HomeMy WebLinkAboutPermit Electrical 1993-6-16
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225 FIFTH STREET ~~YeJ. ELECTRICAL PERMIT APPLICATION
SPRINGPIEW, OREGON 97477 7-; 00\2-
INSPECTION REQUEST: 726_3769.o/J.no=::.=...-__--
OPPICE: 726-3759 tMl'l ~ IIPI C\3a
_ lwUl~d.....acJ SlnnAtll1' ~ . COMPLETE PEE SCHEDULE BELOV
1. LOCATION OP INSTALLA"1'1.'Ulr"- .._0. .. " '"" I. ..I! ,.,,1
'1?(;;(;' 7?A/S~ cfiy-, . A. New Residential-Single or
. .... Multi-Family per.dwelling unit. . ."
LEGAL DESCRIPTION Service Included:
) 7*"r!!!>Z -;r ~::yy t:::> ~~
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JOB DESCRIPTION
-1&/:~~~ r-/5k: ~~~~ '-
.
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor ~16:b~
Address
City
Phone
Supervisor License Number
Expiration Date
"
Constr Contr. Number
:'(
,~~
Expiration Date
.
Signature of Supervising Electrician
Owners Name P8~€ :~~bI!::::~
Address q/~~;") ;~~RC~,..~n__
Clty.~~?/Y"~Phone 7~?P'9?
, or -..
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
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DATE:
RECEI PT I:
RECEIVED BY:
..
SPRINGFIELD
City Job Number 72// -=>_-?
1000 sq. ft. or less
Each additional 500
sq. ft or portion
thereof .
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
Services or Feed~rs
Installation, Alterations
or Relocation:
B.
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
V $ 50.00 ~ #flIIC>
$ 60.00
$100.00
$130.00
$300.00.
$ 40.00'
C. Temporary Services 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
D. Branch Circuits
'S 40.00
$ 55.00
$ 80.00
vol.ts see "B"
above
New, Alteration or Extension Per Panel
One Circuit $ 35.00 .
Each Additional
Circuit or with Service
or Feeder Permi t (-"7_ $,2.00. <'I~
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm ' $ 36.00
5.. SUBTOTAL OP ABOVE 7~ ->
5% State Surcharge ~_ ~
TOTAL ' 7!7-7a..
.
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Permit No: qz.//~=?5
Address: 9'2L~ ~~~:f- ..
Issued byd~__ Date: &7'~93'
//
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1 .
y
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if .the structure is sold
or offered for sale before or upon completion.
, "'
2.
3. A.I
I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.I
I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general 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.
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Signature of Permit Applicant
-
II-
Date
-.::r v,,",-
'/3
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
.
..
NOTE: Tl1isl.nformati9n Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by. the 1.989 OregQn Legislature.
If ~ou are acting as your own cba1fi"aC10r to cons~ruct a new home or make a substantial imp:-ovemiSrJt to an
exist1ng structure, you CBln prevsni mBl~y problems by being aware of the foliowil1g respom~ib:!2!ee~ am:! ClfeBlS
of concern.
~MPlOVEA ~E5)~OG\S5)O[8)OL01f5~Si:
If you hire persons 7'tO~ f'eg~s~0:~::: \f'J1~h 1(<'\0 Cons~t:JcHc:1 Contractors BOBlrd to de labor ill c0i1str~c~:~~8 or @~~!S;~:1g
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at 378-3224.
Workers' ComponsEl~ioJ1 ~L1S1J:~~C3: As an emp!oyer, you a.re subject to the Oregol1 WOi"~ers' CO:"T1pei'1sw~:cn
Law, a\~::: :":~lisi :Jb~81[!'l tA!~;;,~J'~' CO:"1."':Js~satio~ inSl.1ral1Ce for your o;nployees. ~1 YOli 181!1 ~o oh~0.ii1 \j\jc:':{:;:'i~'
comp0tlsa'i:a:: i:'1G~(I'~T:c:J, lie;,,: me.y 0C S:.1C;cct to penalties end wE) :J~ liable fo; al~~ dab,,: cos~s j~ 0:'8 c; yr~L:T
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code requj(::".~~:1t5 ~(:81~ r:t3.V ~o Oro~g:'110 YC~i' Clltsntion through inspectionS'.
Liabi~::y a.r.(~ :'!:--C.:;3:-:Y :Ja.:,'B:~Z ::';S~Tar.C3; GO~~C:1ct yo~r insurance agent to see if yO'-1 (:e;vB ~d?a.uate insurance
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iures, fire, or W:JT~ ~hai ffi\iS'l be re-done.
T~me to S:.1~:;3rv~2Z Emir;lio::s: Me.:{0 sure YO'J have s:Jmcisi1t time to su~eTvise your 8r.1~!oyezs.
Expertise: ;V:a:{e sure you;rt~ve ~r:o e}{pert1ss to act as your own general con~rac~or,lo coord;nate t;'e work
01 rough-in and iin~sh ~rades; and to i1(J1~iiy bU5rding omciais a.t the appropriate times so they can perform
the required inspections,
If you have additional questions, write to:
Construction Contractors Board
700 Summer S1. NE, Suite 300
Salem, OR 97310-0151
Phone 503.378-4621
0244J 10/24/89