HomeMy WebLinkAboutPermit Electrical 1991-5-20
SPFlINGFIELO
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: '726-3759
3.
1. rJ.9CATION Qf......INSTALLATIObh._ \f"(:::...
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-f~DESCRIPTION '
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, '~OB p~SCRIPTIO~ 4-
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A.
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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
/
/
B.
Contractor
ELECTRICAL PERMIT APPLICATION
City Job Number C\\rAG\f.L,
COMPLETE FEE SCHEDULE BELOY
New Residential-Single or
Multi-Family per dwelling
Service Included:
Items
1500 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling l
Service or Feeder
unit.
Cos t Sum
$ 85.00
$ 15.00
$ 35.00 .D....CS.Cf-
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
Reconnect Only $ 35.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expi tion Da te
19nature'Of'supervis~ectrician
Owners' Name \:\\ f)'Cl LV\ ~~ ~.)
Address' oC32>~ \J\4,\~ ~ . ..
Ci ty ~hone 'lI1Co-O/ f.o(p
D.
STALLATION
The installation is being, made on
property I own which is not intended
for sale, lease or rent.
E. '
, :lers Signature: '
~A~~~-'~ g_f~
RECEIPT i:{'" \... Y/. .
\ RECEIVED B~) J L-)t(:J
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5. 'SUBTOTAL OF, ABOVE
5% State Surcharge
TOTAL
. ,1 ;;tI'
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
Branch Circuits
$ 35.00
$ 40.00 ,
$ 80.00
volts see "B" above
New, Alteration or Extension Per Panel
One Circui t '
Two to ten Circuits
Each Addt'l ten or
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
&00
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Permit No: C\ \['f\C\ 2-- . Jt
Address: SBC3~ Dfj.\~ )l)s
IssuedbMm_, 'Date: ~)q/
~FOROFFICE USE ONLY
STATEMENT: ' '
INFORMATION' NOTICE ,TO ,PROPERTY OWN ERS '
, , ' "ABOUT CONSTRUCTION RESPONSIBILITIES'
,Note: Oregon Law; ORS701'.055(4); requiresresidential 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 statemeAt wilL be ,filed with the permit.
,
Fill',in the applicable blanks, and initial box 1 'and either box 2A or 2B:
./
I own, reside in,or will reside in the completed structure.
My genera,I'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 '
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I will be my own genera! 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.
, }~ /~
-14. .-,1
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"ignature of Permit Appliccfn,t Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90' '
..'
E COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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