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HomeMy WebLinkAboutPermit Electrical 1991-6-11 i ~ 225 FIFTH STREET SPRINGFIELD, OREGON 97477 "INSPECTION REQUEST: 726-3769 OFFICE: ,726-3759 CD ~~ 1. Ll)CATIO~1fl'J2ALLA~IOHw; 7?97~ H7(~ J , , ' LEGAL DESCRI~ON . . / t~y " 0+' tv1,g,/:'rDts ,e-- C " JOB DESCRIPTION 1 "7 n;:)3102.xJ' () 11 OC) Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRAcrOR INSTALLATION ONLY Electrical Contractor f) lu Y1 eJ S Address 7 7q 7 ~ H t Jt.~ '2 ; e J-IlUj '..,' CityW..elcI ,Phone 7'1'& 5/(..5--' Supervisor License Number ..... Expiration Date , Constr Contr. Number ,Expiration Date .~ignatureof Supervising,Electrician ;' Owners Name-4ht';aH J-Hs/r' J)J{J D. Address.2.1J97 .-:J }ftj('t'J?zir- Jlut CitJlfr,'bljf1<VPhone 7Wo-. '/?5 ,OWER INSTALLATION The installation is being, made on property I own which is not intended for sale, lease or rent. [)r7CJ~ ,DATE: '[" -II -q I , RECEIPT I: :L(5I,t()- RECEIVED BY: f..)J.<') I ELECTRICAL PERMIT APPLICATION City Job NumberC\ \ (Y-!j.(l 3. COMPLETE FEE SCHEDULE BELOV A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum 1500 sq;ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $ 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 fX"Y:1?- $ 90.00 $130.00 $300.00 $ 35.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 35.00 201 amps to 400 amps $ 40.00 Over 401 to 600 amps $ 80.00 Over 600 amps or 1000 volts 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 Circui t or limited energy panel 5. $ 36.00 $ 36.00 $ 36.00 G.O IV) '" () 0 &> J..,J'YI SUBTOTAL OF ABOVE 5% State Surcharge TOTAL ; ,. . . Permit No: C\ \ C Y n()Co . Address:"l~C\'l \-\(''&1 -6(:> \~\ Issued ~ ~~ Date:C--\ \~\ 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: / . .,- 1. LA--J 2. A. L...J I own, reside in, or will reside in the completed structure. c,r)j: (IlfnVo;C'f) 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. L2s;:..J I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction ContraGtors Board. If I change my mind and 00 hire a general 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 contractor. 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 reverse side of this form. ~ ~~Of ~t~~ 10- JI- 11 bate CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT <I'J.