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HomeMy WebLinkAboutPermit Electrical 1990-10-9 l .. -... ~ . "'/~fh 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~ . '. 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 $T: <""'OD '17l~ '#7 - City~~f1L>--1JiOne ?rc-27 ~ Supervisor Lic~nse Number c!) q 3 -:::\ . Expiration Da'te' IO-I-c;'?-. Constr Contr. Number \A ') ~ ~ Ex iration Date 10-1 ;..Cfc atur~~s;rer~ising Electrician . li?irlft~,- , Ovners Name l }-\ 'i\ \h "{\ ('{\ f _ Address \~'8J~ GtcA ~,~ili'il Ci ty f ^ )C\ Phone -:1 :.l-\l$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 +r iYr .... y " 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 ---Lf ~ ,m SUBTOTAL OF ABOVE 5% State Surcharge TOTAL . ,~,-~....- . . 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. ! ~ '/( )::~. ~ignatu7'of Permit Applicant /tJ- Date 9'-- /7"'??J . CONSTRUCTION CONTRACTORS BOARD" . 0244J 10/24/89 . fl\JUU . . '.' . YwatrE COPY TO ISSUING AGENCY PERMIT FILE \ . ,,~:oPY TO APPLICANT LfJ' lC\Q..,. ~.