HomeMy WebLinkAboutPermit Electrical 1994-9-22 (2)
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The following project as su mea
zoning, and does not require specific land use
approval.
225 FIFTH STREET Zonina t-Df2,
SPRINGFIELD, OREGON 97477 '
INSPECTION REQUEST: DJl2I;._~1.69 Cr/2'"l--fA.Lj ,,'
OFFICE: 726-3?59 'Authorized Signature (l rI\
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1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DES~ION ~
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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 B.
Electrical Contractor O' ,~~-~
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Address
City
Phone
Supervisor License Number
Expiration Date
ELECTRICAL PERMIT APPLICATION
City Job Number qt//t;'? ~
COMPLETE FEE SCHEDULE BELOV
New Residential~Single or
Multi-Family per dwelling unit.
Service Included:
Items Cos t
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
~. $ 40.00
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Services or Feeders
Installation, Alterations
or Relocation:
-200 amps or less $ 50.00
201 amps to 400 amps $ 60.00
401 amps to. 600 amps $100.00
601 amps to 1000 amps $130.00 .
Over 1000 amps/volts $300.00
Reconnect Only $ 40.00
,
Constr Contr. Number
C. Temporary Services or Feeders
Installation, Alteration or Relocation
. D. Branch Circuits
Owners Namel?~I''rf~A.~~~k'" .
. New, Alteratlon or Extension Per Panel
Address2?~~~~fr..p~ ~~/y" .,
u I _ __ - - ~ One Clrcult
Cit~/~~hone 6~;?-5:S'< > Each Additional
~~~ Circuit or with Service
OVNER INSfALLA~InN or Feeder Permit
Expiration Date
Signature of Supervising Electrician
The installation is being made on
property I own which is not intended
for sale, lease or rent,
E.
Owners Signa. ure:
---~--_:_~~~-----==
DATE: ~-2<""7 ~
RECEIPT #: .---: ./ / V:;g ~? . ,
RECEIVED BY: --I...... #I :Y ~~-
200 amps
201 amps
Over. 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see "B" above
, ,.
$ 35.00
$
2.00
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40,00
$ 40,00
$ 20,00
$ 36.00
c/a. go.!!.
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Permit#: ~ S't'fI ~;)
Address:5;;':7::? ~_~ P6;>
Date: ,....;;;z, ::?....'7 sr
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Issued by: '
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Statement: Information 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 "
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following statement before a building 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.
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Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
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1. I own, reside in, or will reside in the completed structure.
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2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
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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
4J 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 that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
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~ature of permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
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(Date)
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Note;' Thi$ /nformation,Notlce to Property Owners about Construction Responsibilities
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was developed by the ~onstruction Contractors Board in accordance with ORS 70/.055(5).
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If 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.
fEM[P>lOV[ElRllRlfE~JPlOU\ll~~I8l~Ul~fES:
If you hire persons not registered 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 employer and the people
you hire will be employees. As the employer, you must comply with the following:
OregGIlU'S wntll1lhlGllidlnllUg tID{ ll21w: 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 Dept. of Revenue at 945-8091.
1UllUemjplllGymellUt nllUSummce U!l1l:: 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
at 378-3524.
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WGrlkers' CGIDjplellUSatiGIlU nllUSURr2llIll.ce: 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 at the Department of Consumer and Business Services at 945-7888.
1U.S.lfllUtemall lRevellUURe Servnce: 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 1-800-829-1040.
01~[E!RllRlfE~~ONS~I8~Ul~IES AN[l) AIRHEAS OIF CONClEIRlN:
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CGidle cGIDjpllluannce: 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. .
Ualbjllnty amll jpllwjplerty dlWllllage nllUSillll"2lllUce: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, waterdam!lge from pipe punctures, fire, or work that must be
re-done. '
'lIlime tG sUIljplervnse eIDjplllGYees: 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.
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If you have additional 'questions, write or call the Construction ~ontractors"Bo<ird '(PO. Box . 14140;,Salem,' OR 97309-5052,
503/378-4621). The Board is located at 700 Summer S1. NE Suite 300, in Salem. . ; ,
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