HomeMy WebLinkAboutPermit Electrical 2002-5-30
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
,-Q.0~
ELEM.lli PERMIT APPLICATION
P')} --003 - '-~O
City Job Number t/c. S ~ ~
3. COMPLETE FEE SCHEDULE BELOW
1. LOCATION OF INSTALLATION
',5'b (:., ~M.p_ O~r >/-;7~' New Rcsidential-Single or
I P-t t.J Multi-Family per dwelling unit.
LEGAL DESCRIPTION Servifj,e..Included:
I ~ 0 Z. 35"33 0 3:>q!? rniAct as submitted has the TOIIOsWI1~ ,
I nt:: lul1v.'rt.", r. not require specifiC land u ,2, , f
zOning, and does
JOB DE~GR9?Tij>' aripro\7al / 1 ;DeL 1000 sQ.fLor less
Cdn1 ~-ltn-. f)5;..IL tth .~g ~/ rJ. 0 r 0 ~Each addit~nal 500
S J '. I :>q. ft or portIOn
Permits are non-transferable r&\texpire e d"'\J-.I. ~11.eI'Zgf
if work is not started within 180'l:iit~eo SIgnatur - Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder
Items Cost Sm:n
;j Ge
! $106.0lf1ld~;-
tr tit d&
) $19.0811 (q(~
$ 50.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
+- ~/4' Installation, Alterations or
Electrical'Contractor 5 I HSl.e f..r'z& I(;. ,tU:::/tXf'l"c- Relocation:
Cfc. I 'f/:?' {. v'JJ,~ I~
Address O' 0 ~ rP.:?"'C@J<iY< ",,' 200 amps or less
I#. ' " ^ 201 amps to 400 amps
citfUJfiel~ Phone 6'V f ...., 7 2. ~ I Y.fk 401 amps to 600 amps
601 amps to 1000 amps
Supervisor License Number tft{.J "i"S . Over 1 000 amps/volts
Reconnect Only
Expiration Date /.1 /f N €f .
. , "i'r J? <.P&/J:- C. Tcm
Constr Contr. Nuni C. C IJ fb t> U J ()~, () l
'~.;-;;,
Expiration Date_I /t 1&1<3
$ 63.00
$ 75.00
.1,f1,ii,<-$125.00
It, ',," '::$163.00
$375.00
$ 50.00
Signature of Su lcrvising Electrician
" ////
-/.?~
",.~--_.. - y
Owncrs Name t1~ .1J~;6~
o amps
\>"to 600 amps
OVe!r 600 amps or 1000 volts see
"B" above
$50.00
$69.00
$100.00
Address (; 6-:LJ C~t:~
Cit{)/~ p~
IP-r
Or'''' . ~:r~ -'" :. ;.~
D. Branch Circuits .'.,:'j'~<'(~J).\"~..
New A1tcrati'!lli,or,e......-.wn~Grl~.Pet'Pane1
, ..:,..> ",<)\.'::>:~,.
?ne ein,nit .'.}. .\':\.~~\;:~,_~~.::. .
, " ..~ . . .:' . ."
'Ea~h Additio~Cl(eir211i.rci~ ;\vith Service
or F eedei; Peil\lit. .
$43.00
$ 3.00
OWNER INSTALLATION
The installation is being made on
property lawn which is not intended
for sa Ie, lease or rent.
Owners Signature:
E. Miscellaneotls(Setvice/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergyIRes
Limited Energy/Comm
$50.00
$50.00
$25.00
$45.00
Minimum Electric Permit Inspcction Fee is $45.00 + Surchargcs
TOTAL
~~(;,.)......;
IZS .-
,) .. ~
~~
J e~ ~ lJ/J
/I /o/1Iti(
4. SUBTOTAL OF ABOVE
7% State Surcharge
8 % Administrativc Fee