HomeMy WebLinkAboutPermit Electrical 1997-4-27
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zoning, and does not roquire specific land use
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225 FIFTH STREET Authorlzod Signa;ur. ]V JA' l
SPRINGFIELD, OREGON 97477 .
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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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
E1~ci~ical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name R ObFg---J"::r ~ILIJR.
Address '2-'37 Ct D n Q,rJ Dc. h )1
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CitY'~INqF,rf)rJ Phone '1Jf/--/73o
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Ovners Signature: ;:/
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RECEIPT #:_ 'i ?_r~~-O
RECEIVED BY: f~
ELECTRICAL PERMIT JirPLICATION
City Job Number lJ\~l[)~\~
3. COMPLETE FEE SCHEDULE BELOII
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included: '
It ems 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
,B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 am~s 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' 'OT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 100u
$ 40.00
$ 55.00
$ 80.00
volts see liB"
above
D.
Branch Circuits
"
New, Alteration or Extension Per Panel
One Circuit / $ 35.00 ~s. (Q
Each Additional
Circuit or with Service ~.ee
or Feeder Permit ./ $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE '3.1. s;.!!C.
5% State Surcharge \..'l:!....
3% Administrative Fee \\\.
TOTAL ~..,. ("
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Permit #:
.
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Address:
Issued by:
Date:
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
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 70 1.010(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 3A or 3B:
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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.
D
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 pem1it 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 sidc of this form.
(~ M
~gnature olQ'ermit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
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Hnfo~maltion Notice to Property Owners
, About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilitics
was developed by the Construction Contractors BOll/YI in accordance with ORS 701.055(5).
Ifyo.u are acting as yo.ur own contracto.rto. co.nstruct a new ho.me or make a substantial impro.vement to' an existing structurc,
yo.u can prevent many problems by being aware o.fthe fo.llo.wing respo.nsibilities an<;l areas o.f concern.
EMPLOYER RESPONSIBILITIES:
If yo.u hire perso.ns no.t registered with the Co.nstructio.n Contracto.rs Bo.ard to' do. labo.r in eo.nstructing 0.1' assisting in the
co.nstruction 0.1' impro.vement 0.1' a residential structure. yo.u will, in mo.st instances, be ruled to. be an emplo.yer and the peo.ple
yo.u hire will be emplo.yees. As the emplo.yer, yo.u must co.mply with the follo.wing:
Oregon'switbbolding tax law: Asan emplo.yer. you must withhold income taxes fro.m employee wagesatthetime employees
are paid. You will be liable for the tax payments even if you do.n't actually withhold the tax from your employees. Fo.r more
info.rmation, call the Orego.n Dept. of Revenue at 945-8091.
Unemployment insurance tax: As an emplo.yer, yo.u are required to pay a tax 1'0.1' unemplo.yment insurance purposes o.n the
wages o.fall emplo.yees. Fo.r mo.re info.nnatio.n, call the Orego.n Employment Department at 378-3524.
Workers' compensation insurance: As an employer, yo.u are subject to. the Orego.n Workers' Compensation Law, and must
o.btain workers' co.mpensatio.n insurance for yo.ur emplo.yees. If yo.u fail to o.btain workers' co.mpensation insurance, yo.u may
be subje.ctto.pen'lltiesand will be liable fo.rall claimco.sts ifo.neo.fyo.uremplo.yees is injured o.n thejo.b. Fo.rmo.re informatio.n,
call the Wo.rkers' Compensatio.n Division at the Departmento.fCo.nsumer and Business Services at 945-7888.
U.S. Internal Revenue Sen'ice: As an employer, yo.umust withho.ld federal income tax from emplo.yees' wages. You will be
liable fort he tax payment even if you didn't actually withhold the tax. Fo.r mo.re informatio.n, call the Intell1al Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit halder far this project. yo.u are respo.nsible fo.r resalving any fa i lure to. meet cade requirements
that may be bro.ught to. your attentio.n thraugh inspectio.ns.
Liability and property damage insurance: Co.ntact your insurance agent to. see ifyo.u have adequate insurance co.verage fo.r
accidents and o.missians such as falling to.als, paint o.verspray, water damage from pipe punctures. fire, 0.1' wark that must be
re-dane,
Time to supervise employees: Make sure you have sufficient time to. supervise your emplayees.
Expertise: Make sure yau have the expertise to. act as yo.urawn general cantracto.r, tacoordinate the wo.rk afrough-in and finish
trades, and to notify building o.fficials at the appropriate times so. ihey can perform the required inspectio.ns.
Ifyo.u have additio.nal questio.ns, write 0.1' call the Co.nstructian Co.ntractors Bo.ard (PO Box 14140, Salem. OR 97309-5052,
503/378-4621). The Bo.ard is Io.eated at 700 Summer St. NE Suite 30Q,_i!!,Salem,
prop.own.pm4
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