HomeMy WebLinkAboutPermit Electrical 1995-11-4
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225 FIFTH STREET Q <?' 0"'::;:4<1.,, ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 .t. ""~ r"9(f.~~ 0. 0'7\ / 2 { j
INSPECTION REQUEST: 726-3769 "lilt!} ~/...... 'l> Job Number 7' {J VIP 7
OFFICE: 726-3759 OrQ-"cy' ""'~ibt",__ '
oSIUIl. LETE FE't~pULE BELO\l~
l. LOCATION OF INSTALLATION fililro "
i()Q~ t.l'\IlJ\.ll.>...J1;, Residential-Single or
ti-Family per dyelling uni .
Ser . e Included:
Items Cos t
J 1B~l!j'ffJ(fY/ / 1--
J9B DESCRIPTION. . nJ
I 0t ~ Y\1ll. I , \ l1. Ul.rlun_ Cl
Permits are ,non-transferable and expire
if york is not started yithin 180 days
of issuance or if york is suspended for
180 days.
Sum
NO.t~gq::sq. f to or less $
E~gh iI?'SL~i \',,!:a.ib.IRINF THE WURK
THIS sq(lWf t Of Lpot''t\on 1:
AUTr.tl1~,rgJ!lfUNDER THIS PERMIT IS NO S
COMHi\'E:d~1!Ml..,~~e'~'I<! ,ttI?~~aAED FOH
o u'ar, DYEtI lng
ANY ~~JYli'.cie"rcrr;rF'eeder
85.00
l5.00
,$ 40.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders \0
. Installation .AM~a;f,i'iffi\;,t
Electrical Contractor..c..~S 8~tlrt,^, ,'1''''". or,{~~~I1lgil8A\neOle9ooU\I~:rth
,I I ~Iu.:, ",,,EN dOll\ed b,/ \eS ale set
Address P.O.~,.,.J, l'l-g1..., \0\\002~o\eall\\~e~,l'\~uhO~fl.9~-OO~ 50.00 ~o
. --:' f NO\i\i@IP!1a1,n )f_O~04'OO'UUfljPd\ ,he IUleS ~ 60.00
Ci ty, ~nJ\jm.~l.ULL. Phone 1741-11. ?-,/.-, 'o~Wl5%fri lSol'iRliti00PW1fu!s\pIAphOoe $100.00
--r V \n 9~~1.l<ilil i'$ MI!,\~i)@"~~'O~I~.ttica\iO[$130.00 1~t'l,OO
Supervisor L cense Number I (" ~(() s, 00 c&'lllA~\\1!{)~ "'PlRlli'v.o\l.\~~3' A) $300.00
~rtOl!~,ij~"]oO-332-2 ~ $ 40.00
Expiration Date IO-I-qq nU Cen\eps
,/ C. Temporary Services or Feeders
Constr Contr. Number ,1S<q,q Installation, Alteration or Relocation
Expiration Date q-I- 00 200 amps"or less $ 40.00
201 amps to 400 amps $ 55.00
Over 40l to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
Signature of Supervising Electrician
/7 ~'l' ~-z,~ ~
,~ .--- . ,-;
OYneL'~ Name ~b~~) ~\\hf\rd';'
Address 1.,~~~ ~rF0' , ,
City 0.~~n\.. Phone.!lJ).,~'5D/~
OIlNER INSTALLATION
The installation is being made on
property I own yhi~h is not intended
for sale, lease or rent.
Owners Signature:
~~~E~----77~4f~~----------~--------
RECEIPT D:, I ' {'it. '[liP )........-
RECEIVED BY: 'h:", Y"A~
D.
Branch Circuits
.'
Ney, Alteration or Extension Per Panel
One Circuit
Each Add it ional
Circuit or yith Service
or Feeder Permi t I () C
$ 35.00
$
2.00 ~D
E. Miscellaneous (Service/feeder not included)
-Each installation .
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
580,60
19 00
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