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Permit Electrical 2002-1-9
\ , - - '. ,.. I .-.....r' 22)FIFTH,STREET, : ""\.,, ",' .SPRlNGFfELD', OREGON 97477; . .'j;" : - , . ' .' - - - ., ~> -', -."- < . 'INSPECTION REQUEST'726'3769'" ' , 'OFFICE: '726-3759 ::,1; l, ',:: :" ii",'" "'i: I I :: ,r" r. >~ . '; I , f;'" \ ," ~ ~_>~) ~::. j' I' I ~ I - Ld . . ". I I .:,' I ,I. LOCi\ TION ,OF INSTALLATION , 1. \~ t.-, --/q L <gJ :p ~ ' ,"^~...' of' ~ ,.. -; f~ :""',, E~E~C~:~~RM1T AP,~L1CA:rION t-1ll (~itV'iIoh N;II;i~er:0ri:.(SO'S7./:"" P I ,'~ L,~ :~.~',"1 P? (';;<::>:(;':</, -: , .' "', ~' . -,' " . ,.~.-3:~ COMPLETE FEE SCHEDULEBELOW" , f'i :i,;'~;L:. .,;t":~~,'-' '/ l,~,<-'J:' _'. "; j ~ - ..,' "",I .._~.......-:.I f( "Nc,Y:R~identbll..;Single' or"'-';~'"'-'"";-" . Multi-Family per dwelling unit. Service Included: \ " LEGAL DESCRIPTION 1702.."36;'0 o /7c) 0 ,', , JOB DESCRIP1;.{ON . 1000 sq,ft, or less 5 (2" L h.rL ~ "'~ 1 1.....".... >>e Each additional 500 ," 'ng project es submitted h~hjj:tIlnQl<1lr1;on Pernllts are non-transferable Wi\\l'I' \'I!d does not require speclfiM~fUse if work is notstarted within 1 ~~n ,~n (l- Each Manufd Home or of issuance/:u ,if work is suspen ed for Zoning CD ~,f~\::.:." E' ".dling 180 days, .;',:," J -Cj - (J '2- ServicP~der ,1";,,(': Date -r<.v.J _ ~~'? : ' 2, CONTRACTOR INST ALlA.liWil/e6lISlgVature F;, 3.. He"' or .eetlers I' .', " EleClriCal~~n;iacto;>:'~o-.t"t C~IJ 12l..., L ~:l~~::::~:~' AIt7t::~:,o~ '.,:: '.;~ ~i,';...,':'.,., ". '''. .. ',- ", "" r C'/ ..,,'," " Addressf4'~'}d~' Ct),v-, ~~1:^:::j"... h, 200ampsorle~t,:,,\ji"!'''''':>''''$~N~~'b::)' r )// 'or!: " 1. '7/ : J' 7 t/)..., 201 amps to 400 amps,::, ~ $ 75,00 -. Cityl-cl: 'L~: ,Phone //J;,' -:,I'I.P '1,,,401ampst'1606a~ips;.,;"; ,,_$125,00_ " ." 1, ,,: /, : . "." :," 601 amps t~ 10~0,amps''''l'Q~\o; $163,00,," Sup~rvisor Lice~~eINulllb~.r .3 q P'Lf ' ~-._tlitC'0v-ef7(jo&aifiPS/y~~,:.~;, ;j,,;,:)', - $375 00 -, i {!... -' , . . i;__\.JV"..~' < )\....jI~O'.I~\U'oqj.~~.... . ~..~~ $ -, I . '."u.,,' ..-,..,~'. ')~' ~~'r-~,"'i;.'.~t:Reconnect ny do..'F!.,'!}t":::'I~",\"~ 50.00_ "'/ .1,.""1 . .', 'l:"l"<'~ -'''In'''S\~'\l,\'r'''''''<''''' ~'? ExpirationDate" 0- 1ft .;.., (J'-S<' , ,,~'t;~l ,~~"/1tC,1..'"