HomeMy WebLinkAboutPermit Electrical 1991-10-8
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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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 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
Ovners Name VY\ (1/\.J( 7' /V'\Oy.t/1.J^-.J
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Address \ -;))0, 0 I Lj ri e......
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OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
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DATE: JDI<i\"" I'
RECEIPT II: ') I<;:ji
RECEIVED BY: \':-}p.,
SltIIING~I~LO
City Job Number
3. COHPLETE FEE SCREDULE BELOV
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A. Nev Residential-Single or
Hulti-Family per dwelling uni t.
Service Included:
Items Cost Sum
1000 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 $ 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
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 vol ts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B"
above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Liniited Energy/Comm
One Ci.rcui t
Each Additional
Circuit or vith Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00 ~~.CX)
$ 2. 00 'd ,no
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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Issued by'
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Date: ltn /
Permit No:
Address:
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. L...,X::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
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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 (10 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 Ap-pljcanf
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10- 9-0/
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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WIelITE COPY TO ISSUING AGENCY PERMIT FILE
P.lNK COPY TO APPLICANT
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