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Home My WebLink AboutPermit Electrical 1998-12-16*;, figl gg:,;l xrt*I##,#,ottor&o Sr- -.TNGFIELD ELECTRICAI PERHTT APPLICATION City Job Number FEE SCEEDTILE BELOV 225 FIFTE STREET SPRINGFTELD, OREGON INSPECTION REQI.JEST: 0FPICE: 726-3759 1. LOCATTON OF TNSTALLA TTON LEGAL DESCRTPTION CONTRACTOR TNSTALI-ATTON ONLY trical Contractor Add Ci ty Phone ( JOB DESCRTPTTON Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 1.80 days. Nev Residential-Single orMulti-Family per dvelllng unit.Service Included: ftems Cost 1000 sq.ft. or 1ess S B5.OOEach addi tional, 50Q r ,,}}I, ,..sq. f t or portion ' ' t':r- ri irl!: \l\lt )tlt' Each Manuf ,d Home. or. --l- . -Modular Dvelling Service or Feeder $ 4O.OO A Sum 2. E1 Supervi-sor Lice Expiration Date B Services or FeedersInstallation, Alterationsor Relocation: Tempo rary Se rooobs iot-t{Eeffi€34a).Installation, ALteration or Relocation 200 amps"or less S 40.00 201 amps to 400 amps - $ 55.00 over 401 to 600 amps - S 80.00 0ver 600 amps or 1000-6ITs see r?Brr a56E S ture of Supervising Electrician 0vners Name Ci ty Phone 735</rD7 OITNER INSTALLATION The installation is being made on property I ovn which is not intended for saIe, lease or rent. 0sners Signature: Ai-j il()irl:U raW 6a am it}-- those fortfi"- 1 nn center.lhf0fe tt$p Hed@n6- esby- ec numbe forthe Ore-Q-ofr-Uti lity Notification-- 1./o,7f,bl Numbe 200 201 407 601 0ver Reco,><- C Cons t r Expi ra r Con t r.mber D. Branch Circuits Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Additional Circuit or vith Service or Feeder permit lO $ 2.00 70 -Each installation Pump or irrigation _Sign/Out1ine Lighting_ Limited Energy/Res Limited EnergY/Comm SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL o 7.5 2 $ 40.00 s 40.00 $ 20.00 s 36.00 25 DATE:1( RBCEIVED b- ed&17 Da te-- maress Sg'gjz d, //a,,,/r/". e 2 ,<1 E. Miscellaneous (Service/feeder not included) Permit # Address ,s, 3 g+k t? Issued by: 'tt Date: statement: lnformation Notice to property owners About Construction Responsibilities Note: Oregon Law, ORS 70t.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to 3ign the following statement before a butlding permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architecl and engineer applicants, exempt from registration under ORS 70t.010(7), need not submit this stotement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38 l. 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. 3A. 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. 38. 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 that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. tz /tt ,br t applicant) llrhite copy to issuing agency permit file, pink copy to aPPlicant) OR (s -7W ,a /B rtl t( tr 1l,s*Eiw Information NOtice to Property Owners About Construction Responsibilities \ Note: |'itis lnJbrmation Notice to Property O*'ners about Ccnstructiott ltt'sprsnsibilititts u,as deveLoltett hy the construction crsntructors Eoatd in accordunt:e vvith oRS 7{}l'055{5)' If you are ac6ng lrs -your own eontactor to consmrct a new home or make a substantial improvement to an existing sr'ucttrre' you can prsvenr nrany pnrblerrs by being aware of the following responsibilities and'area's of concem' EMPLOYER RESPONSIBILITIE$: If you hire persons not registered wiltr the.construction contracrors Board to do labor ir} constructing or assisting in the construction o, i*prou"*eirt of a residentinr ,t r.tur", you will, in most insiances, be ruled to be a'n employer and the people }]1t il;ilf Ue eri"rpfoyees. es tne employer, you must comply with the fouowing: oregcnrs withhotding tax traw: As an employ€r, you must withhold income taxes from empioyee wa8e$ at the tirne employees a.re paid. you will be {iabte for the * pov*lnir'eren ir you don't actually withhold the tax from your employees' For utore iri**ution, call the Oregon Dept. of Revenue at 945-8091' unemployment insurance tax As an emproyer, you tr f*quir,r $ pay a 11for unemproynert insurance purposes on the wages of all emptoyees. For more informatio", cufi the Oregon Employment Department'dt378-3524' Worker,s compensation insurance: As an employer, you aresubject to the Oregon Workers' Compnsation Lalv' t*O *u*t obtain worken, compensation insurance for your "*ptoy*".. II'y?o fail to obtain workers' conrpensation insurance, yctu lllAy be subject to penalties and will be .liable for ail claim Josti if one .rf your emplglee.s is injure<t on *re 3ou. F'or more infonnation' call the workers, Conrpensation Division at the Department of Consumer and Business Services at 945-7888' u.S.Internal Revenue service: As an employer, you must withhold tbderal income tax from emplayees'wages'You rvill be Iiable for the ux payment even if you tlidnt aJtuariy wittrhold ttre tax. For more informadon, cali the lnternal Revenue service ar 1-800-829-1040. OTHER RESPONSIEILITIES AND AREAS OF CONCEBN: Code eompliance: As the prmit holder for this project, you are responsible for resolving any failure to m}et code requirenlents that may be brought to your attention tkough inspctions. tiability and pnoperty damage insumnce: Contact your insurance agent to see if you have adequate insurance coverage fbr accidenis and omissions such as fatting tools, paint overspray, water damage from pipe punctules, fire, or worli that rnust be re-done. Time tei supervise employees: Make sure you have sufficient time to sapervise our employees' Expertise: Make sure you have ttre expertise to act a$ your own general contractor, to coordinate tlre woik of roughrin and fini*t traeles, and to notify building officials at the appropriale times so they can perform therequired inspections. '...If yon have adclitional questions, wrire or call the Construction Contractors Board N trox 14140, Salem, oR 9?309-50-52, 5031378-M21), The Board is located at ?00 S*mmer St. NE Suitc 300, in Salem prop-own.pnr4 t/94 sP40'1