HomeMy WebLinkAboutPermit Electrical 1999-04-12S IGFTELO
INSPEcf,ToN REQI EST,
^2fr6'-,A[Sonatu,eOFPICE: 726-3759
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ON OF
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225 FIFTE STREET
SPRTNGFTELD, oREGoN 97h7
. LOCA
IJGAL DESCRT
JOB DESCRIPTION
5",
Electrical Contractor
Address
Ovners Name
Ihe following project as submitted has the following
zqnrng. and does not require specific land use
approval L> tfl-Zoning
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ELECTRICAL PBRHIT APPLICATION
Ci ty aJob Numbet /7o47 7
3. COMPLETE FEE SCEEDTIT.E BELOII
A. Nev Residential-Single or
MuIti-FamilY Per dvelling un
Service Included:
I tems
it.
Cos t
$ Bs.oo1000 sq.ft. or less
Each additional 500
sq. ft or Portion
thereof
Each Manuf'd Home' or
Modular Dvelling
Sertice or Feeder
Services or Feeders
installation, Alterations
or Relocation:
s 15.00
B
Sum
tzk-\
Wr*c/
Permits are non-transferable and expire
ii "ort is not started vithin 1B0 days
;; ;;;;";"" ot if vork is susPended for
180 daYs.
2. COMRACTOR INSTALLATION ONLY
200 amps or less l/
201 amPs to 400 amPs
-
401 amPs to 600 amps
-
601 amPs to 1000 ?mPs-
over tbOo amps/volts
-
Reconnect 0n1YSupervisor License
Expiration Date
Constr Contr um ber
Expi ra t Da te
Signature of Supervising Electrician
TemoorarY Services or Feeders -il:Uii.ii""l eri"rition or Rerocation
200 amPs''or less;fi ;;; io aoo amps
-Over 4b1 to 600 amPi--
6r"i OOO amPs or 1000 vorts
Branch Circuits
Nev, Alteration or Extension Per Panel
---14rioT)(/ts 50.00
$ 60.00
$100.00
$130.00
$300 .00
s 40.00
a56vil
$ 40.00
$ ss.00
$ 80.00
see ttBtt
40.00
40.00
20.00
36.00
Address \c-S 4 ,J 6vtt 3r $ 3s.00
Ci tY U
Signature
Pho qr 1.11 3{4 t
One ,Ci rcu i t
gachi Rdditionar-Circuit or vith Servrce
or Feeder Permil
-Miscellaneous (Service/ feeder
-Each installation c
Pump or irrigation. :
sign/outrine Lightlng- :iif,it"a EnergY/.Res
-
:;i;i;;e Ener[Y/comm )
SUBTOTAL OF ABOVE
5Z State Surcharge
g7 Aa*inistrative Fee
TOTAL
$2.00
not in cluded )OVNER INSTALLATION
The instalLation is being made'on
DroDerty r ovn 'rliln-it iot intended
ioi'".rL, Iease or rent'
E
DATE:
RBCEIVED
4,
5
P
s 40.00
I
Permit #:?2t9-,27
Address z
Issued by:Date
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note; Oregon Law, ORS 701 .05 5 (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 residential building, electricol, mechanical, ond 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.
blanks and initial boxes I and2, and either box 34. or 38
l. 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.Jame)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 with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
a
Fill in
I hereby certiff that the above information is correct and that I have read and do unders
t Construction Responsibilities on the reverse side of
tand the Information
this form.
It*Lq<
of permit applicant)
(?Vhite copy to issuing agency permit file,
pink copy to aPPlicant)
Notice to p erty Owners
q
(Date)
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