HomeMy WebLinkAboutPermit Building 1992-5-15
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225 FIFTH STREET , ,O\"oJ. t-~;~\<'. G~
SPRINGFIELD, OREGO~. 97~pr'?X)..f\~O\ ,.,;'\, ",
INSPECTION REaUEST~w126~:1769 W':;;;..
OFFICE: 726-3759 ''''''~\\;~c\' , :' \,
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1. LOCATION OF INSTALLATIO~\A., ~~0
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are 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
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
SI"'IING,t=ICLU
unit.
Items
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion ,
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling 2~
Service or Feeder $ 40.00 <R.cl ~
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
COMPLETE PEE SCHEDULE BELO\l
A.
New Residential-Single or
Multi-Family per dwelling
Service Included:
$ 50,00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Constr Contr. Number
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
Signature of Supervising Electrician
Owners Name IA/KE Wk ~
Address ,(% 3", 7' J~~~~;:t;:J
/
CitY__l:;=.v//'/~ Phone 7'1'7-/04/
O\INER INSTALLATION
The 'installation is being made on
property I own which is not intended
for sale, lease or rent,
Owners Signature: . ~
V ~~ W~
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DATE:_ _ .:) - /5' -7'2
RLIor..lr< If: ~~ ~ q,
RECEIVED BY: .cr-~
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
$ 40.00
$ 55.00
$ 80.00
see "B"
above
New, Alteration or Extension Per Panel
One Ci.rcuit
Each Additional
Circuit or with Service
or Feeder Permit
E,
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
5.
SUBTOTAL OP ABOVE
5% State Surcharge
TOTAL
$ 35.00
$ 2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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Permit No:
Q2tJ'loD
41,~6 ~A7N
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Date:
<\-/r=-5" I
Address:
Issued by:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1, L.. ~( _. I own, reside in, or will reside in the completed structure.
2 . ~ I I understand that I must register as a construction contractor if the structure is sold
- . Dr offered for sale before or upon completion,
3. A.I
I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B,I ~will be my own general contractor.
-
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 with a contractor who is registered with the Construction Contractors Board
and I 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 understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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Signature of Permit Applicant
S--/s-'l~
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
,.. ..
INFORITION NOTICE TO PROPERTY O_ERs
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE:" '~,T~iS In~9Ql)ati!?n Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701,055(5),
passea by the 1989 Oregon Legislature.
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If' you,.aie 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.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing Dr assisting
in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an
"employer" and the people you hire will be "employees", As the employer, you must comply with the following:
Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at
the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
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 DHR
at 378-3224, ,-
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 be subject to penalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434.
U.S, Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3960,
OTHER RESPONSIBILITIES 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 and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint overs pray, water damage from pipe punc-
tures, 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 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 SI. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89