HomeMy WebLinkAboutPermit Electrical 1991-4-15
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225 FIFfH STREET ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769 Ci ty Job Number q) 0 :;) j L-/
OFFICE: '726-3759
1. LOCATION OF INSTALLATION
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, 3. COHPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
JOB DESCRIPTION
;V) 1-1 '7 Par,
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, CONTRACTOR INSTALLATION ONLY
Items Cost Sum
1500 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Hanuf'd Home or
Modular Dwelling )
Service or Feeder $ 35.00 ?-, c;. ,00
Electrical Contractor
D. Services or Feeders (10 Branch Circuits
'included). Installation, Alterations
or Relocation:
Address
City
Phone
Supervisor License Number
EKpiration Date
Constr Contr. Number
.EKpira tion. Da te..
Signature of Supervising Electri~ian
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
$ 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
, , -, 'D. . Branch Circuits ' ." .
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Address
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Ci ty ~('fJ Phone
OVNER INSTALLATION
The installation is being, made on
property I own which is not intended
for sale, lease or rent.
$,35.00
$ 40.00
$ 80.00
see "B"
above
New, Alteration or Extension Per Panel
$ 35.00
$ 50.00
$ 15.00
E. Hiscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Owners Signature: Signal Circuit or
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. RECEIrl. i: l"'h~ TOTAL' ':J..,t-,,-')('" ,. -...
RECEIVED BY: IN!"!
One Circuit
,Two to ten Circui ts ,
Each Addt'l ten or
portion thereof
$ 36.00
$ 36.00
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Permit No:
C)Jn:2jLf
S:?,2, S VY\~ -Fl 3,b
Address:
Issued by:
m
Date:
4/J<:..h,
. 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, eKempt 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 bOK 2A or 2B:
-
1, I ........1
I own,reside in, or will reside in the completed structure,
2, A. L-cJ 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 contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors 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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Signature of ..permit Applicant
Y) Ie.. )"1 I
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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VvHITE COPY TO ISSUING AGENCY PERMIT FILE
-PINK COPY TO APPLICANT
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