HomeMy WebLinkAboutPermit Electrical 1991-9-16
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
97477
726-3769
1. LOCATION OF INSTALLATION
/.?'~O /EH~;r;>AL
LEGAL DESCRIPTION
1;;'~?bl2.-/2. ~?~O
JQB DJ:SCRIPTION .
Arf r>1 ~ (' A/H' .l A J ;t;::v
Perm1ts are non-transferable and exp1re
1f vork 1S not started wlth1n 180 days
of 1ssuance or if work 1S suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electr1cal Contractor
Address
Clty
Phone
Superv1sor L1cense Number
Expirat10n Date
Constr Contr. Number
ExpHation Date
Signature of Supervising Electrician
Ovners Name j:?/./~ y1:>5< c>
Address ~ L~h'7..R#k.
C1ty <..vr<Pae?Phone 7Y7-:;,:;/3>o
?
OVNER INSTALLATION
The 1nstallat1on 1S be1ng made on
property I own WhlCh lS not 1ntended
for sale, lease or rent.
7/l::;eJ.;1t~ '
/-"-'-----"."1~'/!T----J--~------
DATE: -,- VI -,
ReCEIPT l!: , . 0.);~ ( /?
RECEIVED BY: V \J /)~ T
-';:J -
1
SP'IINCt"ILLO
C1ty Job Number
9 / <!79e:;;-~
3 . COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Fam1ly per dwelling unit.
SerV1ce Included'
Items Cost
Sum
1000 sq.ft. or less
Each add1t1onal 500
sq. ft or port1on
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
B. Serv1ces or Feeders
Installat1on, Alterations or
Relocat1on:
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
C. Temporary Services or Feeders
Installat1on, Alterat10n or Relocat1on
200 amps or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80 00
Over 600 amps or 1000 volts see liB" above
D. Branch C1rcults
Nev, Alteration or Extension Per Panel
,
One C1rcu1t ~ $ 35 00 ~~~<>
Each Addl tlona1
C1rcu1t or w1th Service
or Feeder Perm t -'- $ 2 00 -:z . ~
E. M1scellaneous (Serv1ce/feeder not 1nc1uded)
-Each 1nstal1atlon
Pump or 1rr1gat1on $ 40 00
Slgn/Outl1ne L1ght1ng $ 40.00
L1m1ted Energy/Res $ 20 00
Llm1ted Energy/Comm $ 36 00
5. SUBTOTAL OF ABOVE -:? /_ -=-
5% State Surcharge /. R S
TOTAL 'A'~.~~
,
Permit No ~ \OC\ S~
Address \C'ff~\ ~\) n-t~ <II \J
Issued by ~\tI(\-) , ~ate -q-I. In Yl
STATEMENT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note Oregon Law, ORS 701 055(4), requires residential bUilding permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the bUilding permit can be Issued Licensed Architect
and Engln,eer 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 box 1 and either box 2A or 2B
1 ~ I own, reside In, or Will reside In the completed structure
2 A L-J My general contractor IS
Contractor registration number
I Will Instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board
OR
B I (~;:}I 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 ao hire a Qeneral
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
'i aA~U r;) L/i<-L ?~
/~Igirature of P~fnl!VAppllcant fie
9-/6 - 91
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 10/24/89
JI,t<:...
1)lll (C...
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
(j'J.