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HomeMy WebLinkAboutPermit Electrical 1992-9-4 tif 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 ()(.~ [.1'" . ~_