~t, :'''~~i-\: ,.k~ -:~\~~~:..1,,1", ,.; r.-r' '." '. '.,), I' ", (\\"IO\;'C' 'T'" or' "y'Sc"1i"i~:;c[e'so' "F' ders ,'fIf,..,~",f ,. L.C~nstr f~n~'N~~ber ',16.747:' ,:"::t~;~:j':~i~h;::~n;~~~;!i;~~-~;~eio:a;i~~~/: '. '; . -,_~",.....~ , .._ '. ..n l' ~ " J.. '",' ('~~ t,.Ift ' -'I "'., ;;......__:..._:,'... _ 61:. "~"'~.;,'-;.l; -' \J1~ ~~ .c,~, --'> . i-:','~ +J,' ,'('t',' ~ -. ," .(:>;Explf3tlOnDate '-- - ~",~,._' " , ,,'t ~\\~~oo.a~npso[;\e~~ (~: t '~7dil~'" ,~") ~\~',$)O.OO ~' -,' I"~ .~_ '- _~ ~ f\Ul\''Iol'~ 1201~a~m~st6'i400'a~-'s . f 'I~' ), '/"1' "$69.00 . " '." ~" --"Ct".",P, P,,,, ,-"- " " ;;;, Sign:!tu~eof_~upervis g lectricir'lIl -........-:;,.Ov-"!,40Uo..600 a.mps":~.:' ..,,' $100,00 , ' . .~' '.;. '.. ':>'" Over 600'amps,or_lO.?Ovolts ,see, " ,,'~ "-'\;, _, " .,'~.. "BlIabove ~'-~~~""'l.:..\.'~ :.- .;. ',". I. ':', ,-" ~,:,:,.,4'_"'"", - .'''- 1\ '\:':". '. ;." /'_I'~->':' ,<""::~'. ";"""" J t. D. Branch Circuits }, lyw,;ers Namc~'Y; (Je(VllefL NC\';/1it~i~~on or~~tension Pe/P~,!el,\,{ :,. '...... Ad~ress}';~,~~9 k\ yJ- NO~~~~LL~~IREIF-filg\t.10R~d3,~0'~ , .;,~it.:,,~~!@'c. ~~~r~i>; 7V 1-68~/ ~=~~~$X1~~;~..'~;~:i'OO"Lf' ,OWNER INST~LATION', ' M\lV 1RODAY.f'ERIOD.,.:; __ ' ; , '. . . The instalhition is~eing' Iilade on E. l\Ti1itellhneous (Service/feeder not included) ., :, /"': '1 ',' ptopert~/I o\vn 'which is no'tintended ;;. f; i:Each i~stahati~ri" 'i. " ) r \, '." '. '" j'.. ' ~.' ,.>,") '." . ';';:". -,y: c' ::"/ ~>:"-i'i ' "':;1',;(,,:: l~ Pllriip",'6.'f,:i'ir. ig~ titibk~":',i:,~" >,,( \ $50.00 '. ',' , for sale, lease,or,~~~t. '. ~ ,f:,: ',. ..,:, '~J~. _ _ .,', " "..J .: SigivOI;liine)...(ghting~'$50bO . . O";n'~~s Sign~ltut~:..'.. "...-' '~',,1" :,,,~t;~:~:~l" :1 Limited Ehergy/Res _ -:", $25.09 .".{ ',:,,'.\, , i ,~:':>ci'H~~t~t~j~:~~gy/C~~l~> $45.00 .' " -' .' ., l\'Iinimum Elcc'triC"Permit Inspection Fcc is 545.00 + Surcha'rges ':..:'/i','< . '.' 6r' 4. SUBTOTAL,OFABOVE : "-,",,,,. . ", 7% StateSu;'charge ,.' 80/0 Admini'strativc'Fc'e: '" ":" '.j .. j", " " 190 :~3IH8iJ::J :39NtJH3 ."" ,-' g!;:'6l; $Zt(l03Ml~' , ", .. (;OO~ 60N\ir: 31lj(J :.'" , '. v1LLOOO-TO;#SN\i~I " .', ., "',.', l( /:j,j c: 5-<<'- .",' (,',,:'j' II; .' ',', , ' , 'J.' 7(~ " " " h. " ",:'...1:' TOTAL