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Home My WebLink AboutPermit Electrical 1995-08-23a qICITY SPF OneeON Zonin 97477 726-3rc*-Zkjb Autnorized Signaturo' OE JOB Permits are non-transfera and exPlre if vork is not s tarted vl thin 180 days ed foroflssuance or I f vork ls suspend 180 daYs. 2.INSTAIJ^ATION ONLY Electr Cont,ract,or Address ci Supervisor License Explration Date Constr Contr. Expirati Slgna Owners Add S Ci ty Phone OIINER SPRIrtlGFIELD BIJCTRICAL PERHIT APPLICATION CitY Job Nunber BBLOg 33i,XtxH,35r,",- rxCPscgox REQUBSI: Orrrcg, 726-3759 The installatioir ls beirig made on property I ovn which is not intended for sale, lease or rent. cioes not requlfo specitic lanri 1 a. A New Residentlal-SingItuiti-r"*ilY Per dwe Service Included: Ie or IIing unit. Cos t $ Bs.oo Sum B 1000 sq.ft. or-Iess r""t, .daitional 500 sq. ft or Portion thereof Each Hanuf'd Home or Hodular Dvelling Service or Feeder Services or Feeders instaltation, Alterations or Relocation: 200 amPs or 201 amPs to 401 amPs to 601 amPs to 0ver 1000 Reconnect I tems less \ 400 amPs 600 amPs 1000 amPs $ 1s.00 $ 40.00 s see rrBrr a,5ove amps 0nly /volts g 5o.oo =5O$ 60.00 $100.00 $13o. oo $300.00 $ 40.00 c.Temporary Services or Feeders -i;;'t;rr;iion, Alteration or Rerocation 200 amps or less ,oi ffi; to 4oo amps -Over 401 to 600 amPS - Over 600 amps or 1000 volt' D. Branch Circuits Nev, Alteration or Extension Per Pane1 One Circuit $ 35.00 Each AdditionalCircuit or vith Service or Feeder Permit - $ 2.00 E. Miscellaneous (Service/feeder not included) $ 40.00 $ 5s.oo $ 80.00 Orners Slgnature: -Each installation Pump or irrigation $sign/outline-Lighting- $ l,imited Energy/Res I $ Limited Energy/Comm S 40.00 40.00 20.00 36. O0 SIIBTOTAL OP ABOVB 5Z State Surcharge TOIAL DATB: Phone RBCBTVBD 5 oo te of Supervlsing Permit #:EAddress: Issued by:Date: 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 Board to sign the foltowing statement before a buitding permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, 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 and2, and either box 3,{ or 38: W 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. 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. OR 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 dounderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. w fl lt:, lq{ (Signature of permit applicant) (White copy to issuing agency perrnitfile, pink copy to applicant) - t v'4tr") 1 Inforvnation Notice to property Owners About Construction Responsibilities to Propergt Owners about Construction Responsibilities by the Contractors Board in accordance with ORS T0l 0ss(s). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,you can prevtnlmany problems py,Qing aware of the follgwing responsibilities and areas of concern. Ei, PLOYER RESPONSI BI LITIES: If you hire persons not regi,stered 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 **ploy., and the people you hire will be employees. As the employer, you must cirmply with the following: Oregon's withhotding 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 even if you donlt actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-809L Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers'compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation, call the Workers' Compensation Division at the Department of Consumer and Business Services at g45-7888. U.S. trnternal Revenue Service: As an ernployer, you must withhold federal income tax from ernployees'wagbs. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Intemal R"r*ro" Service at l-800-829-1040. OTHEH HESPONSIBILITIES AND AREAS OF CONCEHN: 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 and property darnage insurance: Contact your insurance agent to see if you have adequate insuranoe coverage for accidents and omissions such as falling tools, paint overspray, wa0er damage from pipe punctures, fire, or work 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 ahd finish trades, and to notify building officials at the appropriate times so they can perform tlre required inspections. -,i', \ i .. If you have additlcm4l qug+ti\na; write or call the Construcrion Conrractors-$o:#O1p0 BAx t4l'4e, Sslehi OR g7A09-5052, 503/378-4621). The'Board ii located ar 700 summer st. NE suire 300, in salem. prop-own.pm4 lt94