HomeMy WebLinkAboutPermit Electrical 1995-02-10CITY OF SPP OBEGO'V
SPRI,{GFIELO
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ELE TRICAL PERHIT APPLICATION
apProval'
225 FTITH STREET
SPRTNGPTEID, OREGoN 97477
INSPECTION REQIIEST:726-3769'*e rl
OFFICE: 726-3759 Authorized
1. LOCATTON OF INSTALLATION2rn s. Mi/ (-
require sP'l'ciiio
\
Ci ty Job Nunbe, q SCl 1D
JOB DESCRIPTION
Rr, . t?Lt^(< FaaFt^Px>A?E I at c
Permits are non-transferable and expire
if vork is not started vithin 180 day-s
of issuance or if vork is suspended for
180 days.
2. COIITRACTOR INSTALI,ATION ONLY
Electrical Contractor
Address
city- Phone
Superviso r License Number {Q S
Exp iration Date tl>-l - q5
Constr Contr. Number N/A
Expiration Date
Signature of Supervising Electrician
0vners Name (^r )llaw^|a na 2,kl ?pz,
Address ABn *t,
Ci ty $,f[1;ttrt&b Phone 2L -4%a
OIJNER INSTAI,LATION
The j,nstallation is being made on
property f ovn vhich is not intended
for sa1e, lease or rent.
Ovners Signature:
DATE:
COHPI,BTB FEE SCEEDT'LE BELOV
Nev Residential--Single or
Multi-Family per dwelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
s 8s.00
$ 1s.00
s 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
-401- amps to 600 amps _601 amps to 1"000 amps_
Over 1000 amps/voIts
Reconnect 0n1y
Temporary Services or Feeders
fnstallation, Alteration or ReLocation
I-EGAI
l-7o 33
DESCRIPTION{,, 51so I
A
D.
Sum
40.00
55.00
80.00
ee ,Brr aEoE
l, oo
B
$ s0.00
$ 60.00
s1o0.0o
$130.00
$300. 00
s 40.00
c
Nev, Alteration or Extension Per Panel
one Circuit I $ 35.00 35.Oo
Each Additional
Circuit or vith Service
or Peeder Permit 3 $ 2.00 6,P
E. Miscellaneous (Service/feeder not included)
200 amps or fess $
201- amps to 400 amps
-
S
Over 401 to 600 amps $
Over 600 amps or 1000-61-[s s
Branch Circuits
-Each installation
Pump or irrigation $
Sign/Out1ine Lighting- $
Limited Energy/Res
-
$Limited Energy/Comm S
40.00
40.00
20.00
36.00
q
5 SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTALBRECEIVED
-p -q{
Permit #:la
Address:lrlo 5 tl,t tL*
Issued by:out", 240 4
statement: lnformation 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 thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, erectricar, mechanicar, and prumbing permits. Licensedarchitect and engineer applicants, exemptfrom registiatio, uiai, oRS 701.010(7),need not submit this statement. This statement will be filed with the permit.
Fill in appropriate branks and initial boxes r and2,and either box 34 or 38:
l. I own, reside in, or will reside in the completed structure.
' ';:ff.:t'#SJ3;
"o;;ifi::lt"t
as a construction conrractor if the structure is sold or offered for sare
3,{. My general contractor is
I will insrruct my general contractor,n" $Hilontractorsregistered with the Construction Contractors Board.
Contractor regis. #who work on the structure must be
OR
3B. I will be my own general contractor.
Ihereby certify that the above information is correct and that I have readNoticebout Construction Responsibilities on the
$
If I hire subcontractors' I.will hire only subcontractors registered with the construction contractorsBoard' If I change my mind and hire a generalcontractoi i will contract with a contractor who is;#:,Til:,j|jl*:i and wirr i*rn"aiut"ry ,otiry ti";fo;. issuing this huildins permit of the
of permit applicant)
and dounderstand the Information
of this form.
4Z
to Property Owners a
(Wite copy to issuing agency perunitfile,
pink copy to applicant)
(Date)
Information Notice t6 Property Owners
About Construction Responsibilities
on l,latice tq Pia)perty RWO,e11 g.bo,rut Construction Respons;billrlesP$'i''
'*,o,,
drrn'top,rh by the Construction' Cintrat:tors Boardin at:cordance with ORS 701'055t$.i*f
L
If you are acting as yollr own contractor to c{xstruct a new home or make a substantial improvement to an cxisting structure'
yolr can prevent many froUleoo ly being aware of the foliowing responsibihties and areas of corrcern'
EM PLOYER B ESPON$IBILITIES :
If you hire persons not registered with the construction contractors Board t, do labor in constructing or assisting in the
c'nstnrction or improvenrsnt of a residentiar structure, you wilr, in most instances, be r,red to be an employer and the people
you hire will be "*ptoy""'' As the employer' you must comply with the following:
oregon,s withholding tax raw: As an employer, you must withhold income taxes from employee wages at the time employees
are paicl. you will ueliabre for the ,o" poy*inr, *r*n ir yn,-, aon'i o"tuaily u'ithhord the tax from your employees' For more
information, call the Oregon Dept' of Revenue at 945-8091 '
unemproyment insurance tax: As an emproyer, yo., 1e reuur3d to pay a tax for.unemployment insurance purposes on the
wages of alr employ"";^F;; ;ore informaii*, "uir
tn".or*gon g*ptyient Division at iu ixpur*t""ot sf r{uman Resources
'i. ;\
at378'3524 .: _ :
workers, compensation insurance: As an employer, you aresubject to the oregon workers; compel:u1o:,tu*' and rdrst
obtain workers,compensarion insuranclfo;;;;pl";pes, If 1"'" i^il to obtain rvorkers' com'pptytY insurance' yolr may
be iubject to p"nu*i"*rJ w*l be liable r", "ir".lri* ""o#li on" ;;;;piJt* t: iniured qr'r ilejgu ,,!9r^13re informdtion'
call the workers, compensation Division ;;;;p"*menr of cor,ru*". und Business Services at 945-7888'
u.s.Internar Revenue service: As an employd: yor.Tlsrwithhold federar income tax fird'm employeesi'wages' You will be
liable for the rax payment even if you didn,t actualry withhord'the "- il;;;;il;il', ""il ti'e internat Revenue Service
at l-800-82F1040'
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
code compliance: As the permit holder for thii nro]rcf:r^]u are responsible for resolving any failure to meet code requirelnntr
that may be brought t" Vcl'lt ""ttion
through inspections' i
Lis*ity and proper,ty damageinsuol"l contact your insurance agent to see if youtave a@uate insurance coverage for
accidenrs and omissioi, ,o"h as falling.toors, paint overspray, *;;;;;;" mmlipe punnut'*' fire' or work that mustbe
re-done.
'fimetosuperviseemployees:Makesureyouhavesufficienttimetosuperviseyouremployees.
Expertise: Make sure you havelhe.expefiise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify uuiiaing officials ut tt,. oppropriate times so they can perform the required inspections'
If you have additionar questions, writc or call rhe Construcrion contractors Board (Po Box 14140' Salem' oR 97309-5052'
5A3fi7g-46211. rne g;ra is located ut roo-su**er St. NE Suite 300, in salem'
propown.Pm4
1194