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Home My WebLink AboutPermit Electrical 1992-01-17t I SITI'Il\,(;FtELI) 225 FIFTE STREET SPRTNGFTELD, ORBGON 9747.7 '; . . INSPECIION REQLTEST.'726-37 69 ELESI"ICAL PERHTT APPLICATION Job Number ?z C) FEE SCBEDUI,^E BELOS Nev Residential-Single or MuIti-Family 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 Hodular Dvelling Service or Feeder $ 85.00 s 1s.00 $ 40.00 Services or Feeders fnstallation, Alterations or Relocation: ab 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0n1y . 200 amps or less 201 amps to 400 amps -Over 401 to 600 amps _Over 600 amps or 1000 volt One Circuit S Each Additional Circuit or vith Service or Feeder Permi t lq S Miscellaneous (Service/feeder -Each installation Ptrmp or irrigation $Sign/Outline Lighting- S Limi ted Energy/Res - SLimited Energy/Comm S STIBTOTAL OP ABOVB 5Z State Surcharge TOTAL OFETCE:ffi|',fbn\ 1 PTION ON 1747 Pernits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALI.ATION ONI.Y Electrical Contractor Address ci Phone Supervisor License r Expiration Date Constr Contr.r Expirati Da te S ure of Supervising Electrician Ovners Name /l \ Address cit Phone OITNER INSTALI^ATION The installation is being made onproperty f ovn which is not intendedfor sa1e, Iease or rent. Signa Temporary Services or Feeders Installation, Alteration or Relocation C(A ii. Sum B $ s0.00 $ 60.00 $100.00 $130. 00 $300.00 $ 40.00 c s40 $ss Sso s see .00 .00 .00 il Blr above 35.00 2.oo 5 n not included ) 40.00 40. oo 20. 00 \ Branch Circuits Nev, Alteration or Extension Per Panel :i ':247 E DATE: FGCEI RECEIVED B Y: - /? -?z_ \. 5 tx i:-t 1t,' . ., ?s- _/ = \4n I <+.. Address tk lssued Date R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES 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: 1. l-:=I.. I own, reside in, or will reside in the completed structure. . : 2 3 OR A B I understand that I must register as a construction contraotor if the structure is sold or offered for sale before or upon completion. My general contractor is , Contractor registration num I will be my own general contractor. lf l'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 Constr:uction Contractors Board and I will immediately notify the office 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 Owners about Construction Responsibilities on the reverse side ol this lorm. Signature of Permit Applicant Date CONSTR UCTION CONTRACTORS BOARD 0244J 8191 Z/ 4 r 7 /qq WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT Permit No: I will instruct my general contractor that all subcontractots who work on the struc- ture must be registered with the Constnuction Contractors Board. ( lNFOrrrt/lATlON NOTICE TO PROPERTY trit NERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: Tltis 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 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 RESPONSI BILITIES: 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, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must compty 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 Revenue at 378-33g0. Une ent lnsurance Tax: As an e mployer, 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 DHFI ar 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 lia.ble for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at g?g-74*. U.S. lnternal Revenue Service: As an emp loyer, 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 rnore information, call the lnternal Flevenue 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 E mployees Nilake sure you have sufficient time to supervise your employees. E-xpertise: Make sure you have the expertise to act as your own general contractor, to coordinate the workof rough-in and finish trades, and to notify building officials at thl appropriate times so they can perform the required inspections. lf you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite Gil0 Salem, OR 97310-0151 Phone 503-378-4621o244J fit24t89