HomeMy WebLinkAboutPermit Electrical 1996-7-31 (2)
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SPRelELD
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225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
The following proiect as aubmitted has the followin
zoning, and does not require specific land use
approval. . I ~
, Zonina L-~, -
. Dete1'~I' t1 ~
97477
7 2 ~l)I:6~ed Signature
,
ELECTRICALPERHIT APPLICATION
7VI
t;1ty'Job Number
9~
. . .
3. COMPLETE FEE SCHEDULE BELOV
1.
LOCATION OF INSTALLATIOR
t;, 7 fI '7 F r / ~.
A. .
Ne~ Residential-Single or
Multi-Family per d~elling unit.
Service Included:
LEGAL DESCRIPTION
)702 ~...,-,( 3 /) 7t:n
Items Cost
Sum
Permits are non-transferable and expire
if ~ork is not started ~ithin 180 days
of issuance or if ~ork is suspended for
180 days.
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof ,
E.ach Manuf' d Home.or
Modular D~elling
Service or Feeder
v- $ 85.00 $5r dID
.. J~ DESCRIPTION ., _
-W~~~~/'t ~~~
~ $ 15.00 '7~d~
. .
$ 40.00
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor ~~~
Address
B.Services or Feeders
Installation, Alterations
or Relocation:
Ci ty.
Phone
200 amps or less
201 amps to 400 amps
401 amps to. 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
. Reconnec t Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Supervisor License Number
Expiration Date
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
200 amps' 'or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts s,ee "B" above
.
D. Branch Circuits ,
O~ners. Name -1],.....? I
J&." . DU/'5r{/1"~
Address 6'/dJ /1/ 5L51'1,
Ci ty ~?Pfof Phone7L;t,-;o-7!
OVNER INSTALLATION
Ne~; Alteration or E~tension Per Panel
One Circuit
Eac;h Additional
Circuit or ~ith Service
or Feeder Permit
$ 35.00
$ 2.00
The installation is being made on
property I o~n ~hich is not intended
for sale, lease or rent.
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energ~/Comm
not included)
p~c
---------------------------------------
DATE: ?-"3P.%
RECEIPT #: -:2~~
RECEIVED BY:, ~j/r-"'_ _ .
$ 40.00
'S 40.00
$ 20.00
$ 36.00
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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Permit #: 9hU /~~
Address: ~ ::::> 9? C /""'" ~~.?-
;
Issuedby: ,~
Date: 7---;;;~-:;r::
Statement: Information Notice to Property Owners
About Construction Responsi bi I ities
Note: Oregon Law, ORS 701.055(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 1 and 2, and either box 3A or 3B:
lL1
U
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.
~
3A. 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
L0 3B. 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
Notice to~erty Owners about Construction Responsibilities on the reverse side of this form.
,; J~ ~~AYA"'k J;,~ 50 /7?~
. (Signature of permit applicant) . (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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