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Permit Electrical 2002-8-26
, , ".,' .'.~ ELE CAL PERMIT APPLICATION . Cit~ Job NU~b~;:bZ~bIOZ.;f~~i:j '. .' . . . . . ' ..... . 225 FIFTH STREET 'SPRINGFIELD, OREGON 97477" ".. INSPECTION REQUEST: 726~n69 .. OFFICE: 726-3759}i;;' . . I , ., . ,<': .\ . . . ,3, ,COMPLETE FEE SCHEDULEBELO\V" I" 1\. i >*',' c <,.".,' ~,,'.., , i.' 1. LOCATlqN ()F~STALL-A,l:ION Il25() Dd I~I Sf ;or; / OJ7i7f6 LEGAL DESCRIPTION ' /702-3D3 6/(01 I . ~ .' d has the toll owing . subm1tte. \,!S.E\ JOB DESCRIPTION, h following prolect as Q~ire specillq.ae{)OSll.n. or less t1_ ^ 0 .-!t1eH d es not re . . ~_') ""'ID"'~ t~~~a. and 0 J-iN1. _ Eachaddltl~a1500 approval ~ Stt. fl or portion Permits are non-transferable and expirloning- () , if ":ork is n?t ~tarted ":ithin 180 ~ays of Issuance or If work IS suspelPcre~ fo,r d Signatur~ 180 days.' AuthOrize. ~"':". ,--:.-: - -. . ". :,,~ New Residential-Singie or " Multi-Family per dwelling unit. Sen'ice Included: i.., '. Items Cost Sm:n $106.00 $ 19.00 ach Man Home or odular Dwelling Service or Feeder .' .,.... $ 50.00 . , I 2. CONTRACTOR INST ALLATION ONLY B. Sel"vices or Feeders . ~(' W\~f.~ ~leJn.;c..- R Q. f ~ l~ ~VC(.tl.e1.. i- Installa~ion, Alter~tions or . Electncal"Contracror '. ..f'. V't\.C.....;. ! RclocatIOn: .,' . Add"" "'l'~~~.>h a. I I 1tA>l a t"A~~~: ;~~ :~~: ~~ ~~~ amps Citid lA~dt(~ ek Phone ~c../J '.q9'~;;~9.:" ':J..; 401 amps to 600 amps'~,. . ~ . .' ~Of"'7LJtJi€:!.' . ,,' ,:.:c,~;. ~ : ' ' 6011000 ...,.' . ,', '. "~;'~(I.~('''r1J<' :,....::;-:,.;\>;::...~,.::{i,.., ampsto... aI~lps, ..... .'.. . Supervisor ticenseN'umber . >;{CI!:k:S'l:.;, :~,\i:;J, < .< ...over 1000 amps/volts ,,?;~w<i>, '. . ,,' "\:' ' . , '.i,~:?;;:{v'.~,:~,~AAt\G.~pnlY':,':ti'.,,::t'N,Q\\\el Expimtion Date ~ l'n. ';"1J:!11 ~ '~i'lj~l'r: ..:~". tIUi' , ~"'f!~:~~~{g, >, , C C ':N':' b:\;"'.' .' ,;,~;J:'~'>:}f.)I.:.~~i'" ;r,~>' "O:>~ '~~1&~e' . , onstr ontr. Ulller >,).:,<'l_~~t;> ,~'; lrtlil. ~,~~lltlOIL:..~,\. ",:'<:/~:. .'. " ,'..;.:: ., " ';->," "', \; 1,D:~};;, '.'.. >;.::~ .,;J.< ,:'~?, Expiration Date Dtr,;" '2'-/ ,41,:5', :." '.. . rl;,' (;~ ess ;i;:~,:::<;;,:: ,,)<y.t1:i}?O.90 . . .... .. .,," 201 amps to 400 amps>" '.:':$69,00 Signaturc of SUJlcrvising Electl"ician ' I .':'.- Over.401 to 600 amps. ../ '. .::,,$.lOo,ob Over 600 ampsqr ~ 000 volts see so".:;:> I ~ , L. ',., -'-' '-~'~3<.,,; "B" above . . '/:~,:;>~.':,\ ; .,it_:_:~, . ':f".., ~,- '. ., ,,:. ./ 'y10,:.:',-,, '..,J .~,' , ?Jte/r 1A ""'fll~ ,I "..;.., ~ <"., " ,. ~ : wOwncrsNa~eS~ ~_' Rtre, '~A-is : 7 Address .' l(z,'5'"6 Cit)' ~f''t\ sr I .p. Branch Citcuits .. , New Alteration or Extension. ~er Panel . ~.t6 ..... ., '. ,.'.: ,a\, iq.qmr~syq.. One! eiibti(I~~.~~d :;" th~ Ore9()h'$U3:tb~1~ ~;.I\\\J\"ft'UleSa"" .' ',' 'se rutes areset10 . .~,. t'ntO center. t no 0952001- \.Ba'Glf'Amhtional. CiFcu>it-0r-wtm\'S€'~ce ~ : 'otFe~'h~5Peg~ii -u~~~n"~;~)i~S of the. &J3~o by J090. ~()U rrla~ 0 to INota: ths telepho~e E. MisceUnne:elij +(S€I~,i1:~lfc~dcr noftinGhidetl5icatlon I ~. I" J.- . +1:\,:\ Oregon U !In)' ,.... . j'ltJ\(!: 00I~~allatI611 ". ';nO~>"J.32~2344). . Pump or'ilrl'1[c1ttiUrl$1."'O'J ... . $50.00 Sign/Outline Lighting $50.00 Limited Ellergy/Res $25.00 Limited Energy/Comm $45.00 Phone OWNER INSTALLATION The installation is being made on property I o\.vn which is not intended for sale, lease or rent. OWllcrsSignature: 190~tl3IHS\j:J : 39 NtiH:J gV'GL $ G:a:J3~ lW~ ~OOG 9;:: E-Jn\7: 31\70 OG~O!OO-10:#SNB81 I I I . IYlinimum Electric Permit Inspcction Fcc is S45.00 + Surclllirgcs 1. SUBTOTAL OF ABOVE .b -:> . I 7% State Surcharge l{L/' 8% Administrative Fee .)(:) L-l l()- 7Z TOTAL