HomeMy WebLinkAboutPermit Electrical 1991-5-2
B. Services or Feeders (10 Branch Circuits
included). Installation, Alterations
or Relocation:
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: ' 726~3769
OFFICE: '726-3759
3.
1.
L~~g~~~ ~~U~:li \ G
n()dE~~ l)4~i
\\\. ~ .
A.
, ~JQB~ qRSCRI
\ i~-,
Permits are non ransferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
CONTRACTOR INSTALLATION ONLY
Contractor
ELECTRICAL PERMIT APPLICATION
City Job Number 0\M\~'
COMPLETE FEE SCHEDULE BELOY
New Residential-Single or
Multi-Family per dwelling
Service Included:
unit.
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
8~
100 amps or less $ 35.00
~ 101 amps to 400 amps $ 60.00
City Phone 401 amps to 600 amps $ 90.00
601 amps to 1000 amps $130.00
Supervisor Over 1000 amps/volts $300.00
Reconnect Only $ 35.00
Expiration Date
Constr Contr. Number '"
Expiration Date '" ,
Signature of.supervising Ble~Ci~ ~
, "c*~~
Owners Name ~~~rS\~)J 121\ "L D.
,Address o'6~'S MlnM~'\G
City_~ \d" p~one lfJb-:Jlll
O~ I STALLATION
C.
The installation is being, made on
property: I own which is not intended
for sale, lease or rent.
E.
Owners Signature:
~ i 1/)/"'\.,' ~u ~
D~~E~--~~.~-~~----------------~
RECEIPT i: --..J, /\:~ \\\C\kJ
RECEIVED BY: ( /1/./ 1 LJ
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
$ 35.00
$ 40.00
$ 80.00
volts see "B" above
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
,Two to ten Circuits
Each Addt'l tenor
portion thereof
$ 35.00
$ 50.00
$'15.00
"
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Signal Circuit or
limited energy panel
not included)
$ 36.00
$ 36.00
$ 36.00
~".1, 6 . 00
1. '75
d(o ,7....<) _
5. 'SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
.,.,....-". ....
.
.
Address: ,
C\ \M\~
~~LQ 'ffiLb f~ 6
~, Date: ,~, .q{,
Permit No:
Issued
FOR OFFICE USEONL Y
-~t,'STATEMENT:
" " INFORMATION NOnCE'TOPROPERTY OWNERS
'.' oABOUT."CONSTRUCTIONRESPONSI BILITIES
Note:.QregonLaw, 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 box 2A 0(2B:
1.cf2
2. A, ,
,/
I own, reside in, ,or will reside in the completed structure.
. My genera,1 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---I ~~
B" I ~ ,I will be my owniJonoral contractor.
,
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board, If I change my mind and co 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.
')' '
- ( (\\Y~JlAf(\ K\ II I -'1-P/Y"'\
"S'ignature o~ Permit Applicant
~ - .-J-Cj I
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
@Jl