HomeMy WebLinkAboutPermit Electrical 2001-2-27
DEVELOPMENT SERVICES~eNllc' as submitted has the following
lonlng. and does not require specific land use
approval.
Zoning /.-.7) 12-
Date 'l- ~ 0- i-o\
97'4t1V>rized Signature ~
726-3769
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
"LECTRICAL PERMIT APPLICATION
City Job Number 0 I ()tJ/7Lf n!
A. New Residential-Single or
Multi-Family per dwelling unit.
LEGAL DESCRIPTION Service Included:
S/All-LIt u;./ 1ItJ1lltf: ,I 7 t'7S :;t. -, do "'d-0752(.e7
JOB DESCRIPTION ,,,, ,J., 1000 sq. ft. or less
jN5TlJ-{;(., 1.5,j~t;UJi.' /hJt(?'"MJn UK!, Each addi tional 500
, .1. ~t ~le~dr'?set;G', sq. ft or portion
Permi ts arednon'bHansf~ralil:el and.Cexpire thereof $ 15.00
if work is ,n.ot)'s,t.artegit.wi,thi~n r:[:8.o30!'YS Each ~'1nuH~I,,!Iome or ORK
of issuance %iliJ :-:9,r,ls ~,,~ !'J!~'p.~!),4~d for Modu~afJDWEi1'~~E~'!:\AllE)(Pi?E If1'HEW '.
180 days. . "'\" .;"", ,\101.,'!I'cal'lor Servlce\(ol'EFeeder _, "~p$R40rOONO\
, . ,j. "...... NO'..) l- ''t... .'
2. CONTRACTOR INSTALLATIOl(bNLY B. service"~J1J1:~~~!d~~~R\~:~~~DONEOI'OR
Installation~NAl:terations
Eiec trical Con trac tor P4CJPtt!.- SG<:.UllfrV or Relocat-ion:l)A'< PER1UU,
,- ",1\11 ,..........
Address_Pd- &1( 3"5/ 200 amps or less
201 amps to 400 amps
City Sll~ Phone54/~q7tJ(,; 401 amps to 600 amps
601 amps to 1000 amps
Supervisor License Number 35{,S::Tf.AE. Over 1000 amps/volts
J / Reconnec t Only
Expiration Date /O/D//4;;}
Constr Contr. Numb~r ;tfb::Jt!J 3
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
3. COMPLETE FEE SCHEDULE BELOV
1.
LOCATION OF INSTALLATION
/f1!:i/ t...{)CK~"'::N
It ems
Cost
Sum
$ 85.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Si~~:6I~~ViSing Electrician
(g ,
Owners Name t:,~tftJ GIUJS.5
Address 10'1/ U;CJ(J.#IvG'N
Ci ty S@l{2JtI~;qG~D Phone 71f7-5'f.1q
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see liB" above
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outlioe Lighting
Limited Energy/Res
Limited Energy/Comm
Owners Signature:
\(
DA~E~zjr~;r~-~j'LJjT--~--:------------
RECEIPT II: II ()U 4.!::::t2"j ,
RECEIVED BY"r) , ~ n/"u ~ 0
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
$ 2.00
not included)
$ 40.00",
$ 40.00 ~=;j
$ 20.00~::::~
$ 36.<!Q:c:J'.'.'~-
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