HomeMy WebLinkAboutPermit Electrical 1994-1-27
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; bmltted has the lollo"
225 .FIFTH STREET The,fO\lOWinglroI9~t~:~~ire speci1;~~ lanE~.u.JCAL
SPRINGFIELD, OREGON 97477 zoning, ~,nd oes I\~ . .
INSPECTION REQUEST: 726_3mrova.. (L Ci ty .Job Nlimber
OFFICE:" 726-3759. . Zoning~
1. Y?~~'fIOttl>r INS'IlN-~~Oft,M) I 3. COMPLETE FEE SCHEDULE BELOV
t ~ C)\ W U.o1lVO,A,l.rih ri <~'igntlture~'\~f7N~ldential-Sirigle or
',' 3\(150 l;J1-n..J Multi-Family per dwelling unit.
~Al-">>E~~.rrION.' Service Included:
t J IUL-~)~' fY)P()f'-_.~ Items Cost
=!:~~:f~::~1le ~;~L~!:!~;~~;~:~~~ : :::::
if work is not started within 180 ~~s .Each Manuf'd.Home or
of issuance or if work is suspended for Modular Dwelling
180 d~ys~ Service orF~eder
PERKIT APPLICATION
Cf4-'OOtCf.
Temporary Services or'Feeders
Installation, Alteration or Relocation )
$ 40.00, . f(
$ 55.00
$ 80.00
. vol tssee "B" a'bove
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
Installation, Alterations
or Relocation':
Electrical Contractor
Address
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 ~mps to 1000 amps
Over 1000 amps/volts
RecoOllec t Only
City
Phone
Supervisor License Number
Expiration Date
C.
,
Constr Contr. Number
Expiration Date'
200 amps
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1900
. ..
. . . . .
Signature of Supervising Electrician
· ::::~t ~)~
Ci tSfn UWJ (!)b ~
D. Branch Circuits
Sum
.$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
New, Alterati~n or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
OWER INSTALLATION
One Circuit
Each Additional
Circuit or with Service
or Feeder P~rmit
The installatioh is beirig made on
property I own which is not intended
for ~ale,lease or ren .
E.
Owners Si
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RECEI PT, .:
RECEIVED BY:
-~--tl1'/-6ft--~1~-
1\ n f f\^ j t\ ~ U '-""
V1lUA-/
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL .
$ 35.00
$ 2.00
not included)
$ 40.00
$ 40.00
$'20.00
$ 36.W
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