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HomeMy WebLinkAboutPermit Electrical 1998-06-30225 FIFTH STRXET SPRINGFTELD, OREGON 97 INSPEOITON REQLIEST. 72 0FFICE: 726-3759 1. LUCA'I ON OF STALLATIONo SPRD1.GFIELD too ELECTRICAL PERUIT APPLICATION City Job Nunber 3. COHPLETE FEE SCHEDULE BELOI{ A Nev Residential-Single or Multi-Family per dvelling unit. Service fncluded:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion t hereo f Each Manuf'd Home or Modular Dvelling Service or Feeder $ 8s.00 s 1s.00 s 40.00 B 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_ 0ver 1000 amps/vo1is Reconnect 0n1y I,EGAL i? 032'1 3 DESCRIPTION 3 eo rl5 c um JOB DESCRIPT i,tsrl) Permits are non-transferable and expire if vork is not started vithin 180 days oj issuance or if work is suspended for 1.80 days. 2. CONTRACTOR INSTALIJ,TION ONLY EIec t r i cal Con r rac rc, 0l^t N C-(\ Addi:ess Cl ty..-- Phone Supervisor Li cense ilpfibg._ Expj.::at ion Date_THIS pEnfur,r ^r,^. . _-rrrrlT ENALL EXHBE rr ?rre frffi ii:I, ii i'iiil.li, Ii"3i'i "1o "u t i on OH,SA amps''or less s s0.00 s 60.00 s100.00 $130.00 $300.00 s 40.00 s $ $ s s $ $ $ Constr Contr. Num Expiration Date Signature of Su 40. 00 55.00 80.00 ee trBrr aSove )i pervising Electr Ovners Name address 2 fa-c - D. Branch Circui ts Nev, Alteration or Extension Per Panel 01 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000-7oTTs onecircuit / s35'oo Each Addi t ional Ci rcui t or vi th Servi ce^ or Feeder Permil L $ 2.00 ICi ty OVNER INSTALLATION The installation is be property I own r"hich i for safe, lease or ren 0sners ture: DATE: pr,o".71L^ f 21 I made on ot intended 1ng cn t. E. Miscellaneous (Servj.ce/feeder not incfuded) -Each Pump o Sign/0 Limi te Limi te insri utl dE dE t a1la t i. on rrigation ine Lighting_ nergy/Res nergy/Comm 40.00 40.00 20. 00 36.00 SUBTOTAL OF ABOVE 5Z State Surcharge 32 Administrative Fee TOTAL DI RECEIVED BY: 1[5 3q ry /.q( S or,n>,!,>l --4t' Permit #:0 Address d (Lr 6(/t Issued bvJ Date:?a fr Statement: lnformation Notice to property owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appti- 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. Fill in the appropriate blanks and initial boxes I andz, and either box 34 or 38: Z 1. 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. (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. OR W 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. I hereby certify that the above information is correct and that I have read and do understand the Information about Construction Responsibilities on the reverse side of this form. 6 lo -fg (Signature of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) Notice to Property (Date) AI) T 3A'. 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