HomeMy WebLinkAboutPermit Electrical 1991-2-14
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225 FIFTH STRKRT
SPRINGFIELD, OREGON 97477
, INSPECTION REQUEST: 726-3769
OFFICE: , '726-3759
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1.' l,OCA'f70q OF IN;iTAJ,JAT);ON '
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LEGAL DESCRIPTION
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Permits are non-trals4erable 'and expire -D
if work is not started within 180 days
of issuance or if work is suspended for
180 dars.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor, '
,Address
City
,Phone
Supervisor License Number
Expiration Date
, Constr Contr. Number
Expiration Date
Signature 'of Supervising,Electrician
OWO" "'~\\NT(\1'I \\'I-r.\<;\ o~
Addr~ss f\f\Q,l\ \\\~..Df\'fl 0 ~JJ
City ~0rt. Phonel4\n,,~
OIlNER IN)TALLATION
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The installation is being, made on
property. I own which is not intended
for sale, lease or rent.
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DATE: A.l4,q \ '" _
, RECEIPT If ~' , IYJ-lN)
RECEIVED BY: (. I In
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ELECTRICAL PERHIT APPLICATION
City Job Number q \(\ 1\'1
3. COMPLETE FEE ScnIIDULE BELOV
New Residential-Single or ~
Hulti-Family per dwelling unit. ,
Service Included:
, Items Cost . Sum
1500 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Hodular Dwelling
Service or Feeder
$ 85.00
$ 15.00
$ 35.00
B. Services or Feeders (10 Branch Circuits
included). Installation, Alterations
or Relocation:
100 amps or less
101 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 35.00
$ 60.00 LO()
$ 90.00
$130.00
$300.00
$ 35.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps'
Over 600 amps or 1000 volts
$ 35.00
$ 40.00
$ 80.00
see "B" above
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
.Two ,to ten Circuits
Each Addt/l ten or
portion thereof
$ 35.00
$ 50.00
$ 15.00
E~ Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
, Signal Circuit or
limited energy panel
5.
$ 36.00
$ 36.00
$ 36.00
LoO .00
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SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
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Permit No: q \ () \ \ 'l
Address: l\ 'f\C\T) \'t\~( 0 f\ hO ~ li
Issued b01 fY) ) _ Date: 6)/14 fil U
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. 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 box 1 and either box 2A or 2B:
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1. ~ I own, reside in, or will reside in the completed structure.
2. A( L-.J My general' contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. ~ I will be my own general Gontractor.
! '-/ If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and 00 hire a Qeneral
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 Gontractor.
I hereby certify that the above Information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reVerS!!;f:;;r4/~ ,~~ /(j-91
')Signature of Permit AppligEfnt Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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