HomeMy WebLinkAboutPermit Electrical 2001-5-22
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DEVELOPMENT SERVICES DEPARTMENT ","'''''l\oe"..
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~oo'Og, aOv v' 2.- (541) 726.3753
apP10,a\ (<'\ - \ FAX (541) 726,3689
200'O~ 6 -'
~ d~CTRICAL PERMIT APPLICATION '
9741J.le ~ -. 1t
726':37~aed Sigoal",e City Job Number /II /-tJo~c-cx-u/
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3. COMPLETE FEE SCHEDULE BELOY
1. c::::::L.QC4~N RF ~~LA~IO"..LL,
J )~:iJ? ~. J~ A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
LEGAL DESCRIPTION
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Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days,
Address '7 S W
City~i~ Phone
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OYNER INSTALLATION
225 FIFTH STREET
SPRINGFIELD, OR 97477
Items Cost Sum
1000 sq. ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 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
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000
volts
$ 40.00
$ 55.00
$ 80.00
see "Bll
above
2. CONTRACTOR INSTALLATION ONLY B. . Services or 'Feeders
'--r - r r(),/o Installation, Alterations
Electrical contractor"..J"'Jj-II-:CI..K:..1l-JJ7l2or Relocation:
AddressJ.} tJIoS- I, "). 11"~1 .:i:::l::= f ~ 200 amps or less
r '. ,201 amps to 400 amps
Ci tyt::llJent? ' Phone(c~}' c.s 7-l-O 401 amps to 600 amps
, Go' . Co 601 amps to 1000 amps
Supervis License Number.. 'J () 7-/J L ) Over 1000 amps/volts
i ' Reconnec t Only ,
Expiration Date i() / I 101
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Constr Contr, Number,?>'=t0R7--t':
Expiration Date /D/t Jill
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Signature ~~ng Electrician
(I
Owners Name
fifl p. Branch Circuits
N' ~New, Alteration or
-r LJo-S ~:2- Y
Extension Per Panel
$ 35,00 3S,
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
60
$
2. CD
2.00
The installation is being made on
property I own which is not intended
~00:~3~AS&~le, lease or rent,
:39N~~ers Si~ature:
OL'O~ $ G:a83~ lW~
WOG GG ^~W:31~a
~6~~uyy=~y~~---------------------------
DATE:
RECEIPT #:
RECEIVED BY:
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 J> 1. (Jb
7%. State Surcharge ~ '... ...,.-:j.V
3% Administrative Fee [0 to
TOTAL \ (C-::::rD
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TRANS#:01-0005494
DATE:HAY 22 2001
AHT RECD:2 $ 40.70
CHANGE:
CASHIER:003
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