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HomeMy WebLinkAboutPermit Electrical 1991-10-14 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OFrINSTALLATIO~ _ I f)(')() 'vvJ:ACd., K1.i JdU LEGAL DESCRIPTION \'9o~OJ \ '::)1\:>"'1.-,00 .JO{l D~;;CRIPTION < ~7 r()('Cl~' -:=:\"'U\)\'~ 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: ~ Y01<-l/ ~J-cu- ~1~~~==-~_-L_-~~~~~------------------ """tol nil: ::::t I c:::; 'X RECEIVED BY: ~ City Job Number q 11")0S3 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 <:,;:). c:v SUBTOTAL OF ABOVE 5% State Surcharge TOTAL , Permit No OJ \oC/S'3 I OO() ~'\. ,J\Q~~ fltvoe Q~ Date ID/I ,-d,.., 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 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 / \/ 1~ 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 J, ~0 C;r L/o~, .~ Signature of Permit Applicant 11/', 10 -/U-"1/ Date CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 ,u/c<fL- ),,~iu WHITE COpy TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT o1l,