HomeMy WebLinkAboutPermit Electrical 1991-10-1
225 FIFTU STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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1. LOCATION OF INSTALLATIqN
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are non-transferable and expire
if work is not started within l80.days
of issuance or if work is suspended for
'180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date -
Signature of Supervising Electrician
Owners Name R\r_hcd~ . ~c~ktVls
Address--U3.0 . ()I~""pic c+
City ~~"\~.clcl~ Phone ;'2.C 9.!i2':1
OYNER INSTALLATION
. The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signatu19 ~' '\,--.
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DATE: /t9 - / -'1c:
RECEIPT jj: . 2) <(74-
RECEIVED BY: _1k.4~:"""_
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City Job Number 7/// SS
3. COMPLETE FEE SCHEDULE BELOV
A.. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f .
Each Manuf'd Home or
Modula'r Dwelling
Service or-Feeder
$ 85.00
$ 15.00
$ 40.00
B.Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
~ $ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
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C. Temporary Services or Feeders
'Installation, Alteration or Relocation
200 amps or less $ 40.00
201 .amps to 400 amps $ 55.00
.. '.Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
D. Branch Circuits
New, Alteration or Extension Per Panel
One Ci.rcu i .t
Each-Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2: 00
E. Miscellaneous (Service/feeder not included)
.-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE. ~O~
5% State Surcharge ~S-o
TOTAL - C? fro
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$-
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Permit No:
9///ss
Address: /2 so qrA?/?/('
Issued by: ~~ Date: (/J// /V
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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. L--J I own, reside in, or will reside in the completed structure.
2. A. L--J 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.
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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 Owner!<-about Construction Responsibilities on the
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CONSTRUCTION CONTRACTORS BOARD
0244J 10/24189
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WHITE COPY TO ISSUING AGENcy'PERMIT FILE
RINK COPY TO APPLICANT
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