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Home My WebLink AboutPermit Electrical 1995-04-03SF ;FIELO Tho {ollowing nrolecl as 6ubmit16d has the lollowingi ':i.'t!,t.ii1c ,Jc,{rs ilot roquiro specific land uee iilltjr OVal. l-.DD .1-225 FIFTE STREET SPRINGFIET^D, oREGoN INSPECTTON REQTIEST: OFFICE: 726-3759 1 ELECTRICAL PERUIT APPLICATION Ci ty Job Number ?$oy'3o COHPI-ETE FEE SCMDULE BELO9 Nev Residential-Single orMulti-Family per dvelling unit. Service Included: I tems Cos t ) lrlY.^ I OP INSTATLATTON I't. llib 3 A I.EGA.L DESCRTPTION JOB DESCRTPTIONA (:(C Sum 21- c1 O Permits are non-transferabLe and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALLATTON ONLI Electrical Contractor Address ci ty-Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician 0vners Nane rAn",,"-t?,vt61 Co*l-f , 1000 sq.ft. or less Each additional 500sq. ft or portion thereof Each Manuf'd Home. or - Modular Dvelling Service or Feeder s 8s.00 s 1s.00 $ 40.00 B Services or PeedersInstallation, Alterationsor Relocation: 200 amps or less 201 amps to 400 amps - 401- amps to 600 amps - 601 amps tor1000 amps- Over 1000 amps/voIts - Reconnect Only s s0.00 s 60.00 s100.00 s130.00 s300.00s 40.00 C Temporary Services or Feedersfnstall-ation, Alteration or Relocation 200 amps"or less S 40.00 20L amps to 400 amps - S 55.00 Over 401 to 600 amps - S 80.00 Over 600 amps or 1000-toITs see I'Bt? a6ov,re- D. Branch Circui ts Nev, Alteration or Extension per panel One Circuit i. S 35.00 Each Addi tionalCircuit or vith Service E or Feeder permi t ./ $ 2.00 J1!. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $Sign/0utline Lighting- S Limi ted Energy/Res - S Limi ted Energy/Comm S SUBTOTAL OF ABOVE 52 State Surcharge 3Z Admi n i.s t ra t ive Fee TOTAL Z<j Address ,Sf't Ni /14 AtCi ty " nL/2 -7d8 OVNER INSTALTJ\TION The installation is being made on property I ovn vhich is not intendedfor sale, Iease or rent. 0vners Signature: DATE: RECEIPI RECEIVED 40. 00 40.00 20.00 36.00 aa0',15 ----7v7- 5 z2z /icz 3C /.2 o?oac Permit #: Address: Issued by: 55r N. /?z 5./ , Date:,s- Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction pertnit appli- cants who are not registered with the Construction Contractors Board to sign the following statementbefore abuilding permit canbe issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Filt in the appropriate blanks and initial boxes 1 and 2, and either box 3,{ or 38: x K 1. 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 for sale 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 Consffuction 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 building permit of the name of the contractor. I hereby certify thatthe above informationis correctand that I have read and dounderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. permit applicant) (White copy to issuing agency perrnit file, pink copy to applicant) OR rffar9 .. .*. i..* ' *nfonnation Notice' tO Property Owners :_., Abou{Oonstruetion.Responsibilities J. * .' {org, Iltrs Jru/ur*tesri*n &'*rjce to Prysyserty Ownersc&ose, C'orstrut'tion Re,rpoxsibilities tvt;s t{evrksy: *,1 h's the Constrtx:tion'Crstrlr*tr*rx Sarlrd in actorr{cttce with ORS 7At.{}55(5). If yau are acting as ysur own contractor to construct a new home or make a substantial improvement to an existing structure, y$ii fa$ {;rcvt:nt rxany pn:rbi**rs by being aware ol the foliowing responsibilities and areas of concern. EM PLOYER RESPONSI BILITIES: prop-own.pm4 u94 If you hire persons not registered with the Construction Ccntractors Bnard to do labor in constructing or assisting in the construction or improvexrent of a residential strucaure, you will, in most instances, be ruled to ba an ernployer and the people you hire will br: employees" As ttre employer, you rxust cnmpiy with the following: Oregon's withholding tax law: As iin e*rployer, you rnust withhokl incorne ta-xes from employee wages at the time employees are paid. Yoll will be tiable fr:r th* tax paymonts even if you don't actuatriy withhold the tax from your employees. For more infr:rrnation, call the {)regon Dept. of Revenue at 945-8091 . {.Jnemployment insnrance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on t}e wages of ali employees. For mcre information, cali the Oregon Employment fivision at the Depadment of Human Resources at378-3524 \:, .r Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, *O rsust obtain workgrs'compensation insurance for youremployees. If you fail to obtain workers'compensatioq insulance, youq94 besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinform$idfu. call the Workers' Compensation Division at the Department of Ccnsumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. Yuu will be liable for the tax payment even if you didn't actualiy withhold the tax. For more information, caLll the Internal Revenue Service ar 1-800-829-1040. OTI-IEH HESPONSIBILITIES AND AREA$ OF CONCERN: Code compliance : As the permit holder for this project, you are responsible for resolving any failure to meet code that rnay be brought to your attentian through inspections. Liability 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 work that must be re-done. Time to supervise employees: Make sure you have sufficient time tc supervise your employees. Exper.tise : 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 perf<rrm the required inspections. Ii you have additional questions, write or call"the Construcl,ion Confractors Board tPOSox l4l403alernrOR 97309-5052, 50313?8-4621). The Bnarcl is iocated at 7$0 Summer St. NE Suite 300, in Salem.