HomeMy WebLinkAboutPermit Electrical 1991-09-20---ra_t
C'TY OF OREGO'V
225 FIFTE STREET
SPRINGFIEI.,D,ORBGON 9747
INSPBCTION RBQTIEST
OFPICE: 726-3759
1 LOCATION OF INSTALI"ATION
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IJGAL DESCRIPTION
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JOB DESCRIPTION4 * <-u.o/rz-^ ,'_
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COIITRACTOR INSTALI,ATION ONLY
Electrical Contractor
Address
ci Phone
Supervisor License Ndmber
Expiration Date
Constr Contr. Number
Expiration Date.
Signature of Supervising Blectrician
BI..ECTRICAL PERHIT APPLICATION
City Job Number
COIIPIJTB TBE SCEBDULB BELOII
Nev Residential-Slngle or
Multi-Family per dwelling unit.
Service Included:Items Cost.
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portionthereof $ 15.00
Each Manuf'd Home or
-Modular Dvelling
Service or Feeder $ 40.00
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200 amps or less /
201 amps to 400 amps _401 amps to 600 amps
601 amps to 1000 arps-
over 1000 amps/volts
-Reconnect On1y
200 amps or less
201 amps to 400 amps
-over 401 to 500 amps
-Over 600 amps or 1000 volt
3
A
Sum
B. Services or Feeders
Installation, Alterations or
Reloca t ion:
Temporary Services or FeedersInstallation, Alteration or Relocation
ft2-&€
s see wgrr
"ffi
er not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
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$ 40.00
$ ss.00
s 80.00
city %:z-ae: phone g#abl
OSNER INSTALI,ATION
The installation is being made on
property I own vhich is not intendedfor sale, Iease or rent.
ignature:
DATE:
RECETPT
D. Branch Circuits
New, Alteratlon or Extension Per Panel
One Ci.rcui t
Each Additional
Circuit or with Service
or Feeder Permit
E Miscellaneous (Serv
-Each installation
Ptrmp or irrigation
Sign/0utIine Lighti
Limi ted Energy/Res
Limi ted Energy/Comm
$002
i ce/ feed
ng
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5 STIBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
RECEIVED BY:
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ovners Nu " &r * oya>-
eddress <r:;:; U ?<r?e* -
E
Permit No
Address:
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lssued 7
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. 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 applicable blanks, and initial box 1 and either box 2A or 2B:
1.lTl I own, reside in, or will reside in the completed structure
2. A.My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
,.2At*7 Date: d-,-;Zr-4?//
B I will be my own general contractor.
I I hire subco4tractors, I will hire only subcontractors reoistered with theConstruction Contractors Board. lf I chanoe my mind and Eo nire a oeneiaicontractor, lwill contract with a contrattor-who is reoistered with theGonstruction Contractors Board and I will immediately-notifv the officeissuing this building permit of the name of the contraitor. '
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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g ature Permit Appl cant
CONSTRUCT]ON CONTRACTORS BOARD
0244't 10t24t89
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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