HomeMy WebLinkAboutPermit Electrical 1998-11-2
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rHIS ~Date . '-,
225 FIFTH STREET AU PeRMI'" ,~LECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 rHOR A~edSlgnalule J' '
INSPECTION REQUEST: 72613~~,~.s YleD UNDL eXPIRe 'ti ty Job Number q ~ / J. 7 7
OFFICE: 726-3759 AN',' NCeDO eR rJ./tS 1FrHF,.,_
180 D R IS AJ~ P~~l'LE'WJif\EE SCHEDULE BELOII
1. LOCATWN OF INSTALLATION ;1'( PeRI 8ljNDo ,_I ITISN,
/h'1n /!t;UtlCt; I?/ 00, ' A. I1NewFlResPlential-Single or
, I Mul d'1Family per dwelling uni t.
LEGAL DESCRIPTION Service Included:
/I/> 11 \ J I fJ 6 2.() j) Items Cost Sum
. yOJl DESCRIPTION ,/
fIrlgf.IV; rWiJ, CIt.tM.'Ii _ '
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
Electrical Cont~actor ()Js E(c<...!-,,'C...
Address 2.1.~l I-t..v","::>
Citv
Z"'1-"'-
YN (.,0;15
3'0/'r)
Phone
Supervisor License Number
Expiration Date
/0) 6 }
'7 1i3 '2-'1
5" ~~
Constr Contr. Number
Expiration Date
/1..
-
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular, 'Dwelling
Service or Feeder
,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
$ 85.00
$ 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
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
volts
$ 40.00
$ 55.00
$ 80.00
see "B" above
Signature of Supervising Electrician
~~
V I I D. Branch Circui ts
Owners Name tv! O~/jJ /f/t:f({j/)J)
I . / I' ,/ New, Alteration or Extension Per Panel
Address /t 'lrJ ~t' it.cO ,e, ((" J~
~ j1. I ( One Circuit $ 35.00 J
Ci ty 'l2tf'k, !-rt;"{L-Phon; 72-'.,3'--" Each Addi tional
I Ci rcui t or wi th Service ~-
OIINER INSTALLATION or Feeder Permi t f $ 2.00 -
The installation is being made onf~~::EN7/~Or~iscellaneous (Service/feeder not included)
property I own which is not int~a/~UksadOPt~~stallation
for sale, lease or rent. inOAR9/onCente P'~~Ii':f.l:'l!'Q:.g90J9_n $
0090 Y. 52'001_0;'St>gn{lt~!.tilti'enVti.lhing $
Owners Signa ture: cali. Ou may obI 1.1~jlnbij ~ril!d!&#l( tt#; $
mg the a'Di-nhi. CfMlgg"'; Q6lIitn $
nUmber ~ center (N-"" S Of t.. e'(,OI
. Orthe n' oteil/l ',e r'l.l", .
~AT~~--------/77~--fr---------------'-'etJter i;t::>>I[!i!r~~~:~8H~~e
RECEIP'fli: .61" Wt<AtI/tJ ]/1~ 3~qfdilll~;;trR'el.lve Fee
RECEIVED BY: ,r;J 'TOTAL
"
40.00
40.00
20.00
36.00
'3."0'0
J~ ~
/.1 I
~ 5. fG.