HomeMy WebLinkAboutPermit Electrical 1991-10-14
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1.
LOCATION OFrINSTALLATIO~ _
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LEGAL DESCRIPTION
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.JO{l D~;;CRIPTION
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Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or 1f york is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name --rr~L< ~~C./')
Address JOn (') rpo~^ ~/A2 ~d
City ~~\ne Phone /41 -<J60
OVNER INSTALLATION
The installation is being made on
property I own which 1S not 1ntended
for sale, lease or rent.
Owners Signature:
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RECEIVED BY: ~
City Job Number
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3. COHPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Mult1-Family per dwelling un1t.
Service Included:
It ems Cos t
Sum
1000 sq.ft. or less
Each add1t1onal 500
sq. ft or port1on
thereof
Each Manuf'd Home or
Modular Dwelling
Serv1ce or Feeder
$ 85.00
$ 15.00
$ 40.00
B. Services or Feeders
Installation, Alterat10ns or
Relocation:
200 amps or less ) $ 50.00 Sn 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
C. Temporary Serv1ces or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see "B"
above
D.
Branch Circuits
New, Alteration or Extension Per Panel
One Ci rcUl t
Each Add1t1onal
C1rcuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E.
M1scellaneous (Serv1ce/feeder
-Each 1nstallat1on
Pump or 1rr1gation
Slgn/Outl1ne L1ght1ng
L1m1ted Energy/Res
Lim1ted Energy/Comm
not 1ncluded)
5.
$ 40 00
$ 40.00
$ 20.00
$ 36.00
s.o 00
'.) ,0
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SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
,
Permit No
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Date
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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 bUlldmg permit applicants
who are not registered with the Construction Contractors Board to sign the
followmg statement before the bUlldmg permit can be Issued Licensed Architect
and Engmeer applicants, exempt from registration under ORS 701 010(7), need
not submit this statement This statement Will be filed with the permit
Fill m the applicable blanks, and mltlal box 1 and either box 2A or 2B
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I own, reside m, or Will reside m the completed structure
2 A L-J My general contractor IS
Contractor registration number
I Will mstruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board
OR
,
B L4' 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 mmd and ao hire a fleneral
contractor, I Will contract with a contractor who IS registered with the
Construction Contractors Board and I Will Immediately notify the office
Issuing thiS bUlldmg permit of the name of the contractor
I hereby certIfy that the above mformatlon 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 11/',
10 -/U-"1/
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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