HomeMy WebLinkAboutPermit Electrical 1991-8-9
225 FIITH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1.
LOCATION OF INSTALLATIO,
tUb I " .5a.s~w . ~
LEGAL DESCRIPTION
/10 ~ 3 S J./l-I '2..-100
JOB DESCRIPTION
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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
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name ~IN F f1.vuvJ'
Address \~ CLfMIVA-n=R l.ANF
City ~PRD Phone 71./~ -i/IS<!
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
own~l~~e/) ,
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7-0 q '17,
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DATE:
RECEIPT II:
RECEIVED. BY:
S.-IIINGFIELO
City Job Number
3. COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dwelling unit.
Service, Included:
Items Cost Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations or
Relocation:
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
'Installation, Alteration or Relocation '
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\
$ 40.00
$ 55.00
$ 80.00
see "B"
above
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
New, Alteration or Extension Per Panel,
One Circuit
Each Add it ional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
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 OF ABOVE 40,00
5% State Surcharge Z.oO
TOTAL 42,00
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Permit No:"~C\\D8\ S "
A~dress: '.if\~ \jj ~l\ ~~,
Issued bY~\[)~_' ~ate:' tifrUq!
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STATEMENT:
'INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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:Note:Oregon Law, ORS 70.1:055(4), requires residential building permit applii::ant~
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 submitthis statement. This statement will be filed with,the permit
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Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
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I own,. reside in, or will reside in the completed structure.'
My gerieral contractor' is
2. A'-C:::::J
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Contractor 'registration number
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I will instruct my general contractor that all subcontractors who work on
, the structure must be registered with the Construc~ion Contractors Board.
OR
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B. L-.J I will be my own general contractor.
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If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my.mindand Clo 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. " .
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I hereby 'certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about ConsJruction Responsibilities on the
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Signature of Permit.Applicant-', Date /---
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,.;....-.,
. CONSTRUCTION CONTRACTORS BOARD
0244J 10/24/89 ' '
U\P ....
WHtTE COPY TO ISSUING AGENCY PERMIT FILE
NY TO APPLlCA~T , ~.