HomeMy WebLinkAboutPermit Electrical 1991-12-31
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ELECTRICAL PERMIT APPLICATION
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
Ci ty Job Number <7/ /C::::>9 0
3.
COMPLETE FEE SCHEDULE BELOV
1. LOCATION OF INSTALLATION
l./L/72 Z;;>~/Sy
LEGAL DESCRIPTION
/7 -~2' '3::?-"3 C/ ~ VL/=<- ~
'.
A.
New Residential-Single or
Multi-Family per dwelling
Service Included:
,
unit.
Items
Cost
Sum
JOB DESCRIPTION 1000 sq.ft. or less
,~cL~#7~ 47'o/~ -:I~~/c-p~.l"<Z-./~Fach additional,500
(. sq. ft or portion
Permits are non-transferable and expire thereof
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder
$ 85.00
$ 15.00
$ 40.00
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
Installation, Alterations or
Relocation:
Electrical Contractor
Address
City
Phone
200 amps or less $ 50.00
201 amps to 400 amps $ 60.00
401 amps to 600 amps $100.00
601 amps to 1000 amps $130.00
Over 1000 amps/volts $300.00
Reconnect Only. $ 40.00
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C. Temporary Services or Feeders
Installation, Alteration or Relocation
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps ~r 1000
$ 40.00
$ 55.00
$ 80.00
volts see "B"
above
Owners Nanie (//C,7Z>75 ~~
Address ~~
Ci ty -:5~15 Phone 7q~ -.<:'~
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D.
Branch Circuits
New, Alteration or Extension Per Panel
OVNER INSTALLATION
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 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)
Ovners Signature:
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---------------------------------------
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
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DATE:
RECEIPT #:
RECEIVED BY:
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