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Home My WebLink AboutPermit Electrical 1992-08-11TY OF OREGO'U 225 FIFTB STREET SPRINGFIELD, ORBGON 97477 INSPECTI0N REQUBSTz 726-37 OFPICE: 726-3759 1. st'rttN(;FrEL(, lr A Nev B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0n1y lrft:::ssrJtr:t -PERHIT APPLICATION u$9 69 Ci ty Job Number ON AulhorirerJ S,gnature 3. COHPIJTB PEB SCEEDULE BBLOS C $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Sum 2z{oo_\ v- I,EGAL DESGRIPTION JOB DESCN,IPTION 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. CONTRACf,OR INSTALT,ATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name Address /-za I I <2'- @ 57, Ci ty Yhone Z,s-a" -8{*1 OVNER INSTALLATION The installation is being made onproperty I own vhich is not intendedfor sale, Iease or rent. Ovners Signature: DATE: RECETPT Single or MuIti-FamiIy per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dvelling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits Nev, Alteration or Extension Per Panel one ci rcui t ,at $ 35. OO Each Additional Circuit or vith Service or Feeder Permit $ 2.00 SUBTOTAL OF ABOVE 5Z State Surcharge TOTAL 7?s 200 amps or less S 40.00 0ver 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see "B[ above E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/outline Lighting- Limi ted Energy/Res Limited Energy/Comm .<s,o' 00 00 00 00 $40 $40 $zo$:o RECEIVED B 5 ;<7- 7{.<Jt>,ld-- - Permit No:?zzze e, L7s /V, 324 sI- -%-"ffi,Address: lssued by R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38: I own, reside in, or will reside in the completed structure. t: I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A 1 2 Date: WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 3 My general contractor is , Contractor registration num I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3. B-]::1"I will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understand the lnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. S4na* klr',,i'o 8-'7 S i g ffi-tir?-e of Perirl i t -A[plican t Date CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 \ ^- INFORT',nflON NOTICE TO PHOPERTY 0'ol\EHS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with OFIS 701055(5); passed by the 1989.Oregon Legislature. - lf you are acting as your own contractor to construct a hew home or make a substantial imff<xgment to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYHR NESPONSIBILITIES: lf you hire persons not registered 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 "employer" and the people you hire will be "employees". As the employer, you must comply with the fotlowing: Oregon's WitLholding Tax Law: As an employer, you must withhold income taxes 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 your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsurance Thx: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, callthe Oregon Employmenl Division DHB a|378-3224. Vorkers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees" lf you fail to obtain workers' compensation insurance, you may be subject to penalties and will be'liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 973-7434. U.S. lnternal Revenue Service: As an em ployer, 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 lnternal Flevenue Service at 221-3960. OTHEfi HESPONSIBILITIES AND AREAS OF CONCERN: .rde Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet .*'Je requirements that may be brought to your attention through inspections. Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage frorn pipe punc- tures, fire, or work that must be re-done. Time to Superv ise Employees: Make sure you have sufficient tirne to supervise your employees. Expertise: I\ilake sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish lrades, and to notify building officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to Construction Contractors Board 700 Summer St. lrlE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 a244J 10124189