HomeMy WebLinkAboutPermit Electrical 1991-2-26
225 r~r.n ~.AL6.
'SPRlNGFlELD, OREGON 97417
. .INSPECTION REQUEST: .726-3769
OFFICE: . '726-3759
1. U)~O,NO~STALLATION (\.
~ \ \ _" n XY\ 0....1(\(7.:.
LEGAL DESCRIPTION
"llt~~ON "
permit~re non-transf~rable 'and ~xpire
if work is not started within 180 days
of issuance or if work is suspended for
180 days,
2, CONTRAClOR INSTALLATION ONLY B.
Electrical Contr,actor1l00m)}~ .
Address.!E....f)(\~ -D.liL! ~('J1 &9-.
Ci ty C\. c; r(\ Ve~ Ph~Qe q4~ -S If,J 72-
. Supervisor License Number c!)f}()R S
Services or Feeders (10.Branch'Circuits
included). Installation, Alterations
or Relocation:
100 amps or less
101 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnec t Only .
$ 35.00..
$ 60,00
$ 90,00
$130.00
$300,00
$ 35.00
Expiration Date /o.q /
Constr Co~tr. Number 3 81<.2) /)
Expiration Date A If) / q
. I I
Sign.~. e'of supervising. Electrician
\. ~.....~ ~. \\ \\SJ ~1' ~ .
. '.' - . .t.(Q....h0......~_.d_ 0... _J.l_I!., Branch Circuits
. Owners Nam~l..\'l ~llmr\1~l M.LlQ.(~ .
...... 'I'\/Iq~ rYl." fl..?\l;~' New, Alteration or'Extension Per Panel
Address,..:.....JVj ., \ .10 .J.L I " . .
..... e:;:'-' ':.'. ...-1("/, 317'//'\ OneCircuit. $35.00
City' (~P~l1 n; Phone ~I.. )-'- _ V. .Two ,to ten Circuits" $ 50,00
. . .' Each Addt'l ten or
.OVNER IN ALLATION' portion thereof $ '15.00
The.installation is being. made on
property I own which is .not.intended
. for sale, lease or rent,
OWners Signature:
DATE:
. RECEIPT I:
RECEIVED DY:
a?~Co.<4 (
~~~
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 35,00
201 amps to 400 amps. $ 40.00
Over 401 to 600 amps $ 80,00
Over 600 amps or 1000 volts see "B" above
E~ Miscellaneous (Service/feeder not included)'
-Each 'installation
Pump or irrigation.-
Sign/Outline Lightin~
. Signal. Circui t or
limited. energy. panel'
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$36.00
$ 36.00
$ 36,00
1m ,a:;
'7.01.../
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