HomeMy WebLinkAboutPermit Electrical 1994-11-14INSPECTT0N REQTIEST | 726_3169OFFTCE: 726-3759
The foliourinQ proJect as submittoC has lhe
zoning, anclEileanot requiro spocilie land225 FIFTE SI?.EET
SPRINGmELD, oR&coY 9747
1.OF r
I.EGAL DESCRIPT roN
JOB DESCRTPTION 2o
El-ec t ri cal Con t rac tor
Address
seerarcereio
t.ril
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
appi'oval.
7
Dstc -lrl.
I tems Cos t
$ 8s.00
':: :,::..i. ,,.,...-CLggyB''--T-8. rEE scmDULE BELov
d<Nev Residential-Single orMulti-Family per dvelling unitService fncl_uded:
A
Sum
Permits are non-transferable and' expireif vork is not started vithin 180 diysof issuance or if vork is suspended ior
180 days.
2. COMRACTOR INSTALI,ATION ONLY B
1000 sq.ft. or 1ess
Each additional 500sq. ft or portion
thereof
Each Manuf,d Home or
-
Hodular Dvelling
Service or Feeder L/
Services or Feedersfnstallation, Alterationsor Relocation:
$ 1s.00
$ 40.00
$40
./o.'"
er
ci ty-
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps-
0ver 1000 amps/volts
-Reconnect Only
Phone
$ s0.
$ oo.
$100.
$130.
00
00
00
00
00
00
Supervisor License Number
Expiration Drte
Expiration Date
Signature of Supervising Electrician.,-
Ovners Name
Address
cit pnone 7 Z-Q *f .7 7Cr
OVNER INSTALI..A,TION
The instal]ation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Ovners
DATE:
200 amps or less $ 40.00
201 amps to 400 amps
-
S 55.00
over 4b1 to 600 ambs
-
S 80.00
Over 600 amps or 1000 voTts see uB" a66TE-
Branch Circuits
Nev, Alteration or Extension Per Panel
Temporary Servi.ces or Feeders
Installation, Alteration or Relocation
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
s300
D.\
/rr*)
c
E Miscel-laneous (Service/feeder not included)
-Each instaLlation
Pump or irrigation $ 40.00
Limited Energy/Res
-
$ 20.00
Limited nnerly/comm $ 36.00
^90
RECEIVED B
t
c-'/).-
5
zo
7oZ 3/
Constr Contr. Number
ELECTRTCAL PERHTT APPLTCATION
city Job *r o", % 1 7 45
/,<u= Ll 37YttL
Permit #:
Address:/)Zrz,3 7
Issued by:Date:
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 the
following 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, exemptfrom registration undir 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 and2, and either box 34 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 forsale
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.
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 notiff the office issuing this huilding permit of the
name of the contractor.
Iherebycertify information is correct and that I have read and do understand the Information
about Construction Responsibilities on the reverse side of this form.
_f
OR
(Signature of permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
Notice to
(Date)
t{-
N
,ru
'-.!- r\, L'r
rnTorinatidniNotice to Property Owners
- r.. Abotrt Qonqtruction Responsibiliiies
' 'r.( -'\ :, , --\ "; . \
, - r''! . --,-,i-"-- f,),,,.^1t , lnfur*tati.sdffojrr,r, to ltt't,Sttrt1'Awtx:r.t ubot$ (t,tt'tlntt'tit)n ll<tpansiitilities
\ ''r:- '/\\)Ier / i';.!-. i' l.f.{r"f (&.rr!,,pr:rt h.r.thrl C'r,nstiictittn Ct.,ntrotltsrt Bourrl in nt'q'rtrrlrtnt't'utilh oRS 7fi1 n55(5)'
trf you ;re a*tirrg a$ y{)$r owri {:or.}{ra*{{}y'to e onstvuct a }'}rw }rom* or m*ke a ssbstanliai in:prr:v*lr:en{. t* ;il.l e xisting stfttcture'
yolt clilx Elrevent rcqny probtrems by troing aware of the foliowing responsibiiities and areas of consern'
EM PLOYER H ESPONSIBILITIES:
"If .you hirei persons not registered rvith the construction contractors Board to do labor in constructing or assisting in the
,.. *""ir*ilnn'ol:
irnprovernent of a resirientiai strucrure, you will, in most instances, be ruled to be an en:lployer and the people
you hire will be employees. As the ernployer, you must cornply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wa$es atthe timc employees
are paid. you will be liable for the tax payments even if you don't actually withholcl the tax fram your ernployees. For more
information, call the Oregnn Dept. of Revenue at 945-8091'
Linernplcyment insurance tax: As an emplcyer, yc,u are required lo pay a tax for unemployment ifisurance pu{poses on the
*og"nof*llemplayees. Feirmoreinformation,calltheOregonErnploymentDivisionattheDepartmentot'HumanResources
at 3?8-3524.
lrycrkers'cornpensation insurance: As ;rn employer, yoll ate subject to the Oregon Workers'Compensation Law,
'.(
and'rtiirst
obtain workers'compensation insurance fbr your employees. If you fail tq obtain wotkers'compensation insurance, you{n}
besubjecltopenaltiesandwillbeliableforatlclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinform$jdhi,
call the Workers' Compensarion Division at the Department of Consumer and Business Services at 945-7888
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax &om emplcyees' wages. You will be
liable for:the tax payment even if you didn't actually withhold the tax. For more information, call the Intemal Revenue Service
at l-800-829-1040.
OT}IHH RESPON$IBILITIE$ AND AREAS OF CONCEHN:
Code compliance: As the perrnit holder for this project, you are responsible for resolving any failure to rneet code requirbglent,
that may be brought to your attention through inspections. ,..,,
LiabilitJ and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for '
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or yo$ &at must be
re-done.
fime to supervise employees: Make s*re you have sufficient time to supervise yortr emptroyees.
Expertise; Make sure you have the expertise to acf as your own general contractor, to coordinare the work of rough-in and finish
trades, and tr: notify huilding officials at the appropriate times so they can pe, fut'm the required inspections.
If you hav'e additional questions, write or cail the Construction Contractors Board (PO Box 14140, Sateni,'OR g73Og-5A52,
54y378-4621). The Board is located ar 700 Summer St. NE Suite 300, in Salem.
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