HomeMy WebLinkAboutPermit Electrical 1998-01-25ONEGOAICITY OF SPF"VG
225 FrFTE STREET Authorlzed
SPRTNGFTELD, OREGoN 97 477
INSPECTION PSQITESTz 726'3769
OFFICE: 726-3759
1. LOCATION OF ALLATION gd/ lrt
LEGAL DESCRIPIION
JOB ON
osnar€ n l4,t Br FCTRICAL PBRHIT AppLICATION
City Job Nunber
COHPT,ETE FEE SCMDULE BELOV
SF .GFIELE,
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
1.000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular DveIIing
Sertice or Feeder
$ 8s.00
$ 1s.00
s 40.00
B. Servi.ces or Feeders
Insta1lation, Alterations
or Relocation:
200 amps or less r
20L'amps to 400 amPS
-
401 amps to 600 amps
-
601 amps to 1000 amPs-
Over 1000 amps/volts
-
Reconnect 0n1Y
c.Temporary Services or Feeders
Installaiion, Alteration or Relocation
apprwal.
l'??
3
A
Sum
ee trBr a566
Address
Ci tv Phone
i SuPervisor License Number
i
Exp iration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
200 amps"or less
201 amis to 400 amps
-Over 401 to 600 amPs
-
Over 600 amPs or 1000 volts
Branch Circuits
Nev, Alteration or Extension Per Panel
onecircuit L $35.00
Each Additional
Circuit or vith Service
or Feeder Permi, q $ 2'00
-Each installation
Pump or irrigation
Sign/Outline Lighting-
Limited EnergY/Res
-
Limited EnergY/Comm
*a.a$ s0.00
s 60.00
s100.0Q
s 130. 00
$300.00s 40.00
$
$
$
s
40.00
55.00
80.00
D
Owners Nane
Address
Ci ty
Osners S igna
?r;!@qq -IPhoneP.
OVNER INSTALI.,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
tr
E. Hiscellaneous (Service/feeder not included)
00tr
40.
40.
20.
36.a,
$
$
$
$7
00
00
00
5 SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTALRECETVED
/^ a<Arz, C).4W
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.ATION ONLY
Electrical Con tr^cto, ft tl * ,
Permit*: ?RA/F
Address:
Issued by Date: /-2^ -2'a
Statement: lnformation Notice to Property owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(1), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before o 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 3,A. or 38
B 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
(lrtrame) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
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 rvith a contractor who is
registered with the CCB and will immediately notify 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.
2
applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
w
(Signature (Date)
I
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