HomeMy WebLinkAboutPermit Electrical 1994-9-7
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The 'ollowlng plojeet &lI submitted ll80the folio
zonl,~g, and dOllS not requlr. .pec~\c land us.
epproval.
97477 . .. Zonina L-D ~
726-~911l~1-'i'-f
Authorized Signaturo~ ;;GMI':'::'1'B :-:13 SCHEDULE BELOII
1. j.~AYo.N OF 'W'f.t\L~T ON Cl ('\.J\
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225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
ELECTRICAL PERMIT APPLICATION
City ;~~ NumberMJ~ ~~
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:
New Residential-Single or
Multi-Family per dwelling
Service Included:
(')JOB DES
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Permits are non-transferable and explre
if work is not started wi thin 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor ~~~~~
Address
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
City
Phone
Supervisor License Number
Expiration Date
uni
It ems
~ $ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
58. trO
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr. Number
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
Expiration Date
Signature of Supervising Electrician
Owners Name\l~ (;Yi\'\t1.o
Address \ ~~~
Ci ty %U rt: Phon
O~ ~TALLATION
D. Branch Circuits
New, Alteration or Extension Per Panel
One Circui t : $ 35.00
Each Additional
Circuit or with serv~ 3a,-
or Feeder Permit $ 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
The installation is being made on
property I own which is not intended
for sale, lease or rent.
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5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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DATE:
RECEIPT jI:
RECEIVED BY:
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Permit#: <9C/ /< 2 &T
Address: /g5S- ~~..cy-h~-,
Issued bY~~ _ Date: ~ /.9c;...e-
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction pennit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building pennit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing pennits. 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 pennit.
Fill in the al'l"Vl',;ate blanks and initial boxes I and 2, and either box 3A or 3B:
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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
[] 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 certif that the above information is correct and that I have read and do understand the Information
Notice to P ert wn~7Ztion Responsibilities on the reverse s~ o;t:;~rm.
Signature of permit applicant) (Date)
(White copy to issuing agency pennit file,
pink copy to applicant)
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:n.nform~tion Notice tcfProperty Owners
, _..'- _ . ~Q.out'Constrl:lction,Rcesponsibilities
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Note: This Information Notice to Property Owners about Construction Responsibilities
Wo.f developed by the-CorisiructionCqnrracto;s Board in accordance with ORS 701.055(5).
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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 the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in COJ:lstructing 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 comp'l~ with the follo,;"ing: .
Oregon's withh'!lding tax law: As an employer. you mustwithhold 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 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
accidents and omissions such as falling tools, paint overs pray. 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
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trades, and to notify building officials at the appropriate times so they can. pert;onnlhe required inspecti2.f!s. . .
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If you have additio.nal q~~sti.ons, write or call the Construction Contracto~'Bo~rd.(J)O.B;k )"4140; Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. . " .I
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