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Home My WebLink AboutPermit Electrical 1995-02-24The {ollovrirrg prcject as stlbmitted has the lollowi i".,16, i"o"abes not require speclfic land use aptL 225 FrFTE STREET _ --) .-,,,-L( SPRTNGFTEID, oREGoN 9747t)ato L'i--r r-' l./ vwINSPECTION REQT EST: 726&&69zed Sisnature OFFICE: 726-3759 approval. z 1. LOCATION OF JOB Permits are non-transferable and expire if vork is not started vithin J.BO days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALIATION ONIY Electrical Contractor Address Citv Phone Supervisor License Number Ci vhone 27/.V:f DATE: ST.RIIYdFIELD ELECTRICAL PERHTT APPLICATION ob Number COHPLETE FEE SCEEDTILE BELOIJ Nev Residential-Sing1e or Mul-ti-Famil-y per dvelling uni t. Service lncluded:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder s 8s.00 s 1s.00 $ 40.00 Services or Feeders InstalIation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps _401 amps to 600 amps _ 601 amps to 1000 amps_ Over L000 amps/vo1ts Reconnect 0n1Y 3 A Sum B s s0.00 s 60.00 $100.00 s130. 00 s300.00s 40.00 Expiration Date Constr Contr. Number Temporary Services or Feeders Insta1lation, Alteration or Relocation Exoiration Date 200 amps''or less 201 amps to 400 amps _ Over 40L to 600 amps 0ver 600 amps or 1000-G-ITs D. Branch Circuits 0vners Name Nev, Alteration or Extension Per Panel Address one Circuit A$ 35.00 Each Additional Circuit or vith Service or Feeder Permit $ 2.00OIJNER INSTALI,,ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: E. Miscellaneous (Service/feeder not included) c $ 40. $ ss. $ 80. 00 00 00 see ItBrt aEove 35 ao -Each installation Pump or irrigation _ S sign/outl-ine Lighting- $ Limited Energy/Res $ Limited Energy/Comm $ 40.00 40.00 20.00 36.00 5 SUBTOTAL OF ABOVE 5Z State Surcharge 32 Administrative Fee TOTALRBCEIVED .Ue LEGAL DESCRIPTIONt2"ez-7/-r\ 2?a - Signature of Supervising Electrician Permit #: Address: Issued by: a Date: Statem€nt: lnformation Notice to Property Owners About construction Responsibilities Note: oregon Law, oRs 701.055(4), requires residential consffuction permit appli- cants who are not registered with the construction contractors Board to sign the following statementblefore abuilding permit canbe issued' This statement is required for residential buildiig, electrical, mechanical, and plumbing permits' Licensed architect and engineeiapplicants, exempt from registration under ORS 701'010(7), need not submit this statement. This statement will be filedwith the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A 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 before or upon comPletion. if the structure is sold or offered for sale 3,A'. My general contractor is Contractor regis. #(Name) 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 notiff the office issuing this building permit of the name of the contractor. I hereby certify thatthe above information is correct and that I have read and dounderstand thelnformation Notice to Property Owners about Construction Responsibilities on the reyerse side of this form.%LZ-^)4'a OR Iav-(Date) \V_ lSignature of permit applicant) (White copy to issuing agency perrnit file, pink copy to applicant) ?fuzz^ W Nate wtz',s cle Info'rrnatiori, Notice to property Owners ;, Abou! ;Qonf lrruction Flespo ns i bi I ities 'this lrydbrmation Notice to Properry Awryge- about Construction Re.vetopettbyihihfr futu;-$;iror-,n;rti;i,ii'"r*lrii"i'i'*,,0 spansibilities oRS 701.Oss(s). .: ;ig i iir.i' gupLoilEn nEsF{rttstBluilE8:,e : .. u .*. , ., If you hire persons not rqgistered with the construction Contractors Board to do labor in constructing or assisting in theconstruction or improvemeni ora,"iia"niirri*.;;;:;;, *i;:;ffi ;ffi:;"#ij,"o to be an emproyer and the peopleyou hire will be employees. As the emproyer, you;rri"drr, *irt ,tg rottowing: : : oregon's withholding.t?T'1toi ot an employer, you must withhold income taxes from employee wages atthe time emproyeesare paid' You will be iiable for the ta:t payments Lven if you don't actuany u.ithhord the tax from yorn emproyees. For moreinforrnation, call the Oregon Dept. of ievenue at 94rg091. unemployment insurance tax: As an employer' you are required to pay a tax for unemproyment insurance purposes on thewages of all employees' For more informaiion, cafl the oregoi Employment Division at the Deparrnent-of Human Resourcesat378-3524. workers' compensation insurance: As an employer, you are subject to the oregon workers'Compensation Law, and musobtain workers'compensation in$urance foryorllemployees. If you fail to obtain workers,compensation iorurlI"",;;;,;besubjecttopenaltiesandwillbeliableforaiiclaim"orr"iron"ntyorr"*ployeesisinjuredonthejob. Formoreinformdion,call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7ggg. u's' rnternal Revenue service: As an employer, you must withhold federal income tax from employees,wages. you will beliable for the tai payment even if you clidn't acfually withhold the tax. For more information, call the Intemal R;r;;;;;;at l-800-829-1040. If you are acting ns your own contractor to construct a new home or make a substantial improvement to an ex rstmg structure,yolr can prevent maly problems by being aware of the foliowrng OTHER RESPONSIBILTTIES 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 qnd property damage irxurance: Cortact your insurance agent to see if you have adequate insurance coverage for accident$ and omissions such as falling tools, piint overspray, water damagp from pipe punctures, fire, or wort that must be re-done. Time to supervise 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. If you have additional questions, write or call the Construction Contractors Board (PO Box.14140, Salern, OR 97309-5052, 54y378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.prn4 1t94