HomeMy WebLinkAboutPermit Electrical 1992-04-15225 FIFTB STREEf,
SPRTNGFTEU), ORBGON 97 477
INSPECTION REQUESTT 726-37
OFFICE: 726-3759
1 LOCATION OF ALIATION'6
I.EGAL DESCRIPTION tu
JOB DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALI^ATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name A- lorl'n
Address 6zs zz*z
Ci ty rf Phone '-7/v
OVNER INSTALI,ATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
ch
200 amps or less $
201. amps to 400 amps
-
$
0ver 401 to 600 amps _ $
Over 600 amps or 1000 volts se
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation $
Sign/OutIine Lighting_ $
Limi ted Energy/Res $
Limited Energy/Comm $
st,rilN(;FIELIJ
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
ELECTRICAL PERHIT APPLICATION
99
BBLOg
eor
MuIti-FamiIy per dvelling unit.
Service Included:Items Cost Sum
1000 s q t. or less $ 8s.00
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
s 1s.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only .-
c. Temporary Services or tFeeders
Installation, Alteration or Relocation
B
s s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
40.00
s5.00
80.00
,e tr8tr
Zrt Orc#
above
not included)
40.00
40. 00
20. oo
E
Ovners Signatur_e:Z.- Zd,-
5
DATE:
RECEIPT
RECEIVED BY:
city Job Nunber ? 20 S 7I
Resident
Permit No:
Address:ll
lssued by:- . Date;
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:
1
2
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.
3 A 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 ehange my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certily that the above inlormation 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.
nature o rm t cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT