The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1997-7-25 . SpaFIELD '," "7.- , T. \CE' " WOBIl, bmilted has the 1011 NO' <=vOIR<= IF iHE I ' 1~.lIowing prOject aSqS~iro spoeific lend use SHALL oe"r oe 'if "rid does not re ,HIS PERMI, OER lHIS PERMIi \S~9~vel. I ,..,\ AZ1li1CfrWil Uf-OO;F;.btoNOONEO FOR zonir>9.-LUl - ~~l~N 97477 2 (JC//) lttJ~~Efuo~l ST: 726-37'69'<(l/~' o-r h m ,Wl'Fj~~ PI' '12~9 Authorized SlgnatUft' 3. 1. LOCATION OF INSTALLATION to /.<) !-ItJ'lliA) ~12- , f2La ( '" r1b~l:?{f75i 20 I JOB DESCRIPTION .f buo StrUt;.f .J- /D e./~O.l.lT:S Permits are non-transferable and expire if work is not started within 180 days of issuance o~ if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date ELECTRICAL PERMIT APPLICATION Ci ty Joh. Number OJ / / J ). & COMPLETE FEE SCHEDULE BELOV , A. New Residential-Single or Multi-Family per dwelling unit. Service Included: 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dwelling 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 Items Cost Sum $ 85.00 $ 15.00 $ 40.00 $ 50.00 C:;O ,0 0 $ 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 Pe.te-Re.r-e..z;..n,ak Address ~ I S- I-/.a..~/ d "A.& ,t/2 . ;::j", c.-c , City "Sf./~:/:;~j c:/ Phone 7'1 7 ~ '-t€'6 OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. O\/llers Aigna~e: '. 'f/zti:b iAA,. . ' .. . ( ~ATE~---~~;;---~~-~------------- RECEIPT II: /-f:lJ'l'f' -<. RECEIVED BY: h .rvi--~ 200 amps"or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 volts see "B" above " New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Servi~~~ or Feeder Permi t I V $ 35.00 $ 2.00 2D.QD not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ $ $ $ tD.DD 40.00 40.00 20.00 36.00 -/<......(/( ) / ~. ,j ..... Issued by: q 71/2-f.r/ (PIS H~ br. p)tX/-- r/, < /11 At- Date: % 7,/Ejq~ ~ Permit #: Address: 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 abuildingpermit 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 1 and 2, and either box 3A or 3B: ~ ~ 1. I own, reside in, or will reside in the completed structure. 2. I understand that 1 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! hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If! change my mind and hire a general contractor, 1 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. {Ja;; l~ I~~d (Signature ofperrAA apphcant) _2/-:J.~/'17 (Uate) (White copy to issuing agency permit file, pink copy to applicant) " ,- " . , Informaiion NOiice io Propeiiy Owners Aboui Con~ir~c~ion Responsibiliiies , . Note: This Information Notice to Property Owners about Construction Responsibilities \I'OS 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 prevcnt 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 of a residential structure, you will. in most instances. be ruled to be an employer and the people you hire will be employees. As thc employer, you must comply with the following: ' Oregon'swithholding tax law: Asan employer, you must withhold income taxes from employee wages atthetime employees are paid, You will be liable forthe tax payments even if you don't actually withhold the tax from your employees. For more infornlation. call the Oregon Dept. of Revenue at 945-8091. Unemployment insnrance 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 378-3?24. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law. and mus! obtain workers' compensation insurance for your employees. I fyou fail to obtain workers' compensation insurance, you may be subjectto penalties and will be liable for all claim costs ifoneofyouremployees 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 forthe tax payment even if you didn't actually withhold the tax, Formore information. call the Internal Revenue Service at 1-800-829-1040_ OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder forthis 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 agent to see if you have adequate insurance coverage for accident.s a~d omissions such as falling tools, paint overspray, water damage from pipe punctures, tire, or work that must be re-done. Time to snpervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you havc 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 perform the required inspections. If you have additional questions. write or call the Construction Contractors Board (PO Box 14140, Sal-em, OR 97309-5052, 503/378-4621 ):V-l\eBoarcr IS .Iocated at 700 Summer St. NE Suite 30Q; in_Salern.. , '.' ,:' \' prop-owu.pm4 1/94