HomeMy WebLinkAboutPermit Electrical 2002-5-16
1. LOCATION OF INSTALLATION
'(-] q t ~ :;: c I'A 11
ELEL..dCAL PEmvrrT APPLICATION
225 FIFTH STREET
SPRlNGFIELD, OREGON 97477
INSPECTION REQUEST: 726~3769
OFFICE: 726-3759
LEGAL DESCRlYTION
170Z.3 b30
N ewResidential-Single or
Multi-Family per dwelling unit.
Service Included:
Electrical" Contractor
D~O
JOB DESCRIPTION /.-1 I . 1000 sq.ft. or less
#IiI- WI ru:: ? SlA. a 4 VII L( c.,'e...c...,^, ,l--s Each additional 500
( (I sq, ft or portion
Permits are non-transferable alfcll!;l.)(@lib~ thereof
if work is not started within 18'tYijI~ an~~~rOject as SUbrni Each Manufd Home or
of issuance or if work is suspeiiH@fpf(f#esnot reqUire ~ped 'Wl'btllreltHi/llwelling
eCltir b OWmo
180 days. ZOning ::-'--erv~~Feeder
Date
2. CONTRACTOR INST Akb~ TION . ers ~
' IOflzea S
Ignature ' Ilation, A~ s or
~~~
';!f~~~(,;'f 't.\"\
~~~~;\\~
Items Cost
Sur:n
$106,00
$ 19.00
Z . $ 50.00 /cL>
Address
Address
City
Phone
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Expiration Date.
Signature of Supervising Electrician
City
Owners NamU-a--O( 'r:...'A. I I I ~ ~
( /:j::~i/
~A1Sy sr
Phone --:::Jf~
9S3~ 7g76
L{2o~
Sff='o
D.
$43.00
L( $ 3.00 Il
E.
$50,00
$50.00
$25.00
$45,00
OWNER INSTALLATION
The installation is being made on
property lawn which is not intended
for sale, lease or rent.
&
~ or;:~n"'~
, ".,0.) '1iv-- v 't^-'
"'-'--.t, , U .
.'.i "...;V \..'
Minimum Electric Permit Inspection Fee is 545.00 + Surcharges
TOTAL
J / Z
7 sr
gr;b
\ Z-g~
4. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fcc