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
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