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Home My WebLink AboutPermit Electrical 1995-09-11fra approva!.l- 225 FIFTE STREET SPRINGFTELD, OREGON 97 INSPECTION REOUEST: 7 OFPICE: 726-3759 L F IJGAL DESCRIPTION JOB DESCRI Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days 2. COTIITRACTOR INSTALI^ATTON ONLY Electrical Contractor Address Citv Phone Supervisor License Number Signature of Supervising Electrician ci tr SPfr,,{ Pnone -7 JG536l OVNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Signat DATE: The lollowing proiact as submlisC tias thc loll,:'l'ing zoning, and doe6 rrot reqiiiro s;;*ciii,; icl::l rtgs A ELECTRICAL PERHIT APPLICATION -.. clly Job Nunbe, f/V63 3. COHPLETE FEE SCffiDTILE BELOI{ sPa FIELI) 1000 sq.ft. or less .Each additional 500 sq. ft or Portion thereof Each Manuf'd Home' or Modular DveJ-ling Sertice or Feeder B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less t- 201 amps to 400 amPs _401 amps to 600 amps _601 amps to 1000 amPs- Over 1000 amps/volts Reconnect 0n1y SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL afr, New Residential-Single or Multi-FamiIy per dvelling unit. Service Included:Items Cost Sum s 8s.00 $ l.s.00 s 40.00 _2,* ee ItBrt a6ove s s0.00 s 60.00 s100.00 s130.00 s300.00s 40.00 Expiration Date Constr Contr. Number Temporary Services or Feeders Installation, Alteration or Relocation Exoiration Date 200 amps''or less 201 amps to 400 amps _ Over 401 to 600 amps Over 600 amps or 1000-voITs D. Branch Circuits Ovners Name Nev, Alteration or Extension Per Pane1 One Circui t Each Additional $ 35'oo .Circuit or vith Service -or Feeder Permi, I S 2-00 B E. Miscellaneous (Service/feeder not included) Address h C s $ s s 40.00 55.00 80.00 -Each installation Pump or irrigation $ sign/outline Lighting- S t i.mited Energy/Res - S Limited Energy/Comm S 40.00 40.00 20.00 36.00 5 RECEIVED d . -7y12.dr/ Permit#: 2*%V Address:p Issued by Oate:7*-€ Statem€ht: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be 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. Fill in the appropriate blanks and initial boxes I andZ, and either box 3,{ or 38 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. 3,A.. 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 Construction Contractors Board. W 3B. 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 notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and thatl have read and do understand the Information Construction Responsibilities on the reverse side of this form. f- rr- of permit applicant) (White copy to issuing agency perrnitfile, pink copy to applicant) OR ( Notice to (Date) ?{ e Infolination lrtdUce to Property Owners " . About Qgn.utryctisn Hesponsihilities Nate : This Inf*rmatirsn egr$* tu Froperry {}wner.s sbout Crs*strur.t:ti** Resporusihilities was det,elrsper! by the Coii'iilction Can*fict()rs #**rd i* cr:cr';r*Crag r:e with $RS 7#f .055{5). If y*u are acting as yclur own contractor to constrllct a fiew home ur mak* a sr.rhstantial inipr*vement to an existing slructure, you can prevent maury problems by being aware of the tbllowing responsibilities and areas of concem. EM PLOYER RESPONSIBILITIE$: 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 incorne taxes from employee wages at the time employees are paid. You will be liable for the tax payments evsn if you don't actually withhold the tax from your employees" For more information, call the Sregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an ernplnyer, you are required to pay a tax for r:nemployment irsurance purposes on the wages of all employees. For more information, call.the Oregon Employment Division at the Department of Human Re sources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and n&st obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insufance, you may be subject to penalties and will be liable for ril "lui* "orts if one of your employees is injured on the job. For riiore informatiorl catl the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888: U.S. Internal Reyenue Service: As an ernployer, you must withhold federal income tax from employees'wege$" You will be liable for the tax payment even if you didn't acfually withhsld'the tax. For more informati*n, call the Internal Revenue Serviie at 1-800-829-1040. OTHER HE$PONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure tc meet code requiremqnts that may be brought to your attention through inspections. , .,, Liabiliry and praperty damage insur&nce: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water darnage from pipe punctures, fire, or work that rmrst be re-done. fime to supervise ernployres: Make sure you have sufficient time t* supervise your emplayees' Expertise: Make sure you have the expertise to act as your olvn general contr&ctor, to coordinate the work of rough-in and finish trades, ancl ro notify building nfficials at the appropriate times so they can perform the required inspections. If yog have additi*nai questians, write or call the Constructian Contractors Board (PO Box 1414$, Salem, OR 973t19-5052, 50313?8-4S21). The Bsrard is located at 700 Summer St. NE Suite 300, in Salem" prop-own.pm4 lt94