HomeMy WebLinkAboutPermit Electrical 1999-9-22
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'1'1QJiLCIait project ~~:qU~~~ specifiC land use '
T;/</' 1cl9~.does no /'
epw,f""flMIT SHALL EXPIRE IFT~ L/' _~
Au I HORli3D@iUNot:H rHIS PE -;22. -, e;
CQ.MMENrJ:!;) OF; ',', 'CTRICAL PIillHIT APPLICATION
9I~'(i!' ""AtlAND
7ij\~'SIil~o:- Ci ty Job Number Clq l d. Cj ()
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
4795 FKFrNl<wJ Kr.JD .?tALC 39
6l-E/VW Pp{)
LEGAL DESCRIPTION ~
\'b()?:>Od-~() 6l'icro
3. COMFLETE FEE SCHEDULE BELO\l
A. New Residential-Single or
Multi-Family per d',elling uni to
Service Included:
JOB DESCRIPTION
Kr:PLI't'Lt<- tV,,> Tt?ArrE<?- C;&Lt/;~
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 ONLY ,B. '
Electrical Contractor B'lJtU5 ELGC71Ut..-
Address
Z I 0 /JJ It '-(...( S .:# r'_
City Eur..btJG
'1'1'10 :r
Phone b 1>7-13(" z....
Number .SO <f I-.xf
Supervisor License
Expiration Date 10-/- 0/
Constr Contr. Number 7 ,)'7 C. z-
t -~ - 01
Expiration Date
Signature of Supervising Electrician
tLJ /'fi!~:- .-='
K. D.
r. C;~ilIC6,?
DATE:
RECEIPT #:
RECEIVED BY:
'1-d.d.:c, "'\
30";~
1000 sq.ft. or less
Each add i t ional 500
sq. ft or portion
thereof
Each Manuf'd Home',or
Modular 'Dwelling
Service or Feeder I
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
Items Cost
Sum
$ 85.00
$ 15.00
$ 40.00 L{o
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps' 'OT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
Branch Circuits
volts
$ 40.00
$ 55.00
$ 80.00
see "Bu
above
Owner~ Naljle(A^. MDA1j>>i:4/TH
().J'ht-~ FfL'f rC-
Addressjl1!3D 51).) /:.€:f'.t:. PJ:.~'1 ~jJITGi 3l?S"
One Circuit
Ci tYMk..~ O~r) Phone 5'03 2i.{t..{ 2.300 qUir~.\1!1Jltddi tional
ATTEN-1I0N:ureyu" ,cc,v re 'Cil5cuit or wi th Se:~vice
O\/NER INSTALLATION!OIlOW rule" adopted by the OregoJ'r Fe'4der Permi t $ 2.00
- Tl1oS€' fules are 581 ItJl tll
. ,. 'J'ltihcatirm Center . c.,u,,?!:)[11- ,
The Ins talla t Ion IS beIng hma,qe_oo,n_001l' tI110U(E,.OPMl'sc~rlaneous (ServIce/ feeder no t included
property I OWl'! which '~-V.Jiio{"V'h~3r~~9J.lr' copiet' 0Ilb~~~h'lJW~ta~lat~on
for sale. lease or ren'tl?U_:}O -liE ~ent8', (!\lotE.' th<'lfP~~!,?'9L ";nga ~'on , $
calling. 't o. O-eoo", Ulility NSl'gn'/0utl1ne Llghtlllg $
Ovners Signature: l'1umberlor ~;~: '.~nO.332-"st~imited Energy/Res '$
r;p0,- 'S .. Limi ted Energy/Comm $
40-
4
*t.t4-
"
New, Alteration or ,Extension Per Panel
5.
SUBTOTAL OF ABOVE
.,r. State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
40.00
40.00
20.00
36.00