HomeMy WebLinkAboutPermit Electrical 1998-6-10
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SP.GFIELD
<;C,,;ing. and "does not require specific land us~
c.ppr0val. \.
Zoning rl.iI'
rdt.,.~1 o-'t.l . .. ,
225 FIFTH STREET Authorized Signature l\ ry'\ _. ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477. . NOHv~~ . w()RK qo tV -71 _
INSPECTION REQUEST: 726-3769 S PERMIT SHALL EX~REylr J~ NUiIioer ,() l.flJ lV'
OFFICE: 726-3759 THI i"\.co.11:i'~eERMITISNOT ..
AUTHORIZf.D U~9JitPLETE' FEE ..s~8ffULE BELOV
1. LOCATION OF INS1;'ALLATION r.EO OR IS ABANDONED .
<:;)-~ ~ c:, ~+/....c4 CT COMME!'J~. 1l~~ ~esidential-Single or
ANY ~80 DAY ~Q't:'Family per dwelling uni t.
J 70~~ODO/ Or Service Included: Items Cost Sum
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JOB DESCRIPTION
~ .'J.IAA.T" p~
,~. .
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or.
Modular Dwelling
Service.or Feeder
$ 85.00
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
$ 15.00
$ 40.00
:.
B. Services or Feeders
Installation, Alterations
Electrical Contractor J<~I~q ~(o~~l~or Relocation:
r. . ,.,Je:...
Address (? 0 l&"...,e )...~l ~ '1 "' 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
Ci ty, t:~5..p.....JP Phone
Supervisor License Number
G.~ -b~ 1.1.
do - d t?&f t:..-
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
...
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2.
CONTRACTOR INSTALLATION ONLY
Expiration Date /o-(-<J>1
c.
Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr. Number "lJl?R '7
Expiration Date /'1- ~~o-'ly
~ V'- -AJ-vI
200 amps"oT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
$ 40.00
$ 55.00
$ 80.00
volts see "B" above
Signature of Supervising Electrician
D.
Branch Circuits
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OwnersName~....J S"",~--L.
Address 5)-- Cf p C.v J-J K;a c.T
Ci ty ~'1-h-e" n Phone 1" 1-/77 ,
OWNER INSTALLATION
New, Alteration or Extension Per Panel
One Circuit \
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00 .~~ .DC)
$ 2.00
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
'~ATE~--~-ro-I-It5jf~yr~~-------------
RECEI PT #: I Of.... <; uz. '-1 '\
RECEIVED. BY: l/\ - fl1 tf j ""- __
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
~S,OD
/. IS
L/ ' 6_""<::,:)
~7, (7)
40.00
40.00
20.00
36.00
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Owners Signature:
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