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Home My WebLink AboutPermit Electrical 1993-12-07CITY OF SPR"VGFIELD,OBEGO'U 225 TITTB SlTBBf, SPRTNGFIEID, OREGON 97477 INSPBCf,ION REQT'EST OFFICE: '726-3759 ' 719",37je />-.a t> *./3' SPRI,{GFIELO STIBTOTAL OP ABOVB 5Z State Surcharge TOTAL The lollowing proiect as submitted has the lollowing rlj"i"i, .iiiJ?Siiinot require specific land use Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork ls suspended for 180 days. 2. COIIITACTOR INSTALI,ATION ONLY Electrical Contrac tot 7 -r=a Address Citv Phone Supervisor License Number Expiration Date -- Constr Contr. Number Expiration Date Signature of Supervising Blectrician Ovners Name Address EI,BSIRICAL PERHIT APPLICATION City Job Nunber QVr32a SCEEDT'I,B BBLOS A. Nev Residential-Single or HuIti-FamiIY Per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Hodular DveIIing Servlce or Feeder B D $ 8s.00 $ 1s.00 $ 4o.oo a- Services or Feeders InstaIIation, Alterations or Relocation: 200 amps or less 201 amps to 400 amPs - 401 amps to 600 amPs - 601 amps to 1000 amps_ 0ver 1000 amps/volts Reconnect Oniy Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 over 4b1 to 6oo amps - $ 8o.oo 0ver 600 amps or fbOO voTts see rtB" a5ffi Branch Circuits Nev, Alteration or Extension Per Panel approval. Authoriaed 1. LOCATION OT e IJGAL DESCRTPTION\d?-Sum c $ s0.00 $ 60.00 $100.00 $130. oo $300.00 $ 40.00 $ $ $ $ a Ci ty OSNER INSTALI,ATTON The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. 0cners Signature: DATB: d72-' - Phone ?//-7?Z one Circuit $ 35'00 Each Additional Circuit or with Service or Feeder Permit $ 2.00 E. Miscellaneous (Service/feeder not included) -Each instaLlation Pump or irrigation Sign/0utIine Lighting_ Limited Energy/Res Limited Energy/Comm 40.00 40.00 20.00 36.00 r2^a2-e5 RECBIVBD o --=r-> ---,- signature<t 3- COXpI-F.TE Pgg Permit No Address: 01 ^*- 1 2 lssued Date: R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS701.055(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 underORS 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. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A My general contractor is Contractor registration numbe I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3.8 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 inlormation is correct and that I have read and understand the tnf6rmation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /z - 7-f3 ignature m t cant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 3 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ,/Zaa { ' :a425'* INFORMaYTION NoTIcE To PBoPERTv ofrxens ABOUT CONSTRUCTION RESPONSIBILITIES ..." -..tu.lf yoU are acting as your own bontractCir to construct a new home or make a substantial to ani existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Boar4 to do le.bor in constructing or assisting in the construclion or improvement of . a residential structurel you wilt, in most instances, be ruled to be an "employer" ap{the people-you hire wiil.be "emqloyee.", lr,the employer, you must comply yvith the following: -: , : Oregon's Wittlholding Tdxfaw: As an employer, you must witnnotd income taxes from employee wages at wil]beliableforthetaxpaymentSeVenifyoudon'tactuallywithholdthe tax from your employees. For more information, call the Oregon Depar,tment of Revenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all emplwees, Fer,more informatien, call the Oregon Employment Division DHR at 378-3224. t., Workers' Compensation lnsurance: As an employer, you are subidc.t to the Oregbn Workers' Compensation pensationinSuranceforyouiemployeesttyoufailtoobtainworkerS' compensation insurance, you may be subject to penalties and willbe tiable ftrF'eJl claim costs if one of your employees is injured on the job. For more information, call the Workers',Compensation Division DIF a|373-7434. U.S. lnlPrnal.Bevenue.Seryice: As,an en-rploye-r, you must withhold federql incorne tax from employees' wages. m"entevenitvoudidn;tactLallywitnrlotothettrx'.Formoreinfoimation,call the lnternal Revenue Servide at 221-3960. ! r: ": OTHER RESPONSIBILITIES AND AREAS OF CONCERN: aggg tgtnPlglge: Asthe perrnit holder,for this project,,fou are responsible for resolving any failure to meet code:requirements that may be brougFrt to your attention,througrtr inspections. Liability and Property Dama$e lnsurance: Contact your insurance Sgent'to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray4wdtdr dilmage from pipe punc- tures, fire, or work that must be re-done. -",ifi;'+ii:,,:.*ir..lt+ . ,'itlf *',..,-;;, ltl'l::i ,it:.- .:'i .-. *li: ...,'.i ;.t!-*!:,.- : Time to Supervise Employees: Make sure you: have su ficient time to supervise your emfloyees.:\, 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. '''-i.- lf you have additional questions, write to Construction Contractors Board 700 Summer St. NE, Suite 3O0 Salem, OH 97310-0151 Phone 503-378-4621 NOTE: ' ThiS lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5),. passed by the t9'89 @reggn Legislature. o24N 10t24t89