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Home My WebLink AboutPermit Electrical 1994-03-18?^/1. ilu-k ctT YOF OREGOfr 225 FTTTB SInBEf, sPRn{cFrELD, oRBGox gl4l7:. i I,EGAL DESCRIPTIONif c 11v17_ alTA'z_ JOB DESCRIPTION permits are non-transferable and expireif vork is not started vithin 180 days of lssuance or if vork ls suspended for 180 days. 2 COTITRACTOR INSTALI,ATION ONLY EIect Contractor Address Cl ty Supervisor License Expiration Da Constr . Number Expi ion Date ture of Supervising Electrician Ovners Name UI (; /L 'v ltt Add SPRT'VGFIELO BLtsG_-l&rCAt PERilTT APPLICATION ob Nunber q SCEBDTILB BELOV ia1-Single or per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or -Modular Dvelling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 Services or FeedersInstallation, Alterations or Relocation: t 200 amps or 201 amps to 401 amps to 601 amps to 0ver 1000 Reconnect -/-c.fu--o 600 amps 1000 amps Sum B less 00 00 00 00 00 00 50. 60. 100. 130 $ $ $ amps 0nIy /voIts $300. $ 40. a citvslr,rqFf - ic/ Phon" ? lV d 8%' OIINER INSTALI.,ATION The installation is being made on piop"tty I ovn vhich is not intended for sa1e, Iease or rent' C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ {.qq 201 amps to 400 amPs - $ Il.9g Over tOt to 600 amPs $ 80.00 Over 600 amps or 1000 voT[s see rrB* above D. Branch Circuits Nev, Alteration or Extension Per Pane1 One Circuit $ 35'00 Each Additional Circuit or vith Service or Feeder Permit - $ 2'00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Light irg- Limited EnergY/Res - Limited EnergY/CommSignature: $ 40.00 $ 40.00 $ 20.00 $ 36.00 aa SUBTOTAL OP ABOVB 5X State Surcharge TOTALDATB: RtsCBIVBD 5 a INSPBCTION RBQUBST: 726-3769 OPFICE: 726-3759 l' i:. .r' Ci-u r-' 2.-ln 11.:t- 3- coHPLRTB ty Resident 1 LOCATION OF Permit No: Address: lssued Date: R OFFICE USE ONLY STATEMENT: TNFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential cohstruction 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 Contractor registration number-. 1 2 74rt>U tr'.l^ SJ- I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 3 OR 3.8 reverse side of this form. 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 iegisiered with the Construction Contractors Board and I will immediately notify the of-fice issuing this building permit of the name of the contractor. I hereby certily that the above information is correct and that I have read and understand the lnformation Notice to property o*ner. about Construction Responsibilities on the C ignature m t cant CONSTRUCTION CONTRACTORS BOARD 0244J 8191 WHITE COPY TO ISSU]NG AGENCY PERMIT FILE PINK MPY TO APPLICANT 4 rtodq il/,Ar\,ta-- TNFoRMXnoN NoncE To pRopERTv oi-nens ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 7O1.056(5), passed by the 1989 Oregon Legislature. lf you are acting ad your own contractor io construct a new home or make a substantiaf ffirottlem-ent to an existing structure, you can prev-ent m.any problems by being aware of the following responsibili.ffes and areas of concern. i EMPLOYEB RESPONSIBILIT]ES lf 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, yo.u 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 willbe liable.for the tax payments even if you don't actuatly withhold the tax from your employees. For more information, call the Oregon Department of Revenue at g7g-gggg. 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. U&IIgrs' tgmPglgation lnsurance: As an employer, you are subject to the Oregon Workers' CompensationLaw,apensationinsuranceforyouiemployees.ttyoufai!toobtainworkerS, compensation insurance, you may be subject to penalties and will be liable for aliclaim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at gf3-7454. U.S' lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.ymentevenifyoudidn,tactuarrvwitfi;bin"t"*'Formoreinfoimation,call the lnternal Revenue Service at 221-g960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Com.pliance: As the permit holder for this project, you are responsible for resotving any failure to meetcode requirements that may be brought to your atiention through inspections. and P lnsurance: Contact your insurance agent to see if you have adequate insurancecoverage for accidents an omissions such as fal ling tools, paint overspray, water damage from pipe punc-tures, fire, or work that must be re-done Time to Supervise E mployees Make sure you have sufficient time to supervise your employees Efpertise.: Make- sure you have the expertise to act as your own generat contractor, to coordinate the workof rough-in and finish trades, and to notify building officials at th; appropriate times so they can performthe required inspections. lf you have additional questions, write to Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 509-9284621 L 0244J 10t24t89