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Home My WebLink AboutPermit Electrical 1995-06-13;/44 ^/el/d&{/trL CITY or spn onecorv- 225 FTFTE STREET SPRINGFTELD oREGoN 97477 fNSPECTTON REQUEST: 726-37OPPICE: 726-3759 1 LOCATTON OP I,EGAI JOB DESCN PTION tsa n rans e expif vork is not starteof issuance or if vor 180 days. d vi thin 180 dayk is suspende df 2. CONTRACTOR INSTALI,ATTON ONLY Electrical Contractor Address Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician 0vners Name Address 2 SC pnone 7f4, -/2/ / SP YGFTELO I tems 1000 sq.ft. or 1ess Each additional 500sq. ft or portion thereof Each Manufrd Home. or - Modular Dvelling Sertice or Feeder Services or FeedersInstallation, Alterationsor Relocation: D. Branch Circuits E Nev Residential-Single orMulti-Family per dvelling unit.Service fncluded: A Cos t s 8s.00 s 1s.00 s 40.00 Sum re ,s or B 200 amps or less L_-20L amps to 400 amps 401 amps to 600 amps - 601 amps to 1000 amps-over 1000 amps/volts - Reconnect 0n1y s s0.00 s 60.00 $100.00 s130.00 s300.00s 40.00 ,<6,? ,{d,oo c.Temporary Services or FeedersInstallation, Alteration or Relocation 200 amps"or less $ 40.00201 amps to 400 amps - S 55.00over 401 to 600 amps - S 8O.OO0ver 60O amps or 1000Erfs see uBu affiE- OgNER INSTALLATTON The installation is being made onproperty f ovn vhich is not intendedfor sa1e, lease or rent. Nev, Alteration or Extension per panel One Circuit $ 35.00Each AdditionalCircuit or vfth Serviceor Feeder permi, ,S_ S 2.OO 4 Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/ou tline Lighting-Limited Energy/Res -Limited Energy/Comm Ci ty Ovners. Signature: DATE: SUBTOTAL OF ABOVE 52 State Surcharge 32 Admi.nistrative Fee TOTAL s 40.00 $ 40.00 $ 20.00 s 36.00 RBCETYED 5 /.Q;_aa^{L Permit #: Address: Issued by:Date: Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residentinl construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statementbefore abuilding permit canbe 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 andZ, and either box 3A or 3B: 1. 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. fr, 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 informationis correct and that I have read and dounderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form.a GY*L-/ (Signature of permit applicant) (White copy to issuing agency perrnit file, pink copy to applicant) x (Date) ?6- KF tr -. \Inforriration Notice to Property Owners .\ "J \* .__ f.boyt Cgnslruction Responsibilities - -... - {!ote: 'flLrs lnJttnrration Natice to Property On;ners ebour Con.ctrurtion Responsibilities' .":- 'was dt,t'ektpetl l>.t'the Constructibn Coilractors Boord in uccordunt.t *'ith ORS 70J.055(5). Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code that may be brought to your aftention through inspections. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, yolr can prevent m;rny problems by being aware of the followrng responsibiliries and areas of concern. EMPLOYER BESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction clr 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 comply with the following: Oregon's withhotding tax law: As an employer, you must withhold income tixes 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 youremployees. 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 Resouroii at378-1524 \ , Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, -O rl$ obtain workers' compensation insurance for your employees. If yor+ fail to obtain workers' compensa{ion insurance, you\qray besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. FormoreinformaLilq. 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 Intemal Revenue Service at 1-800.829-1040. OTHER HESPONSIBILITIES AND AREAS OF CONCERN: requrrements -r Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for ilccidents 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. ' t. Iiyouhdveadditi,onalquestions,writeorcail theConstructionContractorsBoard(POBox l4l40,Salem,8R97309-5052, 5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem prop-own.pm4 U94