HomeMy WebLinkAboutPermit Electrical 1990-12-28,C'TY OF OREGO'V
lf vork ls not started vlthin 180 daysof lssuance or lf rrork ls suspended for
180 days.
2. CONIRACTOR INSTAI,LTITION ONLI
225 TIFTH SI1BET
SPRINGPIBU), oREG0N 97477
INSPBGIION RBQIIBST: 726-3769
OPPICB: 726-3759
1.OP INSTALI.ATION
5 )Fl, 4ue .dQ ?tu>1 a
IAGAL DBSCRIPTION-27
JOB DBSCRIPTION
72Perml t non-transferab explre
Electrlcal Contractor
Address
ct ty-Phone
Supervisor Llcense Number
Explratlon Date
Constr Contr. Number
Bxplratlon Date
ET.BSTRTCAL PBR}IIT APPLICATION
clty Job Nunber %Zg#O
3. COHPI,ETB PEB SCIIEDUI.B BBLOS
New Residentlal-Single or
Multi-Faml1y per dvelllng unlt.
Service Included:
Items Cost
1500 sq.ft. or less
Each addltlonal 500
sq. ft or portion
thereof
Each Manuf,d Home or
-Modular DweIIing
Servlce or Feeder
$ 8s.00
$ 1s.00
$ 3s.oo
D. Servlces or Feeders (10 Branch Circuits
included). Installation, Alteratlons
or Relocation:
SPTIINGFIELt)
100 amps or less
101 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect 0nly
Sum
a*
$300.00
$ 3s.00
$ 35.00
$ 60.00
$ 90.00
$130.00
C. Temporary Services or Feeders
Installatlon, Alteratlon or Relocatlon
200 amps or less $
201 amps to 400 amps
-
$
Over 401 to 600 amps $
3s.00
40.00
80.00
Owners Name
Address ,q f /,,tFi, 4oo.
ctW S ?Fl 0. dl qunphone ')q6 -a33J
OITNER INSTALI,/\TION
The installatlon ls belng made onproperty I ovn vhlch is not lntendedfor sale, Iease or rent.
0sners Slgnature:
DATE:
0ver 600 amps or 1000ErEs see 'B' a56ilE-
D. Branch Circults
New, Alteratlon or Extenslon Per Panel
One Circuit
Tvo to ten Clrcults
Each Addt'1 ten orportion thereof $ 1s.00
Miscellaneous (Servlce/feeder not lncluded)
-Each installation
Pump or irrigation $ 36.00
sign/outline Lighting- g 36.00
Slgnal Clrcuit or
llmited energy panel $ 36.00
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
t,tvl
00
00
$ gs.
$ s0.
E
5
RBCEIVBD BI
b*t *'e
Slgnature of Supervislng Electrlclan
Permit No:
Address:C*'-9,,q ,T (
lssued Date:
R OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Gontractors Board to sign the
fo!lowing 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 or 28:
1.EJ lown, reside in, or will reside in the completed structure
2. A. l-l My general contractor is
Gontractor 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
B.I will be my own general contractor.
lf I hire subcontractors. ! will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe my mind and -do hire a oeneral
contractor. I will contract with a contrabtor -who is reoistered w-ith the
Constructi'on Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contradtor.
I hereby certify that the above information is correct and that I have read and understand
the lnlormation Notice to Property Owners about Gonstruction Responsibilities on the
reverse side of this form.
tjlt*fr lz^v0
Signature of Permit Applicant
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
te
WHITE @PY TO ]SSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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