HomeMy WebLinkAboutPermit Electrical 1999-11-9
225 FIFTH STREET ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 q.~
INSPECTION REQUEST: 726-3769 Ci ty Job Number ( /43/
OFFICE: 726-3759
1. LOCATION OF I~STALLATION J. I;:::;:
\;:;a I ;..,. AS Pv1\'f' ~ ]
.. '
LEGAL DESCRIPTION .
/ 7.' -j." ? C:-,' .... .', .aw;;o,~rE'p "o"to
/r,J \ ~.~ eo ..y.c--;, ((QZJ..
- .0\, . " ".,-; - -1'_'l1".CI..' 'J\' I He V~ t1~VII ",",' lILY
'JOB. DESCRIPTION'" 'L"e~ r<, -e forth
l'{K+-:~f tf-:",:J..!iiMm)~~;.\:' -!:;~'001-
IJ\.!fU' , ";. .', ,T'-" ;PiJlS.~ 'I' fT' i-UleS oy
Permi trs are non~ t raris fenibiE' .'an'a Oexpi re
if vorkmi's, no ns tine.ted lw.i,tj1i,hltilJ80Iidays
of issuance"or....H '.vork~i's-~s.us.i>ended for
180 days.
3. COMPLETE FEE SCHEDULE BELOII
A.
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items
Cost
Sum
$ 85.00
1000 sq.ft. or less
Each ~~~~l.500
sq. 't"t"'U'11ortlon
the rTJdIS PERMIT SHALL I=)(PIJ:l1= IF*~K
Each ~Wl~'Rl?IIBE .
Modu)Af. b've"I'l: n RTHISPERMlTISNOT .//r-.
SerJ.i't!~I~e tlISAB8N80N~()'ftb~0.::t:J,.d.. 0"()
ANY 180 DAY PERIOD .
Services or Feeders '
Installation, Alterations
or Relocation:
2. CONTRACTOR INSTALLATION ONLY B.
Electrical contractorC'mU.,\!OU-<JlI ~Ie:::.
- J"-
Addres~I), 6(J1( d;:;>ClO \ 'L\\((. Ilt2-Qi4t8-200 amps or less
J' . 201 amps to 400 amps
Ci ty C; \ 1 rlUl.\I\ t Phone (() (l.,-:>.,- 1<''?-,1.3 401 amps to 600 amps
..J . 601 amps to 1000 amps
Supervisor License Number .l:f IQO ":\-,c:;, Over 1000 amps/volts
/ ) Reconnec t Only
Expiration Date /0/0/ 6/
I '
Constr Contr. Number Cf~ I(~
Expiration Date \()-()\
Sign.ature of~erViSing Electrician
<:::":. c:7 Q .c.- CI" ij(..O 7 S
~'
Ovners Name 7l7f5tV1o <. li/)/.J)
Address /'2.C; / 0 4~I-,
City.<.n/le! Phone? 1/'-1 ~/2/CJ
01lNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
-----~-------~---------------------
DATE: jI-'1< T/. ,
RECE pt #: r:;jWJ..5'Y~ _ ' , )
RECEIVED BY: 1/. {fluc/'nor
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps. 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circui ts .
$ 40.00
$ 55.00
$ 80.00
see "Bll above
,.
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional.
Circuit or vith Service
or Feeder Permit
>$ 35.00
$ 2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
40.00
40.00
20.00
36.00
$
$
$
$
dnOO
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