HomeMy WebLinkAboutPermit Electrical 1997-12-161. LOCATION OF TALLATION
LEGAL D
7
ION
JOB DESCRIPTION
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Permits are non-transferabl-e and expire
if vork is not started vithin 180 days
of issuance or if vorlc is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electric ] Contractor
Add ress
Ci ty one
Supervisor Li e Number
Expiratio te
Cons t r ontr. Number
llv ration Date
Signature of Supervising Electrician
\Ovners Name
SP jFIELE)
ELECTRICAL PERHIT APPLICAT
Ci Job Number 7
COHPI,ETE FEE SCHEDULE BELOV
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
1000 sq.ft. or fess S 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
-Modular Dvelling
Service or Feeder S 40.00
Services or Feeders
lnstallation, Alterations
or Rel-ocation:
225 FIFTE STREET :
SPRINGIIIELD, OREGON 91471
INSPECTION RE0UEST: 7?-6-3169
0FFICE: 726-3759
Z=lL!ry
J
A
Sum
DD
*qo
200 amps or less I
201 amps to 400 amps _401 amps to 600 amps _601 amps to 1000 amps_
0ver l-000 amps/volts
Reconnect 0n1y
200 amps''or less
201 amps to 400 amps
-Over 401 to 600 amps
Over 600 amps or 1000-7oTEs
$ s0.00
$ 60.00
s 100. 00
$130.00
s300.00s 40.00
C Temporary Servj.ces or Feeders
Installation, Alteration or Relocation
Add ress
Ci ty J Phone v44-5:e q d
O\{NER TNSTALL\TION
The installation is being rnade on
property I ovn r,rhich is not intended
for saIe, lease or rent.
sSi ure:
D. Branch Circui ts
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Addi tionalCircuit or vith Service
or Feeder Permi t S 2.00
s 40.00
$ ss.00
s 80.00
see t'Btt
not
40.
40.
20.
1.4
aSove
included )E
5
Miscellaneous ( Service/feeder
-Each installation
Pump or irrigation $
Sign/Outline Lighting- S
Limited Energy/Res $
Limited Energy/Comm S
00
00
00
00
RE
SUBTOTAL OF ABOVE
52 State Surcharge
3Z Administrative Fee
TOTAL
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RICEIVED B
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Permit #
Address
Issued by:Date
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(1), requires residential construction permit appli-
cants who ore not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. 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 appropriate blanks and initial boxes I and2, and either box 34' or 3B:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A. My general contractor is
Q.{ame) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
38. I will be my own general contractor
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notif,/ the office issuing this building permit of the
name of the contractor.
I hereby certiff that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
OR
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(lYhite copy to issuing agency permit file,
pink copy to applicant)
(Date)
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