HomeMy WebLinkAboutPermit Electrical 2002-3-25
225 FIFTH STREET
SPRlNGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELb,.<1CAL PERMIT APPLICATION
City Job Number 0 ~ ,<.)0 526 "'0 )
LEGl:tESCRIPTION Tb
,... /'VI...< / /70 Z ;;, ?~'((~o//owi~4LfOO
,C-",< " .... Project
8.{.J% ~ aflo doe' as SUb '
11&/ ~ flOt f1J1tt&f'f.
JOB DESCRIPTION ' reqUire sl\Jl1t!l~ or less
<: ~7 'fl..A../ I C C- f- 1',::/", ZOflinq L[)rL ~f6ItFcJetW-'?g,~f100
3-o.S sq, ft or portIOn
Permits are non-transferable an'ci~x~o S -0 2, t 1
if work is not started within 180 days Ignature
of issuance or if work is suspended for
180 days,
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
CONWLETEFEE SCHEDULEBELO\V
L LOCt\;TION ~F INSTALk4~ON
LIe:. (/( ~ //111-1 e {, lU!J.
l../ T....- ~ -
Items Cost
Sm:n
~ $106.00 /D{;,
$ 19.00
ome or
$ 50,00
2. CONTRACTOR INST ALLA nON ONLY
G Co 12 e--13 4)c6-EL ~ ,,-:e I
Electncal Contrnctor
ARa 7DWL B[e_CL~
~clress
CiP!~
B. Services or Feeders
Installation, Alterations or;.
Relocation:
200 amps or less
20] amps to 400 amps
40] amps to 600 amps
60] amps to 1000amps
Over ] 000 amps/volts
onnect Only
"Constr Contr. Number
Expiration Date j,-' 2
'-,,'____,0..- ,-__'-' :.",:
200 amps or Ie
201 amps to 400 amps
Over 401to 600 amps
Over 600 amps or 1000 volts see
"B" above
. D.
Owners Name S'7 CPt+f: 1\( 1(,t'A~
Address, '-1 Z 11.3 1~~-1'Z.~/1 a.~
City Sfr~ p~:t.r7r
Branch Circuits
New Alteration or Extension Per Panel
One Circuit $43,00
Each Additional Circuit or with Service
or Feeder Permit $ 3.00
OWNER INSTALLATION
The installation is being made on
property I o\'vn which is not intended
for sale, lease or rent.
Owncrs Signature:
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$50,00
$50.00
$25.00
$45,00
Minimum Electric Permit Inspection Fee is S45,OO + Surcharges
TOTAL
lot -
7t;z..
'/6'1%
/2 I :1.0
11 H....i
4, SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
'l+(";~.PH'\j !
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