HomeMy WebLinkAboutPermit Electrical 1990-10-9
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SPA.FIELD
225 FIFTD STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
:<' '5 90 M h"/ A'7 ~7"-
LEGAL DESCRIPTION
JOB DESCRIPTION ,
IN?T-4Ll ~J-.y -5a=? \://C~ .
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Permits are non-transferable and expire
if york is not started vi thin 180 days
of issuance or if york is. suspen~ed for
180 days.
2. CONTRACTOR INSTALLATIl)N ONLY
Electrical Contractor ~~r~~_
Address ]Q70 ~ ?6TH $T:
<""'OD '17l~ '#7 -
City~~f1L>--1JiOne ?rc-27 ~
Supervisor Lic~nse Number c!) q 3 -:::\ .
Expiration Da'te' IO-I-c;'?-.
Constr Contr. Number \A ') ~ ~
Ex iration Date 10-1 ;..Cfc
atur~~s;rer~ising Electrician
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Ovners Name l }-\ 'i\ \h "{\ ('{\ f _
Address \~'8J~ GtcA ~,~ili'il
Ci ty f ^ )C\ Phone -:1 :.l-\l$o ;
01lNER INSTALLATION'
The installation is being made on
property .1 ovn vhich is not intended
for sale, lease or rent.
Owners Signature:
~~~~:i:r~~\~yCh
RECEIVED BY: l t 1 ~
3.
ELECTRICAL PERHIT APPLICATION
Q()Ir031
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iYr ....
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Ci ty Job Number'
COHPLETE FEE SCHEDULE BELOIT
A.
Nev Residential-Single or
Hulti-Family per dvellingunit.
Service Included:
Items
Cost
Sum
.,
1500 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Dome or
Modular Dwelling
Service'or Feeder
$ 35.00
$ 85.00
$ 15.00
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 .~~
$ 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:lOOO volts see "B" above
D.
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Tvo to ten Circuits
Each Addt'l ten or
portion thereof
$ 35.00
$50.00
$ 15.00
E.
Miscellaneous (Service/feeder
-Each ins talla tion .
Pump or irrigation
Sign/Outline Lighting
Signal Circuit or
limited energy panel
not inclUded)
5.
$ 36.00
$ 36.00
$ 36.00
U:f) CD
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SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
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Permit No:
ql\ LQ~ I
Address: t_V
Issued bYCJ\ (m )
Date: lJ)j1L qO
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 Istatement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
/'
1,~
2, A, rip
I own, reside i~, or will reside An the completed structu~e, -
My 'T>~Q.~o~tor is _1+-\ 0 rt fQ 0 (' J)I g D_,
Contractor registration number I ~ 11-;)1,
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board,
I
I
OR
B, L-I 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 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 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 ~rm.
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~ignatu7'of Permit Applicant
/tJ-
Date
9'--
/7"'??J
. CONSTRUCTION CONTRACTORS BOARD" .
0244J 10/24/89
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YwatrE COPY TO ISSUING AGENCY PERMIT FILE
\ . ,,~:oPY TO APPLICANT
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