HomeMy WebLinkAboutPermit Electrical 1998-04-16The
zonlng'and not requlre
ipprovot'
225 FIFTE STRXET
SPRTNGFTELD, OREG0N 9
INSPECTION REQTIEST:
OFFICE: 726-3759
72
1.ON OF
I,EGAL DESCRIPTION \Sq
6
JOB-J\-L!",3
Permits are non-transferable and expire
if vork is not started vithin 1B0 days
of issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.,ATION ONI.Y
EIe rical Contractor
Addres
Ci ty ne
Supervisor Li Number
Expiration
Constr C r. Number
Expi ion Date
ture of Supervising Electrician
Owners Name La"-t^
Address Lt bD AErrud. afi^aoJ-
Ci ty Phone ?+L+- m5a
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
0vners Signa
DATE:
SP} iFIELO
PERHIT APPLICATION
City Job Nunber ?gr: *a=
3. COHPTETE FEE SCEEDTIIJ BELOV
A. Nev Residential-Single or
Multi-FamiIy per dvelling unit.
Service fncluded:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Sertice or Feeder
s 85.00
s 1s.00
$ 40.00
B Services or Feeders
Ins tallation, Alterations
or Relocation:
Sumo
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
-40L amps to 600 amps
-
601 amps to 1000 amPs-
0ver 1000 amps/vo1ts
-
Reconnect 0n1Y
200 amps''or less
201 amps to 400 amPs
-
Over 40L to 600 amPs
Over 600 amps or fOOO voITs
one Circuit I
Each Additional
Circuit or vith Service
or Feeder Permit J
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAI
s s0.00
s 60.00
s100.00
$130.00
s300.00s 40.00
c.
D
40.00
5s. oo
80. oo
ee rBr aEove
$
$
$
s
Branch Circuits
Nev, Alteration or Extension Per Panel
$ 3s.oo 43a, ^
,I
$ 2.OO L'
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/0ut1ine Lighting-
Limited Energy/Res _Limited EnergY/Comm
s 40.00
$ 40.00
$ 20.00
s 36.00
CITY OF SPR OFIF,.GO.i,
RBCEIVED B
5 +--/,r/3?.- 0
5rA
-
Permit #: q 6
Address: tGo )>'.a Sh.4aj-
Issued by:q5^{)
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires restdential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before abuildingpermit 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 stotement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 7 and2, and either box 3,A' or 38
l. 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.
3.A. 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
Owners about Construction Responsibilities on the reverse side of this form.
-lG -19
(Signature of permit applicant)
(lVhite copy to issuing agency permit file,
pink copy to applicant)
a-
Notice to P
J v
(Date)
-
out.' 4 - lt -'1 (
<Ir
r-
Information Notice to Pr6iterty Owners
About Construction ResponsibiIities
Workers'compensationinsurante: Asanerrrplover,you+I;epu.bieqflptheOregon,tVgr(erg'{ompqp;gtionLpyiandmgst-:
obtainrvorkers'compensationinsurancelbr_vi:urernpiol'ees. Ifyoufailtoobtairrlvorkers'cornpensalior"iinsurance.r-oirmay-:
Uelu,Uj,elltgpenaltiesandwillbeliabflii:r.ailc,Firncost5ilorrcofy'ouf,emptoyeesi.siniuredorrthc,..yob. FotrL.y",j1{ormatipr.-
call the Workers"Conrpdnsation Dir isioir a1 the Departrncnt olConsiinrer and Busihess Sertibes ai q4S-:gS8l
,
Notq: ,This l1{wrntrtion Nrstice tq Property Ou;1ters aboul{)onstruction Respt.tnsihilitit.s
trcts de,-eloiser{hythe {lonstnrction L'ontrsclot's batu'rl in.act:<tr<}unce y,ith ORS 70t.055fi}
yoil car pr*vcrtt rnar:y probienls b; bcing alvare o1 thc lirlluu ir:g responsibilitics and areas ol'colccrn.
EIII PLOYER RESPOT.ISI BILITI ES :
constr*c1ior: or inrprol'emenl ol'a resid*rrrial slrurture. y'ou lvrll. in rrrost inslanccs. bc rulccl to he trn cnrplrr-vcr arrd rlre per:ple
,vou hire u.ill be ernployees. As the e rnplor,'er. 1ou nrust compll'with th'e foltorvins.
Oregon'slvithholdingtaxlaw: Asanemplover.-voulnustrvithht'rlclincrimetaxesfiomemple)veelvagesatthetirnrernplo.r,ees
are paid. You rvill be liable for the tax payments evei if -vou don't a{ually withhold the tar from yctrr empl6.vees. Fi;r more
infom:rtion.calltheOrrgonDept of'Revenueat945-{1091. !!
Unemployment insurance ta-r: As an emplo,ver. yoil are required to pay a tax lor unenrploy-ment insurance purposes on the
wegeSofallenrployees.Iiornroreinforrilatiorr;eallthe0regonBmplr:,vnrenl.DeparttneIratJ?8-3524'..;,.;l];
U.S.lnternal Revenue Servite: As an employer. yoll must rvithhold federal income tax frorn employees'wages. You rvill.b-e-
liableforthetixpaymenteven if"y"oudidn'tactuallyr.vithholdthetax. Irorrnoreir:fbrmatiorrlcallthelntemdlReienue Service I
atl-800:829r10401 ' L -i
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Codec<lmpliance: Asthepermithr:ld*rlbrtlrisproiect.yoL!a:'ercsi:onsibletbrresolvi*ganl {iiil*nr.it*n}*e{coderequir*tnents
tlrat nlav be brouulit to vour atlcnti*rr throrrgh inspections.
Liabilif"v and pnopcrt-l'damage insurarce: L'r:l'ltact vour irrsLlrancc ascnt 10 se o if ycl* have acl*quxtc insurance ct-rvcrage for
accidents and omissions such as lalling tools. paint o\ crspnlv, u ater darnage trom pipe punctures. fire . ot u,ork that rnust be
re-done.
Time to supcn ise employees: lV1ake sure you have sufficient tirne to supenise 1.'our ernployees.
Expertise; Makesure.r'ouhavetlteerpertisetoactasvouror&'ngeneral contractor,toc*ordinatether.vorkr:frough-inandfinish
traddi. an<i to notl$' building officials at thiappropriarc rimes so ther can pcrfonnthe reqiri'red inspections
If -vou liave additional questiotts. u,rite or call the Cr-;nstruction Contractors lloard (P{) Box l,l140, Salcrn. OR g730g-;0S2,
5031378-1671). 'fhb Board is located at 700 Suinmer St. NE Suite 300, in Saleni.
prop-orvn.pm4
t/94