HomeMy WebLinkAboutPermit Electrical 1992-07-29C'TY
SITIIT}{GFTELr,
225 FIFTB STREET
SPKTNGFIELD oREGoN 97477
INSPBCTION REQIESTz 726-3769 .
0FFICE: 726-3759 t
1 LOCATION OP
3.COHPI.^BTE TEB SCHEDULE BELOS
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ELECTRICAL PERHIT APPLICATION
City Job Number ?2,
HuI t pe
-Single orr dvelling uni t.
Service Included:Items Cost Sum
$ 8s.00
$ 1s.00
$ 40.00
s s0.00
s 60.00
$100.00
$130. 00
$300.00
$ 40.00
aSove
not included)
40. 00
40.00
20.00
36. OO
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I,EGAL DESCRIPTION
JOB DESCN.IPTIONEte-<- SrXyZcz; {. -
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Permits are non-transferable and expireif vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COMRACf,OR INSTALI^ATION ONLY
Electrical Contractor
Address
ci ty- Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Blectrician
Address
ciry 1i77zD. Phone 42 '%
OIJNER INSTALI..ATION
The installation is being made on
property I o\+,n vhich is not intended
for sa1e, lease or rent.
Ovners Signature:
DATE:
RECEIPT
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less ,t'
201 amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/voIts
Reconnect 0nly
E
5. SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
Temporary Services or Feeders
Installation, Alteration or Relocation
c
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permi t /2 $ 2.00 ?a
200 amps or less $ 40.00
2oJ. amps to 4oo amps
-
g 55.00
Over 401 to 600 amps _ $ 80.00
0ver 600 amps or 1000 volts see rrBrl
Hiscellaneous (Service/feeder
-Each installation
Pump or irrigation $Sign/outline l,ighting- $
Limi ted Energy/Res
-
SLimited Energy/Comm $
RECEIVED BY:
,
52,u-
=
owners n^*" fu * Vrrt s
Permit No
Address:
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1
2
lssued
OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, 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
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
A
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.
My general contractor is ,
Contractor registration number-.
I will instruct my general contractor that all subcontractors who work on the struc-ture must be registered with the construction contractors Board.
OR
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-tion Contractors Board. lf I change my mind and do hiria general contractor, I willcontract with a contractor who is registered with the Construition Contractors Boardand I will immediately notify the office issuing this building permit of the name ofthe contractor.
3
I.herely certify that the above information is correct and that I have read and understandthe lnformation Notice to Property Owners about Construction nesponsibitities on thereverse side of this form.
S na ure o Per pp cant e
C-ONSTRUCTION CONTRACTORS BOARD0244J 8t91
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w..F.tlIE_ qopy To tssulNGaGENCy PERMIT F|LEPINK COPY TO APPLICANT