HomeMy WebLinkAboutPermit Electrical 2002-7-16
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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ELECTRICAL PERMIT APPLICA nON
, {J' '""'"\ ' TF:P.NS#:Oi -0009945
City Job Number cA ()C) r- ~~J.Q:~ 16l ~OQ?
, , , nMI I\LLu.L $ ,O-J.L:J
3. COMPLETE FEE SCHEDULE BELOW CHANGE: '
Cf~SHIER: 001
~. LO ',TI01j..pF INSTA!-~],~. ON ,J . I
~ t..j {/ ('1.0 /?tC.P LAL
, ..............,~.
LEGAL DESCRIPTION " '" )
J 1 t:> 3 ~-S- J;l.. I,S'fi4O V
A. New Residential-Single or
Multi-Family per dwelling Unit.
, Service Included:
Items Cost Sum
)9~. ESCRI,PP)3I 'ON,p _. ,~)..' <-, " 1.,000 sq.ft. or ~ess ,
'7::) ':IJUh/'/ ~A/,lJ cSerueL4 - Each ~Wi\Jtttit'%oO
'1/111 ,vo~ ~M-t-C;rCII<<!-, II1.tk/I.iP\t\(~tJf..e~~t
Permits are non-transferable and, expire '",Q ?foiec ,'\e\.\0\\ f. 1l1'ereof ,,' ,
if work is not started within 180 d~\o\\O~~d: OOE;" "'~"f-...l2- Each M~e or
of issuance or if work is suspended~il\~~\la\ ~-~o~ ~
180 days. e.?? 1.;~~~_~..&,...,~ ~ or Feeder ,
2. CONTRACTOR INSTALLAnO~~ . ,~IS 'ces or Feeders
" ' , ' I.lI.J\'t.\:OO SlY" _.("jIlstallation, Alterations or
~Iectrical ContractorQAI./L 0>> ~/e/ fN,Relocation:
Address IJ,o,:BO/' 2-315 tj
NOTIC!![ ~~flL Phone -;,; ytf-'/f:d
THIS ~~ ~Io~~A~~P.1Fi~ IF B
AUTHOhlZED U ~'OtR~'P~ , '
CdMMi~rnMS
ANY 180 QAVPER10 .
Constr Contr. Number ~~ f1 '
',Expiration Date S.,. / ?t - 2/)c;t/
$106.00
$ 19.00
,$ 50.00
AT4Qf)rampsl@r\~gon law requires you h$ 63.00
foll@()Jllutw.s m::!4.Q~f.lad1PJlj the Oregon Utm~175.00
Notiftlilit~~Asrp.~.~~Wtie rules are ~At f~l2:5.00 '
in o~~~~ ,~9~e1fm!bughOARg~?-n~\63.00
009cP."flOJ <m~~cYR\t~opies of the-w!es~~5.00
c~ffi~r~tcevr~er. (Note: the tele~ 50.00
C Tnum, b, e~f r the, or~~ Utility Notification
, ',' empora erYlqe~:Qr_ !_~~ _ '
'.. In t II t' entell't.l' R"I'~?f2344).
s a a lOn, AIrera IOn e oca IOn
/
200 amps or less
201 amps to 400 amps
Oyer 401 to 600 amps
Over 600 amps or 1000 volts see'
"B" above
$50.00
$69.00
$100.00
Signature of Supervising Electrician ,
rlk-, ,
~ 'P h 1/\ ....( ~ f D. Branch Circuits
U/f.o~ NeW, A1terationor E_,ion rec Panel
Address---1.k!{:D (.airier Lv _ , One Circuit ~ $43.00 tf3 (rJO
citC,'PkD Phone:J..!it.~~
OWNER INSTALLA nON
Owners
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Each Additional Circuit or with Ser;i1 ' ..d'\
or Feeder Permit 'T- $ 3.00 12.- ~ vv
, ,
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
Owners Signature:
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
5~. OD
TOTAL
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