HomeMy WebLinkAboutPermit Electrical 2001-6-12
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225 FIFTH STREET zon,n9 eno t1:
SPRINGFIELD, OREGON ~~'4'Y't '9 0
INSPECTION REQUEST: 726-'M'l} -
OFFICE: 726-3759
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51 natUTe .
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ELECTRICAL PERMIT APPLICATION
ity Job Number () I (JOSCjt 0 I
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
-lD, -I r -O,/J Installation, Alterations
Electrical Contractor~I~J-- \-:~~)~~_or Relocation:
Address.z; 1)(08 J J '), I r.J:..,h 4::!:::-, ~ 200 amps or less
I ~ .' , 201 amps to 400 amps
Ci tyt::.-llJE'-V'iP _ Phone(rJSS:}.,l') 7-7-0 401 amps to 600 amps
. /) Q 601 amps to 1000 amps
Supervis License Number, } Y)'1-/} l ) Over 1000 amps/vol ts
, , Reconnec t Only
Expiration Date iO/j /01
. I
Constr Contr. Number \~~~05<7-C:
Expiration Date /D/I J oj
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Signatur~~trician
I 1\ '~-~12... ,D. Branch Circuits
Owners Name I....U,rYv r. r~
^-L New, Alteration
AddressfO;+'" ~~' 'I ~ '
City}),{Y1A,~ . Phone 7-l(7- -13D,7
OVNER INSTALLATION
LEvAL pES(;lUPTION
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JOB DESCRJ;PTION A ( r" '-1/
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Permits are non-transferable and ex~
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
\
DATE~---~71~~Q\---------------------
="",J.PT II:. .
RECEIVED BY: \~U~
COMPLETE FEE SCHEDULE BELOV
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost Sum
1000 sq. ft . or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000
$ 40.00
$ 55.00
$ 80.00
see "B" above
voHs
or Extension Per Panel ~
, ~ $ 35.00")./7 ;...---
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$
2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$ 36.00
'?SoD
40.00
40.00
20.00
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