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HomeMy WebLinkAboutPermit Electrical 1994-06-27CITY OF SPR OREGO'V 225 FIFIH STREET The followlng prolcci zonlng, and does not requlre epociflc hnd ueo ag lubrnlltcd lEthr approval. zonrnc,LM SP'ITltlGFIELD ELESTRTCAL PERUTT APPLICATION lHiEff")r::3ffi" 721#J 6e1z)-HTSPRTNGFIELDoREGON 97477 Authorized 0 JOB DESCRIPTION k' Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if work is suspended for L80 days. 2. COIiITRACTOR INSTALI,ATION ONLY Electrical Contractor Address " Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Exoiration Date Signature of Supervising Eleetrician Ovners Name Address Ci ty Phone 1 OVNER INSTALLATION The install-ation is being made on property I ovn r,rhich is not intended for sal-e, Iease or rent. Owners Signature: x DATE: City Job Nunber COHPLBTE FEE SCEEDTILE BELOS Nev Residential-Single or Multi-Family per dvelling unit. Serviee Included: I tems 4 40 4qt A B c Cos t $ 8s.00 $ 1s.00 $ 40.00 $ s0.00 $ 60.00 s100.00 $130.00 s300.00 $ 40.00 Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder Services or Feeders Installation, Alterations or Relocation: 200 amps or l-ess 201 amps to 400 amps -401 amps to 600 amps _60L amps to l-000 amps_ Over 1000 amps/vo1ts Reconnect 0n1y Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or l-ess 201 amps to 400 amps -_Over 401- to 600 amps Over 600 amps or 1000 voITs D. Branch Circuits SUBTOTAL OF ABOVE 5Z State Surcharge 32 Admini-strative Fee TOTAL above $ 40.00 $ 5s.00 $ 80.00 see ilBil E 5 Nev, Alteration or Extension Per Pane1 OneCircuit -l $35.00 A@ Each Additional Circuit or vith Service or Feeder Permit"*' I $ 2'oo z'e Miscellaneous (Service/feeder not incLuded) -Each instaLlation Pump or irrigation $ 40.00 sign/outline Lighting-, $ 40.00 i,iili ted Energy/Res - $ 20.00 RECEIVED 1-oD '' "'Tiit{"i11frf;1H,^ - qoa 411 Permit #:L|,D q Ll 7 Address: Vc4-l f t%w ,lug Issued by:Cru o o^n lo f-7 -?J Statem€ht: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Inw, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residentiat buitding, 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 ft.led with the permit' Filt in the appropriate blanks and initial boxes I and2, and either box 34 or 38: 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 (Name)Contractor regis. # structure must be I will instruct my general contractor that atl subcontractors who work on the registered with the Construction Contractors Board' ry 38. I will be my own general contractor' OR name of the contractor. Ihereby certifY thatthe above information is correct and that I have read and do understand the Information Owners about Responsibilities on the reYerse side of this form' If I hire subcontractors, I wil hire onry subcontractors registered with the construction contractors Board. If I change my mind and hire a g"ne.ul contractor,r will contract with a contractor who is registered with the cin ano wil immediui"ry notify the office issuing this building permit of the (Signature of Permit aPPlicant) (White copy to issuing agency permit file' pink coPY to aPPlicant) Notice to (Date) T ^7+,t'C'?4