HomeMy WebLinkAboutPermit Electrical 1992-04-24\
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PENITT APPLICATION
,25 FIME STREET
;IlIMFt[u, onxcoil e7477
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City Job Number
PBE SCEEDULB BETOIT
iaI -Single orr dvelling unit.
INSPBCf,ION REQUESTz 726-376
oPFICE: 726-3759
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IJGAL DESCRIPTI
A
DESCN.IPTTON
Permits are non-transferable and expire
if vork is not started within 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALI,ATION ONLY
Electrical Contractor
Address
Ci Phone
Supervisor License Ndmber
Exp iration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name lad
Address 34oo No
Ci ty ei^.,6 ,ld Phone Vll'(r?ir'
Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Eaeh Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 8s.00
$ 1s.00
s 40.00
Services or Feeders
Installation, Alterations or
Relocation:
ur!i,..o,t, 3'
A,1 Nev
MuI ti-Family
Sum
B
200 amps or less t/-
201 amps to 4oo amps
-401 amps to 600 amps _
601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only
One Circui t
Each Additional
Circuit or vith Service
or Feeder Permi t
Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less S 40.00
Over 600 amps or 1000-volts see rrBrr above
Branch Circuits
Nev, Alteration or Extension Per Panel
$s0
$oo
00
00
00
00
00
00
5o.x.
$100.
s130.
$300.
$ 40.
c
D.
$ 3s.00
$ 2.00
OIINER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent'
Signatu
Miscellaneous (Service/feeder not included)
-Each installation
eu*p ot irrigation S 40'99
iig'"zortline"r,iehting] I lP'ooLii,i tua EnergY/Res
-
s zo 'oo
suBrorAl oF ABovE 5uu1
5I State Surcharge -dL,r, -TOTAL
5
DATE:
RECEIPT
I.ECBIVED DI:
E
.x
Permit No:
Address:
lssued
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R OFFICE USE ONLY
1
2
Note: Oregon Law, ORS 701.055(4) , requires residential construction permitapplicants who are not registereO witn the Construction Contractors Board tosign the following statement before the building permit can be issued. This state-ment.is required for residential.l-rtrilding, eleclrical, mechanical, anO pfumOin-gpermits. Licensed Architect and Engineer applicanis, exempt fr6m registratioiunder ORS 701.010(7), need not sudmit thid btatemeht. fnib statement wiil befiled 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.
Contractor registration numbe
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the construction contractors Board.
3.B I will be my own general contractor.
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONS!BILITIES
lf I hire subcontractors, I willhire 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.
OR
! hereby certify 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 of this form.
///u u,7.,-)
^Signature of Permit Applicant
CONSTRUCTION CONTRACTORS BOARD
024N 8191
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
<
INFOT..dATION NOTICE TO PROPERTY t,{I/NERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOfE: 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 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 lollowing responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or iriprovement 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:
o n's Tax Law: As an emPloYer, You must withhold income taxes from employee wages at
e time emP are d. You will be liable for the tax PaYme nts even if you don't actually withhold the
tax from your emPloYees.For more information, call the Oregon Department of Revenue at 378-3390.
Unempl oyment lnsurance Tax: As an employer, you are req uired to pay a tax for unemployment insurance
purposes on the wages of all em ployees. For more information , callthe Oregon Employment Division DHR
ar 378-3224.
Workers'Co sation lnsurance: As an emPloYer, Yo u are subject to the Oregon Workers' Compensation
, and must n workers' compensation insurance for your employees. lf you fail to obtain workers'
compensation insurance, you may be subiect to penalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call th e Workers'Compensation Division DIF at 973-74U.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
You will be liable for the tax payment even
the lnternal Revenue Service at 221-3960.
if you didn't actually withhold the tax. For more information, call
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
coaelequirements 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 Superv ise Employees: Make sure you have sufficient time to supervise your employees.
Expertise: 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 perform
the required inspections.
lf you have additional questions; write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
o244J 10124189