HomeMy WebLinkAboutPermit Electrical 1999-11-3
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225 FIFTH STREET ~"i'S'" " ...... ...... ~."/~GpUcAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ,.<,.~ r {j, ~'" . Cp..;]
INSPECTION REQUEST: 726-3769 ....V~ Ci ty Job Number 70 7 d
OFFICE: 726-3759 ~TTE=t'b1JQftQfe\lOn law ~~~e.!' you to
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1. llrWION lhl~~~^7rLA/ Oi~ t(2 Iy' ~9\t!fiClll~Gi.~gl~'1 Ts~~~~e~;~o~~
, In OARH\Wtql!'F: i~ ~~ iYWM\l!s '8fi t.
LE~AL DESCRIPTION ' 0090. 'fmtl.mYeo la~
/7 0 2./ I? '" u06 i) calling the center. 0 e: the teleppone C t
JD" U 7 number for the Oregon Utility Notlfi'c'alfinn os
l00eri~ iffHO~h.33fe~~44). $ 85.00
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dwelling
Service or Feeder
JOB DESCRIPTION
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Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION of
Electrical Contractor
Address
City
Supervisor License
Expiration Date
Constr Contr. Numb,c
Expiration Date
Signature of Supervising Electrician
Owners Name h;~O:../ f/ r'q ~
Address J'! (/
Ci ty 1//-./ v(
Yc9X- 0-2-
Phone 722- ,'io(
OIINER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~
----------7----------------------------
DATE: 1(!...Jlr;f
RECEIPT #!. I iJ -(/fl/~ . / .
RECEIVED BY: Lf IN p..j
,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
Sum
$ 15.00
,$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
BrN(j},sgcui ts
NSwqS*t.~ration or Extension Per Panel
A f'lM/T SHALL
on~Tf!J)f'&1[J UNI'\!=- EXPIRDf.rHES 35.00
&G:1ifll.A~d-:i..tioh'a'FR TH/S p. WORK
A.ai~c,Ui't:t:O'roQ*S~tfl{ffVi~/T IS NOT
Of: F~ed'erpgAlund t.'f1 D~oFf 2.00
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting-----
Limited Energy/Res
Limited Energy/Comm
200 amps' 'or less /
201 amps to 400 amps .
Over 401 to 600 amps
Over 600 amps or 100u volts
D.
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40.00 /
$ 55.00
$ 80.00
see liB" above
.'
$
$
$
$
'fi)
2-,'H
I. 'L"
I-f 1 l..()
40.00
40.00
20.00
36.00