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HomeMy WebLinkAboutPermit Electrical 1997-12-161. LOCATION OF TALLATION LEGAL D 7 ION JOB DESCRIPTION )/Le, t ().0 o* 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 o,gz- RICEIVED B b-q P l*,,P 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 /*,*je 8*r- "O (lYhite copy to issuing agency permit file, pink copy to applicant) (Date) t 2//( /zf