HomeMy WebLinkAboutPermit Electrical 1998-06-17SPF ,FIELE'
Nev Residential-Single or
Multi-Family per civelling unit
Service Included:
I tems
1000 sq.ft. or less
Each additional 500
sq. ft or portion
t hereo f
Each Manuf'd Home or
Modular Dwelling
SerVice or Feeder
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-A.TION ONLY
Electrical Contractor
Aodress
Ci ty_ Phone
Supervi-sor License Number
Constr Contr. Nr:mber
'1F,.,'-\'Fl.
,.",**\-6f,
,'(gt?AY
(,fufr,
I{OT|CEr
THIS PERMIT SI.IALL EXPIRE IF THE WORK
NDER TH|S pERfiftftrftb?Al, PERHTT APPLICATION
3760OMMENCED 0n lS ABANDONffiE9fuob Nunber QtoTzE
ANY 180 OAY PERlSo' coMpLErE FEE
'.HEDULE
BEL',
225 FIFTE
SPRINGFIELD, OREGON 97 4]7
INSPECTI0N REQUESTz 726-
0FFICE: 726-3759
1 LOCATI4aaON OF INSTALLATION,A/oR-ll" / L'n q1-.A
LEGAL
JOB
J PTION
ION
0710 d
4
Cos t
8s.00
s 1s. 00
s 40.00
50. 00
60.00
100.00
130.00
300. 00
40.00
Sum
(
/
B Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less /
201 amps to 400 amps --7----
401 amps to 600 amps
-60L amps to 1"000 amps_
Over 1000 amps/vo1ts
Reconnect 0n1y
Expir.ation Date__
i
$
s
s
$
s
io
/03
40.
)o
36.
S
)
$
$
C Temporary Services or Feeders
Installation, Al-teration or Relocation
Expiration Date_200 amps"or less $ 40.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000-voITs see rrB, amE-
Address 47//? //ott-qs*
.<?rCct
-Ynon.
24')6&€s-
Sigaature of Supervising Electrician
Ci ty
OIINER INSTALLATION
The installation is being made on
property I ovn rr,hich is not j.ntended
for saIe, lease or rent.
0vne s Signature:
DATE:
RE
D. Branch Circuits
Nev, Alteration or Extension Per Pane]
One Circui t
Each Addi tionalCircuit or vith Service $ 2.oo /?or Feeder Permit
E. Miscellaneous (Service/feeder not incluoed)
-Each i
Pump or
Sign/0u
Limi ted
Limi ted
$ 35.00 3 f
ns tallation
irrigation
tline Lighting_
Energy/Res _
Energy/Comm
00
00
00
00
p
SUBTOTAL OF ABOVE
52 State Surcharge
3% Admini.s trat ive Fee
TOTALRECEIVED B
5 T.7T
5o
ovners x^ "Jf,AfiRf ,U; , bs c L n* t
Permit #:q t0 azt
q|q- u /64 *
n p"fl 6 ^, ,
b'i7 - 9r
Issued by Date:
Statement: Information Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701 .05 5 (4), requires residential construction permit appli-
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, exempt from 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 and2, and either box 34 or 38
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.
3,A'. My general contractor is
(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
38. I will be my own general contractor
If I hire subcontractors,l 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
a nstruction Responsibilities on the reverse side of this form
(Signature of permit applicant)
(llrhite copy to issuing agency permit file,
pink copy to applicant)
Notice to P
(Date)
Address:
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