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Home My WebLink AboutPermit Electrical 1993-04-19a :it.tuNGl:tr:Lu Ort 225 I]IFTII 1;TRI':IiT ST,RINGFIELI), ORIiGON 97 Ti77 INSPIIGIION REQUIIST z 7?'6-37 69 OFPICE: 7?-6-375t);:"?a'f'9'-::;;f"' . .--5. coHPLtsTts PBB CAL PBRHIT AP PLICATION b Number SCIIEDULB BBLOV 1 TION OP INS ALLATION,TAt ST: '"'.- a Permi ts are n n-transferable and exPire it vork is not started vlthin 180 days of issuance or if vork ls suspended for 180 days. 2. CO}N'RACf,OR INSTALITI'ION IiIectrir:al ContracIor Add r:ess ,2a ,/a67 Nev Residential-Single or HuItl-FamiIY Per dvelling unit. Service Include(,:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion the reo f Each Manuf 'd llome or Modular DweIling Service or Feeder $ 85.00 $ 1s.00 $ 40.00 Services or Feeders Installation, Alterations or Reloc.ation: 201 anrps to 4oo amps - $ 60.00 401 amps to 6oo amps - $100.00 601 amps to looo amps- $13o.oo over 1b00 amps/voltr - $300.00 4a N,A LEGAL DESCRIPTION i1 obb$21 DO4D Sum Q.KT5, JOB DESCRITTION 1 B /aaP Ci ty ,.{ trft(t t't o,',u 72( -ff63 Supervi:;or License Number 2 Exp iration Da rc /6 Constr Contr. Numbcr Expiration Date Signature Supcrv i s i EIect c 0 vne rs Name Temporary Services or Feeders Installatlon, Alteration or Relocation /-73 2oo amps or less 201 amps to /r00 amps over /r01 to 600 amps _ 0ver 600 amps or l'000 volt .00 .00 .00 s see xBrr aEove 40 55 BO $ $ $ A<ldrcss lO t lJ =-U Ci ty /Laru"t Ptrone , )L \qn OVNEN INSTALLATION The installarion is being made ott I)roperty I ovn vl'rich is not intended for sa1e, Iease or rent. Ovncrs Signature: DATE: RIICEIPT $: D. Branch Circuits Neu, Alteratlon or Extenslon Per Panel One Ci rcui t Eaclr Addi t ional Circui t or vi th Service or Feeder Permi t $ 3s.oo $ 2.00 E l'liscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Ou tline Light i^g- Limi ted Energy/Res - l,iml ted Energy/Comtn SUDTOTAL OT ADOVB 5f State Surcharge TOTAL L+D N l. $ 40.00 $ 40.00 $ 20.00 $ 36.00 -r1 5e-rc dcI IIIiCIIV[D IIY: L.l rlg 5 ' itr'" /7 CITY OF OREGO'U SPIllrr.,f IELEl 225 PI,r{H STRBET SPRINGFIELD, oREGoN 97477 INSPECTI0N REOIEsTz 726-3769 0PFICB: 726-3759 BLECTRICAL PERI{IT APPLTCATION^ city Job Nunber ']e133 /r0K nfilo:, 1 P INST Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if work is suspended for 180 days. 2 COI{TRACTOR INSTALI,ATION ONLY Elec Address Ci ty ne Supervisor Licens ber Expiration Da 13. COHPLETE One Circui t Each Additional Circuit or vith Service or Feeder Permi t I PEB SCEEDULE BBLOV Nev Residential-Single or Multi-Family per dvelling unit. Service fncluded: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or -Hodular Dvelling Service or Feeder s 8s.00 s 1s.00 $ 40.00 Services or Feeders fns tallation, Alterations or Relocation: A Sum B 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1000 amps- over 1000 amps/voIts -Reconnect 0nIy s s0.00 $ 60.00 s100.00 $130.00 Cons t r . Number Expi ra on Date s ture of Supervising Blectric Ovners Name Address Ci ty Phone OgNER ALI,ATION The inst Temporary Services or Feeders Installation, Alteration or Relocation c s300.00 $ 40.00 $ 3s.00 s .2.00 d5 d 200 amps or less $ 40. 20L amps to 400 amps - $ SS. over 401 to 600 amps - $ 80. Over 600 amps or 1000 volTs see rl 6ove 0o 00 00 Brt a D. Branch Circuits Nev, Alteration or Extension Per Pane1 p t roper ty o allation is I ovn vhic , Iease or made on B. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Light Limited Energy/Res lng Limi ted Energy/Comm STETOTAL OP ABOVE 5Z State Surcharge TOTAL s s $ s 00 00 00 00 40. 40. 20. 36. C BRBCBIVED t lSn ture in tended d) cal Contractor Permit No: Address: lssued Date R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIB!LITIES 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 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 reqistration number-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 1 2 3 .LLalfrrag3.8 I here Iy that the a the n Notice to this form. ca CONSTRUCTION CONTRACTORS BOARD 0244J 8191 Owners about Construction Responsibilities on the r-- | I will be my own geaete{ 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. ation is correct and that I have read and understand te WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT rse side rNFoR;ixrroN NoncE To pRopERT" o-wltERS ABOUT CONSTRUCTION RESPONSIBILITIES 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 1989 Oregon Legislature. lf you aie actinQ 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. ,t. = EMPLOYER RESPONSIBIL!TIES: lf you hire persons not rqgistered with the Construction Contra.ctors Board to do lapor in constructing or assisting in the constructibn or improven'r'ent of a'residential structur€,')tor "employer" and the p-eople,liou hire will b€ "employees". As tlie'br U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. ymentevenifyoudidn'tactuallyWithho1dtheiax.F6rmoreinformation,call the lnternal Revenue Service at 221-3960. u will, in,most'instanceg, be'iuled to be an fnployer, you must cpmply 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,paymeats even if you'don't ac[ually withhold the tax from your employees. For more information, call the Oregon DepartrRent of Revenue at 378-3390. Unemployment llgllelee ]ax: As an employer, you aie required to pay a i"i'to, unemployment'insurance purposes on the wages of all employees. For more information, call the Oroggn Ernployment Division DHR a|378-3224. Workers' Compensation lnsurance: As an employer, you are subject to the Oregon \Ailorkers' 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 hll claim costs:if'onei of your employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at gf3-7434. Expertise: Make sure you have the ex1 of rough-in and finish trades, and to n the required inspections. Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OH 97310-0151 Phone 503-3784621 OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ,*,:::;i:.!, Code Compliance: As the permit holder for this prqect, !oU:or€ responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liabilihi 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. , : ., r Time to Supervise Employees: Make.sure you have sufficient;tirnetb:suporlin€ yow employees. pertise to act as your own general contractor, to coordinate the work rotify building officials at the appropriate times so they can perform lf you have additional questions, write to o244J 10t24t89