HomeMy WebLinkAboutPermit Electrical 1991-5-17
225 FIITH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1. f LOCATIONJF INSTfLATION
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LEGAL DESCRIPTION
I, O~ "2--'2- J 2- I~OD
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if work is not started within. 180 days
of issuance or if work 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 \.\ Q '\x \ \ ~\~\\()D D.
Address lo \ f\ (\ \) \ ~\:\~\G \.'C'l, _
Ci ty ~ oclrl fhone l4 \ -Rtd70
OVNER 'xN~N
The installation is being. made on
property I own which is not intended
for sale, lease or rent.
~ners SignPJ:e~
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RECEIPT i: ~/Jq ~J...l.J-f\.""'"
RECEIVED BY: 1/ Y.\../ -
3.
ELECTRICAL PERKIT APPLICATION
Ci ty Job Number C\ \ ["('f4~
COMPLETE FEE SCHEDULE BELOY
A.
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost
Sum
1500 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 85.00
$ 15.00
$ 35.00
B. Services or Feeders (10 Branch Circuits
included). Installation, Alterations
or Relocation:
100 amps or less $ 35.00
101 amps to 400 amps $ 60.00
401 amps to 600 amps $ 90.00
601 amps to 1000 amps $130.00
Over 1000 amps/volts $300.00 :.:::f:::L..ctJ
Reconnect Only \ $ 35.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 35.00
201 amps to 400 amps $ 40.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see liB" above
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit.
.Two to ten Circuits
Each Addt'l ten or
portion thereof
$ 35.00
$ 50.00
$ 15.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Signal Circuit or
limited energy panel
not included)
$ 36.00
$ 36.00
5 . SUBTOTAL OF ABOVE
. 5% State Surcharge
TOTAL
$ 36.00
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Permit No: q trxJ45S n
Address: ( Q \ 'J rn/onlCUJ
. Issued b(91 (J)() -) Date: (:) ./? A I
FOR OFFICE USE ONLY
STATEMENT:
. INFORMATION NOTICE.TOPROPERTY 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 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 box 1 and either.box2A or 2B:
1.~
/
I own,reside in, or will reside in the completed structure.
, 2. A. L-1 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.
lOR
B. c:ftj)1 will be my own .g9Aeral contractor.
( If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and 00 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.
~e4<~ f) R A')/),1
t gnatr of Permir-A'jJplicant
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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