HomeMy WebLinkAboutPermit Electrical 1998-03-18CITY OF OREGiON
\
225 FIFTE STREET oa"?J(,9J
SPRINGTTELD, oREGOAfiSA&3a
INSPECf,ION REQUESTz 726-
OFFICE: 726-3759
1 LOCATION OF INST ON
LEGAL DESCRIPTION o00
JOB DESCRIPTION
'v\-l e-t-
Permits are non-transferable and expire
if vork is t-rot started vithin 1B0 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALI.ATION ONLY
Electrical Contractor
Address
Ci ty_ Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
Address
Ci ty s F$-\\, r-rR Phone
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
0vners Signature:
esndl,€ ff n^3769 citY Job t'.^a"'?( O ) ) b
SPR, FIELD
\rSo
ELECTRICAL PERUIT APPLICATION
3. COHPLETE FEE SCffiDIILE BELOV
A. Nev Residential-Sing1e or
Multi-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or po rtion
$ 1s.00
The touou,lng Proiecr I a&iltM has the
ii"iid,--o?5eo na requlm spocfflc h'td
apprcud.
h,
Sum
or
$ 40.00
ers
oDr A1 terat ions
ation:
or less fs so.
(^o -to 400 amps s 60.
to 600 amps $100.
I^${to 1000 amps__s130.
Over 1000 amps/voIts $300.
Reconnect 0n1y s 40.
C
D
One Circui t
Each Additional
B
E
thereo f
Each Manuf
ModuI
S
SUBTOTAL OF ABOVE
52 State Surcharge
32 Administrative Fee
TOTAL
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less S 40.00
201 amps to 400 amps
-
S 55.00
over 4bL to 6oo amps
-
$ Bo.0o
0ver 600 amps or lbOO voTts see rrB'r aE6 E-
Nev, Alteration or Extension Per Panel
,Y $ 3s.oo
00
00
00
00
00
00
Circuit or vith 'Bervice
or Feeder Permi t v/ S
Miscellaneous (Service/feeder
-Each instaLlation
Pump or irrigation $
Sign/outline Lighting- S
Limited Energy/Res
-
$
Limited Energy/Comm $
2.oo4-.ry
5 *sa
not included)
40.00
40. 00
20. o0
DATE:-r8- i (
RECEIVED
&.,bo
s 8s.00' _.
amps
Permit #qg 037a
Address: A-m *ct^
Issued by N^,o Date:3-rs -ad
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Boord 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 ond engineer appliconts, exempt from 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 and 2, and either box 3,{ or 38
m 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,l 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 certiff 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.
,-. o )t "7 - ls')g
7- fsigrut*" orfermit applicant)
(LIrhite copy to issuing agency permit file,
pink copy to applicant)
OR
X
(Date)
X
Informalion Notice to rFioperty Owners
About Construction Responsihilitie*
Note : This Infarmation Notic'e ta Prqtertl'{}u1;ygrs abouiOonstrtrction Re.sponsihilities
wos rieve{*petl hy tlre Oonstruction Ccintocioi,i ltot:rd in'accorclunce y'ith ORS 701.{}35{5)
\'otl c*l? prcl'Jt:1 1:]ai1] ftrlhi{itt; by i:*iilg *re,are u1 {.h* il:11'lr.tilrg le sp**:.ibillti*s allri arc:ls *l coirrcrn.
HIVIPLOYER RE$PON$IBILITIHS :
ng or,assisting in the
and the people
Oregcn'swlthkotdingtaxlaw: Asanemplo)'er.)ourlusilvithhtrlclincometaxeslronremplovee*.agesatthetinrerernplolees
are paid" You rvill be liahtre 1br the tax pavmL'nts cven i{'r,ou don'l actuall-v rvithholcl the tax frr:m 3rour ernptroyees. }:or nrore
irrliinnatitrrr. cull thc ()rcuon l)ept. of Revenueflt945-80qI
Unemployment insurttxce tax: As att ernplt)yer. ycu are required to pay a tax fiir uneniployment insurance purposes on the
wages of allenrployees. Ior more infonnationl cail.the ()regon"tlnplgyrlrent Departmgrlt *\)78.312\,,, , . ,.,,.; i,t r,i ,iiii
j L.i .'..,, : r -!
CITl.lERREsp0NslBILlTlEsANDAREAsoF,CoNCERF{:,
thal nray be brought to vour ltlontion lliroirgh inspr:ctions.
accidents ancl otnlssiolls such as falling tools. pairtt o! crspl'a).-11 ate r danragc frcm pipe puncturcs. lire . or *oqk that must Lre
re-tio*e.,
Time tri supcn'is* emplot ets: l\iake sure y,ou have sufficient tirne to supervise I'our ernployees.
f,xpcrtise: Mak*surev*uhave the*xpcrliseloactasv$urorvngeneral c*ntraclr;r,tocoorrjiirate llte vr'-rrkotr,rrr{h-inandfinlsh
ffadeslandtonoti$'buildingofficiak'attheappropriatetlnl1sothe,vcanperfonnthe'requiredinspections " : ,
lf'you have atlditir:nal qu*stitlrts. rvrite or call the Ccl*structirrn Oonlra*t,rrs llorrrl i t'U tlor l.l I {0. Salcln. OIt 9730t-505:.
5031318-4621). "lhe lloarcl is located at 7S0 Surnnrer St. NE Suile 300. in Salem.
: ,,
prop-orvu.pm4
1191
Workers' compensatiux insur*nce: As an enrploysr, y,ou ffs:lqbje:1l.a1h: Oregqn S.orleqp'!.oryp?psq4rp.t,L4.y1 unO m1{1
obtain rvorkers'compensation insurartce lbr vour ernploy'ees. Ifyou fail to obtain lvorkers'cornpensaiion insiiiance, you mryr
besqbiecttopcnaltiesalrd*illbeliableforallu[airncostsilonctrf]ouremplo\eesisiniuredontheiob. Formr:reinformation--
calltire wortdrs'Conrpensatio', bii,i'dioir ut irri.l d*piriment of Corr.*uni".on,l g,irine;s sa*;i.dr ai g+J:zsil?,'rt'' I - | '''
i, ll_ , | .,,.,...r,-,,,
U.S,lnternalRevenueSerr-ite: Asanemployer.yorlmustrvithholdfederalincr:rnetaxfronrenrploy,ees'wages. Youwill_b.-1
liablefortheta>ipaymenteven ify"oudicln'tactuallywithhold.the tax. Formoreintbrmatioir.calltli:6,intAl**af-{e$en*6S"*J;i
atl-800'829-1040.' : 'i ' '--i