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HomeMy WebLinkAboutPermit Electrical 1996-7-31 . ~, SPRelELD ~ \;, 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 The following proiect as aubmitted has the followin zoning, and does not require specific land use approval. ,I ~ , Zonina L...~, - , Dete1'~I' t1 ~ 97477 7 2 ~l)I:6~ed Signature , ELECTRICALPERHIT APPLICATION 7VI t;1ty'Job Number 9~ , ' . 3. COMPLETE FEE SCHEDULE BELOV 1. LOCATION OF INSTALLATION- /;, 7 fI '7 F r / ~. A. ' New Residential-Single or Multi-Family per dwelling unit. Service Included: LEGAL DESCRIPTION )702 ~,"'-,( 3 /) 7t:n Items Cost Sum Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof , E,ach Manuf' d Home.or Modular Dwelling Service or Feeder v- $ 85.00 $5r dID '. J~ DESCRIPTION '. _ -W~~~~/'t ~~~ ~ $ 15.00 '7~d~ . . $ 40.00 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor ~~~ Address B.Services or Feeders Installation, Alterations or Relocation: Ci ty' Phone 200 amps or less 201 amps to 400 amps 401 amps to, 600 amps 601 amps to 1000 amps Over 1000 amps/volts , Reconnec t Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Supervisor License Number Expiration Date C. Temporary Services or Feeders Installation, Alteration or Relocation Constr Contr. Number Expiration Date Signature of Supervising Electrician 200 amps"oT less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts s,ee "B" above . D. Branch Circuits . Owners' Name -1],.....? I j&", 'DU/'5r{/1.p~ Address 6'/dJ /1/ 5L51"1, Ci ty ~?Pfof Phone7L;t,-;o-7! OVNER INSTALLATION New; Alteration or E~tension Per Panel One Circuit Eac;h Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 The installation is being made on property I own which is not intended for sale, lease or rent. E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energ~/Comm not included) p~c --------------------------------------- DATE: ?-'3P.% RECEIPT #: -:2~~ RECEIVED BY:, ~j/r-"'_ . . $ 40.00 'S 40.00 $ 20.00 $ 36.00 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL r3<!J, --~ ~.~~ :;J . I:J e- . /y/? C/o ) \1 . e e Permit #: 9hU /~~ Address: ~::::> 9? C /"" ~~7 ; Issuedby: ,~ Date: 7---;;;~-:;r:: Statement: Information Notice to Property Owners About Construction Responsi bi I ities 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 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: lL1 U 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. ~ 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 L0 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 permit 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~erty Owners about Construction Responsibilities on the reverse side of this form. ,; J~ ~~AYA"'k J;,~ 50 /7?~ , (Signature of permit applicant) , (Date) (White copy to issuing agency permit file, pink copy to applicant)