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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.