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HomeMy WebLinkAboutPermit Electrical 2001-6-12 ~;\te~. \~~~";;g Toiec\ as ~e l-/ ,tle \o\\OWinQ doe; not e 225 FIFTH STREET zon,n9 eno t1: SPRINGFIELD, OREGON ~~'4'Y't '9 0 INSPECTION REQUEST: 726-'M'l} - OFFICE: 726-3759 o~e 3 51 natUTe . 1. -:7-~0T~ OF~S\~?f<r~~ ~nf- A. , ,6 lJj1,1fF;,J~~Si ~1e,1AD1 sP#JN~fifiIt;, Q~*I-iO (541) 7f81.B)l1GE: FAX (5~A~1l 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 f ( 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 \ I 0 7,~ S lJ1J.., ()!:J.WO JOB DESCRJ;PTION A ( r" '-1/ U A4 -tl) ./W2~, ) .ft1 ~ U,f.N-:A 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 '? <;,... -' -- .~~.~()