HomeMy WebLinkAboutPermit Electrical 1995-3-8
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225 FIFTH STREET [1'';0_
SPRINGFIELD, OREGON 97477 .
INSPECTION REQUEST: 726_3769,111.0:) S':)"c.!.,c
OFFICE: 726-3759 '-"-'-
ELECTRICAL PERMIT APPLICATION
City Job Numbe[" cfl-S-.o~~
1. LOCATION OF INSTALLATION
~-IJ~ A./ {lJ 'i" V L.
. LEGAL DESCRIPTION
/707_ ::>..t=::. ?j7J ()?) I 2..7
JOB DESCRIPTION
A dB {JIM (' Iv C-ILTl-
Pe["mits a["e non-t["ansfe["able and expi["e
if ~o["k is not sta["ted ~ithin 180 days
of issuance 0[" if ~o["k is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Elect["ical Cont["actor
Add["ess
City
Phone
Supe["viso[" License Numbe["
Expi["ation Date
Const[" Cont[". Numbe["
Expi["ation Date
Signatu["e of Supe["vising Electrician
O~ne["s Name /l~4QA /PcJcj~-;:;--
Add["ess 2/)3 ./.In. 7Y'o fJL.
City J'/'A'/po,",/,!f.LOl Phone 7.7 6-6.JS~
OYNER INSTALLATION
The installation is being made on
property I o~n ~hich is not intended
for sale, lease 0[" ["ent.
Owners Signature:
,
/J~~ At~/
---------------------------------------
-
DATE: """3 '~7">
RECEIFT ll: /~ 5' qc.-,/
RECEIVED BY: ?'A' .;:< ;;
"
3. COMPLETE FEE SCHEDULE BELO\I
A. Ne~ Residential-Single 0["
Multi-Family per d~elling unit.
Se["vice Included:
Items Cost
Sum
1000 sq.ft. 0[" less
Each additional 500
sq. ft 0[" ponion
thereof
Each Manuf'd Home. 0["
ModularD~elling
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
'B. Se["vices 0[" Feede["s
Installation, Alte["ations
or Relocation:
200 amps 0[" .less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
q$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Tempo["a["y Se["vices 0[" Feeders
Installation, Alte["ation 0[" Relocation
200 amps' 'or less $ 40.00
201 amps to 400 amps $ 55.00
Ove[" 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
D. Branch Ci["cuits
0'
Ne~, Alteration 0[" Extension Pe[" Panel
One Ci["cuit J
Each Additional
Ci["cuit 0[" ~ith Service
or Feeder Pe["mit
$ 35.00 35iD
$ 2.00
E. Miscellaneous (Service/feede[" not included)
-Each installation
Pump 0[" i["rigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE 3c; rJ{)
5% State Surcha["ge i. 7'\
3% Administrative Fee i (\~
TOTAL ? 7 , 1(V