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Home My WebLink AboutPermit Electrical 1995-07-13225 TITTH STREET a^iUkgL SPRINGFTELD, OREGON 9TAitTorized INSPECTT0N REQUEST:. 726-3769 OFFICE: 726-3759 SPF.I'IELO EI.,ECTRTCAI PERHTT APPLTCATTON Ci ty Job Nunber 3. COHPI,ETE FEE SCEEDTILE BELOII A. Nev Residential-Single or Multi-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less S 85.00 each additional 500 sq. ft or portion thereof $ 15.00 Each Hanuf'd Home or -Hodular Dvelling Service or Feeder S 40.00 Services or Feeders Installation, Alterations or Rel-ocation: h, 1. LOCA4a+TION OF INSTALLATION N. lb +t" I^EGAL DESCRIPTION ON Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTATI-ATTON ONLY Electrical Contractor Address ci ty-Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners Name C. Temporary Services or FeedersInstallation, Alteration or Relocation 200 amps or less l--- 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1000 amps- Over L000 amps/volts -Reconnect Only 200 amps''or less S201 amps to 400 amps - $Over 40L to 600 amps - S0ver 600 amps or 1000 volTs s Branch Circuits / )/t s s0.00 s 60.00 $100.00 s130.00 s300.00s 40.00 Sum So,* mve B 40.00 55.00 80.00 ee rtBrr a D Address 4z rv - I brt, Ci ty .l K Phone, W ?ytl--1225 OIJNER INSTALLATION The installation is being made onproperty I ovn vhich is not intended for sale, lease or rent. Signature: Nev, Alteration or Extension per panel One Circuit S 35.00 Each Additional Circuit or vith Serviceor Feeder permi , / Z $ 2. OO 26 Miscell-aneous (Service/feeder not included) -Each installation E Pump or irrigation Sign/0utIine Lighting- Limi ted Energy/Res - Limited Energy/Comm s 40.00 s 40.00 $ 20.00 $ 36.00I 5 SUBTOTAL OF ABOVE 5Z State Surcharge 32 Administrative Fee TOTAL DATE: RECEIVED - )a- oo land uge - ^ 3G z/ o7/ af Permit #: Address:/4L Issued by Date: Statem€nt: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Inw, ORS 701.055(4), requires residential construction permit applt- cants who are not registered with the Construction Contractors Board to sign the foltowing 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 andZ, and either box 3A or 38: tr' 1. I own, reside in, or will reside in the completed structure. V 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale P before or upon completion. 34. My general contractor is - (Narne) 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 38. 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. Ihereby certify thatthe above informationis correct and thatl have readand dounderstand the Information Notice to property Owners about Construction Responsibilities on the reverse side of this form. A-,2*rg permit applicant) (White copy to issuing agency permit file, pink coPY to aPPlicant) (Signature (Date) w Informatibn Notice to Property Owners About Construction Responsibi I ities ': i , Note: This Informauohpttite 1o Property Owners about Cottstruction Responsihilities was developed by the Consiiuction Contractors Board in accordance with ORS T0 t .0SS(5). If yOu are acting as ycrur own contractor to construct a new home or make a suhstantial improvemer:t to ;rn existing structure, you cc.n prevent many problems by being aware of the following responsibilities and areas of concem. EMPLOYEH BESPONSIBILITIES: If you hire persons. not pglstered with the Construction Contractors 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 **pl"y", and the people you hire will be employees. As the employer, you musr 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 forthe tax payments even if you don't actually with'hold 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 at378-3524. ,. ,/ Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, anOfirds obtain woqkers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, yoit.rnay besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredont-hejob. Formoreinformation, 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 rnust withhold federal income tax from employees' wages. You will be liabh forltre tai pdyrirent even if you didn't actually withhold thotax. For more information, call the Intemal R"u"no" Service at l-800-829-1040. OTHER RESPONSIBILITIES AND AHEAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure ro meet code requirernentE that may be brought to your attention through inspections. ''" : LieHitr and prpperty damageinsuranse: Contact your insurauce agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water darnage frompipe punctures, fire, or wor* 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 coordiriate the work of rough-in and finishtrades, 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 (I{l Box t4l41,Sdlenu oR 97309-5052,543878-4621). The Board is located at 700 summer sr. NE suite 300, in iarr." - propown.pm4 lt94