HomeMy WebLinkAboutPermit Electrical 1991-6-11
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
"INSPECTION REQUEST: 726-3769
OFFICE: ,726-3759
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1. Ll)CATIO~1fl'J2ALLA~IOHw;
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LEGAL DESCRI~ON . .
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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)
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&> J..,J'YI
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
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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:
/
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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. ~
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10- JI- 11
bate
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
<I'J.