HomeMy WebLinkAboutPermit Electrical 1999-09-14: -N( LD
OREGONATY OF
225 FTETE STREET
SPRTNGFTELD, oREGoN 97477
INSPECTI0N REQUEST: 726-3769
OFFICE: 726-3759
ELECTRICAL PERHIT APPLICATION
1. LOCATION
DESCRTPTION
O ?Aoo
JOB DESCRTPTION
9e
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days. NOTICE:
2. COI{TRACTOR
6
3. COHPLETE FEE SCEEDTILE BELOII
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:ltems Cost
$ 8s.00
Ci ty Job Nunbe , ?? /2 ?
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
SerVice or Feeder
or Feeders
ion, Alterations
tion:
FOR'zIo amps or less I
201 amps to 400 amps
-401 amps to 600 amps _601 amps to L000 amps_
Over 1000 anps/vo1ts
Reconnect 0n1y
qr
(_.:3AO Y IR S A
Sum
Electri
Address
Ci ty
ca1 Cont
ANYlSODAY
Ph
$ 1s.00
s 40.00
s s0.00
$ 60.00
s100. oo
$130.00
s300.00s 40.00
t
=
Supervi sor Liceffl}@
au
Expiration Dat
er fluhi, IdrutT
rdQlrtr
durilec
nJ ar.ll to saldo3 'llBlqo ^EtLi
iioA 06
Constr Con . Nurnbe
00-z96 uvo uonoru; il L(i
r
C. Temporary Services or Feeders. InstaIlation, Alteration or Relocation
Expi ra on Date
ture of Supervising Electrician
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
0vners ture:
200 amps''or less
201 amps to 400 amps _
Over 401 to 600 amps
Over 600 amps or 1000-vofTs
$
$
$
s
$ 40.00
$ 40.00
$ 20.00
s 36.00
{.O n'
40.00
5s.00
80.00
ee rrBrr aSove
T"0.-..jJ.. bL ,D. Branch Circuits
Ovners Name
Address 3 6 A
Nev, Alteration or Extension Per Panel
Aro.phone 142-6?7+One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
Ci ty
OVNER INSTALLATION
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/0utIine Lighting_
Limited Energy/Res _Limited Energy/Comm
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
I
RECETVED B
5
ttffi
aql
L8*
DATE:
Permit #:/z?v
Address 3,o7
Issued by
/d ,d
,|7Date
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, 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 residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exemptfrom registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
n thg appropriate blanks and initial boxes I and2, and either box 3,A. or 38
,.W" l. I own, reside in, or will reside in the completed structure.
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. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
ili
(D
OR
)ee,A 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.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to P Owners Respo nsibilities on the reverse side of this form.
of permit applicant)
ftVhite copy to issuing agency permit file,
pink copy to applicant)
K (Signature