HomeMy WebLinkAboutPermit Electrical 1992-01-21st'lilN(;FtELO
ELBCTRICAL PERHIT APPLICATION225 FIFTE STREEI
SPRINGFIEI,D, OREGON 97 477
INSPECTION REQITESTt 726-3769
0FFICE: 726-3759
Pernits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. CONTRACf,OR INSTALI,ATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervisor License I'lumber
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners
Address
cit Phone
OIJNER ALI"ATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
gnature:
q\n$l
J
A
1
City Job Nuurber
COHPIATE PEE SCEEDULE BELOU
Nev Residential-Single or
HuIti-Family per dvelling unit.
Service Included:
Items Cos t
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.00
s 1s.00
s 40.00
Servibes or Feeders
Installation, Alterations or
Relocation:
Sum
B
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps
601 amps to 1000 amps-
0ver 1000 amps/volts
Reconnect 0nly
00
00
00
00
00
00
$ s0.
$ 60.
$ 100.
$130.
$300.
$ 40.
la
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or }ess $ 40.00
Over 401 to 600 amps _ $ 80.00
Over 600 amps or 1000 volts see 'rBrr above
D. Branch Circuits
Nev, Alteration or Extension Per Panel
-L s3s'oo6
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Hiseellaneous (Service/feeder not included)
-Each installation
Ptrmp or irrigation
Sign/0ut1ine Light ing-
Limited Energy/Res
Limited Energy/Comm
SI,ETOTAL OP ABOVE
5Z State Surcharge
TOTAL
s 40.00
s 40.00
s 20.00
s 36.00
5
B
Ovners Si
OO
+)\Ooo.
I
q1 -r
Permit No:
Address:
lssued Date
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILIT!ES
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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
1 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.
3.A My general contractor is
Contractor registration number-
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.B will be my
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 lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
g nature o lic Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
2
OR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
lNFOlt'rlATlON NOTICE TO PROPERTY OvI/NERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: . This lnforryration Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Orego.n Legislature.
lf you are acting as your own contractor to construct a new home or make a substantial improvement to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
If 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 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 for the tax payments even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Flevenue 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 employees. For more information, call the Oregon Employment Division DHR
at 378-3224.
Workers' 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, callthe Workers' Compensation Division DIF at 973-7434.
U.S. lnternal Revenue Service: As an employer, 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 Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code 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 from pipe punc-
tures, fire, or work 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 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.
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
4244J 10t24t89