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'. My general contractor is
'tualEs ul '00f 31lns aN '1s reul.uns 001 ]u pelB3ol !i pr:1o8 aqJ '( tzgv-8Lt/t}s
'ZiAS-60;L6XO 'tuaps trIrI xog-qdi,&g srol3erluo3 uorlrnrtsuo3 i,rlt Ilrrr ,ro oir-r,r 'sr;.ri1sonb isualtlppe meq no,{ 3J; .- ' ', -'.1, r
'suotlledsul potrnbal aql u-r.ro.;.rad uur ,{aql os setuq o1e[doldd€ aqi ]u slsIJUyo iiurplrnq i3pou ot puu '-tJpe:l
qslurJ pge ul-q8no.rgo {lol\ eql otrurpJooJ ol -Jo}Jurluoo
1c:eue8 u.tro.lno,{ st: }3e ot asqredxa aq} a,ruq ttr:.{ o;ns e)p}Ai iaslpadx'd
v6il
Turd'u*ro-dord
'sae,(oldrua rnof asrr.;adns ol eutrl luorcgJns aluq nof oms o{uIAI :sa*foldua csp.radns ol afirl;
auop-eJ
aq lsnu luql 1;o1t Jo 'eJU 'ssrnllund adrd uror.; af;eurep rclum ',{erds:a,^.o }utud's^iool frurllu-I cr t{lrls s'-IoISSILuo pu" sluapIJJB
JoJ aBEte^oJ eouurnsur elglrbepn a,ruq no,{ -p aes o1 lua8r ?orElnsm rno{ 1eu1uo3 :aruBJnsul afltzurep ,{lJedord puu {1;gqe;1
'\ . : :-r-rortJadrut q8r'a:qt uorluirriir :ncd ol lqllnojq aq {uu.t n:q1
:NH33N03 J0 SV3HV CINV SslLlllglsNods;lH H3r'!i-o
, .; rt, ;,.- .,1 . / ,' .,; i'i ., . 'r r.i: ''000'[:628t008-l ]U
p2lA,{es snue^eg leu.lalq oq} IIuJ'uorluullo3ur aJour JoC 'w}aq1'Fpr{qlr,n .,{11enice l,uprp no,{,1r u'}^i, }ueut.(r?d ffl aq};oJ qqull
iq ffi* no.&. .sp&a,sapf,oldure uro{ yet aurorur luI3peJ ploqq$^r lsnu-no,{ '.ro.{oldtua uu sY :a3l,rj'}S'anuaaax lcurs}ul 'S'n
L--. i
'v(,rE 8Lt.w
seojrbseu.uetrtnHJoluaurpedeclaqlruorsrtr(Jlueu,(oldurguo8er6owlJEs'uorwutro.lutJ-l:)'-.'-i:rt'i'su;{oiilutllc-ror-3il'^1
i t608-S?6 lc enuaAey 3o 'lda{i uo8c:n 3q} ll?3 'uolleturo}ur
aJonr loC .sae,{oldura tn6{ uror3 xe} er{} ploqqlla {ilennu },uop no{,3t ue,ra s}uou.i,(ed xul aql ii).+ JIL}ljtl ?q lll^a rrc,1 'pluci axr
seaf,oldura euirt cr{}.ls soSuar ee,(tldura uroi; r*rol ouro3ur plorilgl,&r }snu nod'ra,(cldura ue sY :,irEl x*1stl}p1oqq11'u s,u83aj6
:Bur.,no11o3 aqi qlr,\,\ ,(lcluror ]sriur ito{ '.rc,(oldura aqj \\ '+: (olrlttte Jq ill^\ ;r'rrq non
ltO.^, ',:.trt1::it.l1\ lt)llU;plsaJ 3 j ' ;tiJur.l \!)"idtUt :r-t :r:];iJrLIJil[O:']eldoad eql pue ra,(oldrua u? aq ol peln: oq'se:ttu*ui lsoui tll 'ill^\
i;;Jfi,i,rro.,o *u,rr,',-rrruo-. ui ,.rqr1 op o, proog rrorltrrtilo) u{)rt'1nr}suoi) eq} I-{ll\1 pir;rls{?}-r loit suos:eiJ a-,q rro:(31
: -i ':sg]InlgBNOdSeH HeAo:ldgl|J
,;, t t i; "t*iauoj 3o searu ptd' sanqrqrsuodsa: 3ur,tro11o3 erp ;o o:eiru Sura( ,{o s,lr:1qo:<! ,irreiir tuo,ra;ci ue:r no{
0l s$o l!$il a)unp.roL3o xtt pJ^oa s;otJD't11to:lU-o!t)n$t'tt() 1 ;tt'11 tq it.;'!r)1?'\)1" sDt"
,
tqtsuorlsay uoryJ?l"tlsuo1 l?lo(!D s"tauiag ,{ltarltt-t4 ? 3JIION-Ltona.utit;i'ut s?i!.1- :aPN '
\r
sall! I lqlsuodsaH' uollsnllsuoc lnoqv
sroumo ltuacord ol oc$oNlollEru{olul
'(5 ig-c1r"1
sa$!!!