HomeMy WebLinkAboutPermit Electrical 1992-12-14
Th~ following project as submitted.~as the f~Uowin~
" -, d- .oes nol require specllic lanBLECTRICAL
7 77 7,_o,ng, an u
SPRINGFIELD, OREGON 9 4 ~pproval.
INSPECTION REQUEST: 726-3769 ( C
Zonino .
OFFICE: 726-3759
Date Cd' r4-4i:)... 3.
1. ~ON~~~~oriZedSignalureS1.
225 FrITH STREET
W,GAL D~CJP.:PTION
nU3~/d--\3 ()~[::~.rJn
JOB DESCRI~O~ f\. ~ ^ -l-'_
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Permi ts ..~ non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
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Electrical contractor~
Address43\4D a N'f\ f\tJY"
Ci ty e Un Jl.o J Phone 1J4-4--Dfol cr
superviso/~Licerise NUlI!ber 3lo I +5
Expiration Date J D . \.c:r:s
Gonstr Contr. Number tob~crr.
Expiration Date~~ ,,.Q;~. Cf.s
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Signature of Supervising Electrician
~f1~
Owners Na~Ll"rt r\ "\ den 0 ~ D.
Address4RD ffittO~~ . -
Ci t~~!)L . Phone=r1hlolSS
oVNk\1NSTALLATION .
The 'installation is being made on
property I own which is not intended
for sale, lease or rent.
Ovners Signature:
~AT;~---------~-l~~~~~')~~~------
RECEIPT #: u...:....... -\ 1 O'1.'~1
RECEIVED B"Q.) )I_i. tt'A )
SI-'IING-FIELO
City Job Number
COMPLETE FEE SCHEDULE BELOV
New Residential-Single or
Multi-Family per dwelling
Service Included:
Items
Cost
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or .Feeder
$ 85.00
$ 15.00
l
$ 40.00 4D
B.
Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or tess
201 amps, to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
$ 40.00
$ 55.00
$ 80.00
volts see "B" above
Branch Ci rcui ts .
New, Alteration or Extension Per Panel
One Circuit
Each Additional'
Circuit or with Servi~
, or Feeder Permi t. n
$ 35.00
$ 2.001{Q
E.
Mi;c~llaneous ~Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Lim{ted Energy/Comm
40.00
40.00
20.00
not included)
5.
SuBTOTAL OF ABOVE '
5% State Surcharge
TOTAL
$
$
$
$ 36.00
&.cg
~%
'l
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. Permit ~o: . q ~IO~D . _0
Address: ~,\'\\nJ.Qo j) n
Issued bY:~ frfYJ,. ) . Date: ~~~~ r
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FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTIONRE8PONSIBILlTiES
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. Note: Oregon Law, 'ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued'. This state-
ment is required for residential b.uilding, electrical, mechanical, and plumbing
permits: Licensed Architect and Engineer applicants, exempt from registration
under ORS,701.010(7); need. not submit this statement. This statemerit will be'
filed with the permit. ,.
. :Fil~' in t e ,a~~licable blanks, and initial ~oxes 1 and 2,. and ei~~er box' 3A or ~B:
, 1, " ';, 'I: own: reside in', or will 'reside in the completed structure. . - .
.2, I . I.. I. understand that I' must.registeras a construction contractor if the structure is sold
.r'/J or~reorupon-completion.., '.
3.A.r-r: 'I'MY~8~elalcontract9ri" ()^N,_~
. .' (,., Contractorr~gistr~tio~ number v>lo~4"
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Iwill instruct my general c'bntractor that all subcontractors who work on the struc-' .
ture niust be registered. with the Construction CClritractors Board.' '.' ',:,
OR
3, B,I
I I will be my own general contractor.
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If I hire subcontractors, I will hire only subcontractors registered with the Construc"
tion Contractors Board. If I change'my mind and do hire a general contractor: I will
contract wit Ii a contractor who is registered with the Construction Contractors Board
and I will)mmediately. notify the office issuing this building permit of,the name of
. ,. the contractor,
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I hereby certify that the above information is correct and that I have read and understand
the' Information Notice to Property Owners about, Construction Responsibilities pn' the
reverse side of this form. . . ,
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......'ign turictPermit Applicant '
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. L "L...c '-[':'-:''1 R.
Date
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CONS 'RUCTION CONTRACTOF.IS BOARD
0244J ~191 '. '",,' . '
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WHITE COPY TO ISSUING AGENCY, PERMITF.ILE
. PINK COPY TO APPLICANT
~
t' .
INFOR!TION NOTICE TO PROPERTY OtNERS
A!lOUT CONSTRUCTION RESPONSIBILITIES
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NOTE: . .. This I.nfor[TIation Notice ,to Property Owners About Construction Responsibilities
was dev!'lloped by the.Construction Contractors Board in accordance with ORS 701,055(5),
passed by, the' 1989 Oregon Legislature, .
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. " 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 following responsibilities'and areas
of concern. .
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EMPLOYER RESPONSIBILITIES:,
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If you hire persons ~ot r~gistered with the, Constru~!ion Contra<?"9rs,Boimj to do laborin constructing or assisting
in the construction or 'iITlProv~ment ,of a residential, sfructure':.You wile in most i,nstances, be ruled to be an
"employer" and tlie peopl~ ygu'hire wiJl be "e'mployees'''. As the'e,mplbyer,'you must c!>h1ply witli the following:
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Oregon's Withholding Tax Law: As an employer. you lTlust withh,old income taxes from employee wages at
the time employ~es ar~.paic;l. <you ;yill,be liable for the tax' pay,mE!!lts.,even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Depi!rtment of Revenue at 378-3390,
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Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all e,mployees, For mo~e intormati/;m, call t~l!l OregonElTmloyment Division DHR
at 378-3224,
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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 qbtain workers'
co'mpensation insurance, you may,be subject to penalties and wif, be 'liable' ftwall claim costs if one of your
employees is injured on the job, For more information, call the Workers' Compensation Division DIF at 373-7434,
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U.S, Internal RevE1.nuedSeryice: As an"e:lTlph?y~r. ,yOU must ~i~h~ql~ te,ger~1 if}cRme tax. from employees' wages,
You wiWbe liable/or the tax payment even if you,didn'tactfJ,ally't!'ithho!d !hf:qa~. 'For more information, call
the Internal Revenue Service at 221-3960. .. , ". ,".' ,,"'''.. ", '
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
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Code Compliance: As the per'mit holder.for this project. you'are responsible for resolving any failure to meet
code requirements. that maybe brought ,t~ your, atte[ltioiuhrough inspections, .
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Liability and Property 8amagelnsurance:: Contact your.insurance,agent to see if you have adequate insurance
coverage for accicjents and omissions such as falling 'tools, paint overspniy, water damage from pipe punc-
tures, fire. or work that must be re-done,
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Time'to Supervise. Employees: Make sure 'you ,have sufficient, time to supervise your employees,
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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 to:
Construction Contractors. Board
700 Summer 51. ,NE, Suite 300
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. Salem, OR 97310-0151 . ..
Phone 503-378-4621
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"0244J'10/24189<" ,.';.", u. ..,~_ :',:.i
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