COMPLETE FEE SCHEDULE BELOII A. New Residential-Single or Multi-Family per dwelling unit. Service Included: It ems Cos t Sum 1000 sq.ft. or less $ 85,00 Each additional 500 sq, ft or portion thereof $ 15.00 Each Manuf'd Home, or Modular 'Dwelling Service or Feeder $ 40.00 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 $ 50,00 $ 60,00 $100,00 $130.00 $300.00 $ 40.00 ~ Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less -.L $ 40.00 I 201 amps to 400 amps $ 55.00 Over 401 " $ 80.00 to 600 amps Over 600 amps or 1000 volts see "BII above D. Branch Circuits , New, Alteration or Extension Per Panel One Circuit Each Add it i onal 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 ----!i.J) , 00 5% State Surcharge :;.0 u 3% Administrative Fee , /. .L.:U. TOTAL f-I ~. .L-u \\)W~ ~~s blSJ ---'- - ----=- ------=-----~ I , I i , , j I -==-':r _::-- . ~ ' - -r- --'I ==--"-"'-0,/'_ \ . ,I \ . , .,.. '--~ J / I , I I --- i I J " -~, . 10 \ / ) 'I / ~ , . . Permit #: q 70S: S ~ Address: (p q S' I {}; 10. Cr' e~ Issued by: ,/.I1/J~ Date:-1ol'L /q--::r I 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 70],0] 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 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, OR D 38. I will be my own general contractor. If! 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 ofthis form. Th~D ~ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . ..r .. ). llnformal~ion No~ice ~o Propeiiy Owners Aroou~ Cons~ruc~ion Responsibili~ies Note:' This Information Notice to Property Owners about Constmction Responsibilities was developed by the Constr~lcrion Contractors BOll;'d in accordance with ORS 70I,Ojj(j). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure. you can prcvent 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 improvementofa residential structure. you will. in most instances. be ruled to be an employer and the pcople you hire will be employees, As thc cmploycr, you must comply with the following: Oregon's withholding tax law: Asan cmployer. you must withhold incometaxcs from employee wagesatthctime 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 infonnation. call the Oregon Employment Department 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 subjectto penalties and will be liable for all claim costs ifoncofyouremployees is injured on thcjob, Formore infonnation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U,S.lnternal Revenue Sen'ice: 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 holderforthis project. you are responsible for resolving any failureto meet code 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 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 perfolln 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 St. NE Suite 300, in Salem. ' prop.own,pm4 1/94