The URL can be used to link to this page

Home My WebLink AboutPermit 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