HomeMy WebLinkAboutPermit Electrical 1996-2-15
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ELECTRICAL PERMIT APPLICATION
r..i.ty_Job Number 5' ~~~4
225 FIFTH STREET
SPRINGFIELD, OREGON 9747,.7c"o . :5 '1 4fJ'
INSPECTION REQUEST: 72b~3769
OFFICE: 726-3759 ~.u\hori2od s\gnctur8 .
1. LOC4TIpN OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DESCRIPTION ~ /
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Permits are non-transferable and expire
if ~ork is not started ~ithin 180 days
of issuance or if ~ork is suspended for
180 days,
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
Ci ty
Phone
Supervisor License Number
Expiration Date
Constr Contr, Number
Expiration Date
Signature of Supervising Electrician
O~ners Name KCr'aJ &.I/.AJV.<
Address Ch.. L9~5' ~~/~
Ci ty ~)~ ~Phone 'If?-/'!Il2i
OVNER INSTALLATION
The installation is being made on
property I o~n ~hich is not intended
for sale, lease or rent,
Owners Signature:
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III ,I "J ( ijp,0
. ----~-~--------------------------------
DATE: J -I S- ~f
RECEIPT 11:( ),-17) Lit ~ '
RECEIVED BY: II. /~
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3. COMPLETE FEE SCHEDULE BELOII
A. Ne~ Residential-Single or
Multi-Family per d~elling unit.
Service Included:
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\
Sum
Items Cost
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home, or
Modular'D~elling
Service or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations
or Relocation:
ZOO amps or less 2-
201 amps to 400 amps
401 amps to 600 amps
601 amps to' 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00 /[!;t).8'O
$ 60.00
$100.00
$130.00
$300.00
$ 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 liB" above
D.
Branch Circuits
"
Ne~, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or ~ith Service
or Feeder Permi t :z-
$ 35.00
$ 2.00 16<)
not included)
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40.00
$ 40.00
$ 20.00
$ 36.'00.'
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Permit #:
.
7' 5/~,S-4-
4540 Ij/~ )7",
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.
Address:
Issued by:
Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Nofe: 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 pemlit,
Fill in the appropriate 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,
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 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.
~ /~AA/l . 7" v..-----? 2. - / s- C; L
I (Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
~
lInVormaiion Notice io Property Owners
'. . ,Aboui <<;,<?ns~r,:!ciioi'i Responsibiliiies
"
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the COllstruction Contractors Board ill accordallce 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 stmcture,
you can prevent many problems by being aware of the following responsibilities and areas of concern,
EMPLOYER. RESPONSIBIUTCES:
If you hire persons not registered with the Construction Contractor~ 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 mllst comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes I' tom employee wages at Ihe time employees
are paid, Y Oll 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 Dep\. of Revenue at 945-8091,
Unemployment insurance tr.x: As an employer, you are required to pay a lax 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, ]1' you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for aU claim costs if one of your employees is injured on the job, For more informat~n,
call Ihe Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888,
U.S. Internal 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
al 1-800-829-1040,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for Ihis project, you are responsible for resolving any failure to meet code requirements
that may be brought 10 your attention through inspections, ,/
"-
Liability and'projlzrty damage insurance:, Contact your insurance agent to see if you have adequate insurance coverage for
accidenls and omhsions such as falling tools, painl overspray, water damage from pipe punctures, fire, or work thaI must be
re-done,
Time to supervise employees: Make sure you have sufficient time 10 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
Irades, 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, Saleln, OR 97309-5052,
503/378-4621), The Board is located at 700 Summer S\. NE Suite 300, in Salem,
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