HomeMy WebLinkAboutPermit Electrical 1990-10-26 (2)
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SPR,8ELO
225 FIPTU STREET
,SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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L, I,Os;t.'Q;ON OFJ~STALLATION -. 0
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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 INSTALLATI~N ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Da'te
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
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Pbone l21o-Cff27
City
OVNER INSTALLATION.
The installation .is being made on
property .1 ovn vhich is not intended
for. sale, lease or rent. .
Ovners Signa tUff: . () II ;, .
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RECElr! ,: W' .~ \<-f.\/V___)
RECEIVED ny: G\( I.. ) V\' ./
ELECTRICAL PEiU!rr APPLICATION
City Job Number. ~
3. COHPLETE FEE SCHEDULE BELOV '
A.. Nev Residential-Single or
Hulti-Family per dvelling unit.
Service Included:
Items Cost .Sum
1500 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $.15.0Q
Each'Hanuf'd Home or
Modular Dwelling
Service 'or Feeder $ 35.00.
B. Services or Feeders (lQ Branch Circuits.
included). Installation, Alterations
or Reloca tion:
100.amps or less
lQl,amps to 400 amps,
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
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$ 35.00
$60.00
$ 90.00 '
$130.00
$300.00'
$ 35.00
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C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amp's or less
201 amps to 400 amps
Over 401 to' 600, amps
Over 600 amps or:lOOO volts
Branch Circui ts
$ 35.00
$ 40.00,
$ 80.00
see "B"'above
...
Nev, Alteration or Extension Per Panel
One Circuit
Two to ten Circuits.
Each Addt'l ten or
,portion thereof
E.
$ 35.00
$50.00
$ 15.00
Miscellaneous (Service/feeder not included)
-Each installation ,
Pump or irrigation
.Sign/OutHne Lighting
., Signal Circuit or
limited energy panel
5.
SUBTOTAL OF ABOvE
5% State Surcharge.
TOTAL .
$ 36.00
$36.00
$ 36.00
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Permit No: q() \ ~ y1 '
Address: . '\ _~ ()" ~ \=h \-1\ \ ") \ ~ l D\)'f--
Issued by' B)\W .) Date: ..ID).2bIQO
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requiresresidentialbuilding 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.
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Fil~"in /) applicable blanks, and initial box 1 and either box 2A or 2B:
1. ~ I own, reside in, or will reside in the completed structure:
2. A. '---.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 \ Q~
B. c=fl11 will be my own ~ contractor.
I If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and 00 hire a (leneral
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.
(}fan) A"t~A~&
Signature oflP~rmit Applicant
10/26/90' ,
Date
CONSTRUCTION CONTRACTORS BOARD' .
0244J 10/24/89 .' . ,
'E-COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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