HomeMy WebLinkAboutPermit Electrical 1992-9-4
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225 FIFTH STREET II;.. "Ii...... ELECTRICAL PERMIT APqPLICATION .
SPRINGFIELD, OREGON 97477 .,,, leo, (}',V'i"/:';';;".>;;,ji1~"" n nL rx
~~~~IO~2~~~~: 726~~Qt:-=::::::O:C:::: BELOV ~ a.,.~
1. LOCATION OF;r:NSTA~~.':.. .. .44 rq'~.
Ho"C) n \' O_,'\~o~llC ~_ New Residential-Single or
~~Hulti-Family per dwelling unit.
/1 t):j85~~ON !l oyrro ServTCe-rffcluded: Items
rt An L~
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor lfc~P7&C>C/'~
Addressd)O?f) ~()()So 1\ Q]~
Ci ty CO n,truL Phon~ L\{Q. \ -- OQq
Supervisor L~icense Number ,~4 8~
\D.\.q'L .
Constr Contr. Number 3BtCt7
\ . ~ 0 . q,~.
Expiration Date
Expiration Date
Si~tture O~fUP rvising Elect.rician
t}lh~ /'~ ~
Ow s Nanie k rx~ \\ 0 fT\OJ) t- .
A dress \ \nCZi) ~ 1\ \ 0 f\ruilO
City_",~J_~ Phone ~t1~5125
OVNJ ~STALLATION C ~ ')
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~~~~----<:{~2\-~~--~~-------~-----
RECEIPT it: \ _~. - ~ ~ O\C).t )
RECEIVED BY:( - \ [1 ). ) - .
. -~
1000 sq. ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
B.
Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
C.
. .
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B"
above
New, Alteration or Extension Per Panel ~
-L $ 35.00 35..
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
'fOTAL
!
2.00 /J
$
no t included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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