HomeMy WebLinkAboutPermit Electrical 1994-12-14
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225 FIFTlI STREET
SPRINGFIELD, DREGDN 97477
INSPECTIDN REQuEsT: 726-3769
DFFICE: 726-3759
I... LDCATION DF INSTALLATION
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JDB DESCRIPTIDN
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Permits are non-transferable and expire
if vork is not started 'vithin 180 days
of issuance or if.vork is suspenaed for
180 days.
2.-' CDNTRACTDR INSTALLATION ONLY
Elec tdcal Contractor_/6Jo....r T C).. ~o
Add ress .;..---q s,--- \+ R-yJ e.v "Y'.'cb~.. i&JW-/J
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Ci tySyv-;.......jJ.elc1 Phone 71..("/-1,'/8'
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
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O,mers Nam~ k__ n-\ClNiO
Address ~C\~ct9.f\ffPi(
City ~)..la-p~onef4.l-\S1B
DYNER IN~ALLATIDN
The installation is being made on
property I own which is not intended
for sale. lease or rent.
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Dvner;lignature:
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RECEIVED BY'
3.
ELECTRICAL PERMIT APPLICATION
City Job Number ~
COMPLETE FEE SClIEDULE BELDV
A. New Residential-Single or
Multi-Family per dwelling uni t.
Service Included:
Items Cost Sum
1000 sq. f t- 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 $ 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 $ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00- "
$ 80.00
see "B" above
D.
Branch Circuits
New, Alteration or
Extension Per Panel
$ 35.00 -ESaJ
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
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$
2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited EnergylComm
40.00
40.00
20.00
no t included)
5.
$
$
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S 36.00
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SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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Permit #: q L\. \ Y \ L-
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ISSUedby:f}\UYL Date: ~.t4.q4
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Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants wha 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:
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.
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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 (\ . (\
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3B. I will be my own~ 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 Proper~wners about Construction Responsibilities on the reverse side of this form.
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'<. - (Signature of permit applicant) (Date)
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(White copy to issuing agency permit file,
pink copy to applicant)
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][n10r~atiori Notice to Propei1:y Owners
About Cons~ruction !Responsibilities
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Note: This Information Notice to Property Owners about Construction Responsibilities.
was developed by thi Construction COIiiractors 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 manr 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 mosi instances, be ruled to be an employer and the people
you hire will be e~ployees. As the employer, you must comply with the following:
Oregon's withholding tax 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 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 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 must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
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 require'ments
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
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 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 St. NE Suite 300, in Salem.
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