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Permit Electrical 2002-8-15
225 FIFTH STREET SPRINGFIELD, OREGON 97477 .. INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ELE(i~CAL PE~LJCATION City Job Number oZ -ab 9' Jfl> rO, 3.. CO!v1PLETE FEE SCHEDULE BELOW 1. L10CATION OF INSTALLATION .... (,,00 CENTl::"IJ t-J, ~ 8UJt:> LEGAL DESCRIPTION 170:s2S3Y o LfL/O L NewRcsidential~Singlc or. Multi-Family per dwelling unit. Senice Included: Items Cost SUI)1 JOB DESCRIPTION The following project as su~mitted h.a.s tflmq'iSWi'tl.gor less lP~"U..6 ~A1It&D ~i1Q....and does not require speclflcE11~~1 ~5J3ditional 500 approval. Of!-, . sq. ft or po_rtion Permits are non-transferable and expfRflng 5 _@-g.,jtnereo! if work is not started within dl~ter1'1~r~ . ~.r U . &del. ItuuLJ'd Home or of issuance or if work is sUSP;Ot~S~18d Signature _ ~ Modular D\yelling 180 days. Service or Feeder $106.00 $ 19.00 ~- , \ $ 50.00 2. CONTRACTOR INST ALLA TION ONLY Electrical Contractor> E ~ ~ 1\ B. Scniccs or Feedcrs Installation, Alterations or Relocation: Address \ l/fr tA-\<~-\c ~ Rc\, . · .yf:) Cityt ~ \'l7~IPhon,Y85- S:!L Supervisor License NlllllberY\. y.$ \C,. ,<" ,',.' ,-, Expiration Date 10'" 3 ---b:3 Constr Contr. NumberCCBl.Q'5155 . , . 200 amps or less 20 1 amps to 400 amps 401 amps to 600 amps 601 amps to.1000 amps Over 1000 amps/volts Reconnect9uly Temporary ServiCes or F~eders ;Installation, Alteration or Relocation $63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 r'O'''~.(l'OJ 200amps:or less . 201 amps to 400 amps Signature of Supcnising Electrician . 40ltQ600amps .~. ... ..' .. .. . Over600 amp~ ~r(;' ," _>n~' .'.,'~..: ;> ,,":..:,;~",_. '~~cabove <~~~\~\}~~ .. ,. . ". ... . ~~\"'~\?O ,,<\ 'v){\' . 'C.S? ,\\\,W ,/ >~c.' ca...~:J . . ,,1;': ': ,,),,\'\!\;:.. \\~\l~~' !>.'6~~~ . . , ~ ~''''I . .....- ~7 !D. ~,wch ~1{:{~~ c,,"{.;\ 1\,) , .. . .. Ow~~rs Name" ." V bl'$~~o _~ <t- \\~ \~W;~i~f~~~f,~J$~sion Per Panel :j~X ... ...... .' n\, r\\I~\".. r" \lib ... . 'A.ddresslt::iiwCc~~~~:~ \ 6/vd "\;~~~'~~~~r\l. .. $43.00 .. Cit/ S JY.ffn Phon~# Lf8F--- .5Yl. r ~a~h Additional Circuit or with Service .. or FeederPerrnit $ 3.00 ..OWNER INSTALLATION, The installation is,beingIllade on property I o\vn which isnotintended for sale; lease or rent. ;) Owners Signature: E. Miscelhi~eous ,(Service/feeder, not. included) . -Each'installation .'. Pump'o'r irrigatio~ SignfOl1tlineLighting,' ., Limited Energy!.Res ....' Limited Energy/C6mm . $50.00 $50.00 $25.00 $45.00 50.(1\) L90 ~ ~!3IHSoU ; J9Nlj:-i:J OS 'Z,':rCt C:J3i:i lYJlj 2002. 9'T ~]n(/~~11VG 80~(nOO-:~o ~ :;fSNlJb.L Minimum Electric Permit Inspection Fee is S45.00 + Surcharges TOTAL 5l>.~ 3.m 4.0\> C51~ --. ~ 4. SUBTOTAL OF ABOVE 7% State Surcharge 8% Administrative Fee