HomeMy WebLinkAboutPermit Electrical 1995-5-9 (2)
I ~
~. ."
b "'0-' h;l.r. tho followi
Thalollowing project a..ll m.,._". > .
. ond do"'-~ not rl".r!'Jiro &j:lEX;iHc lend use
zonmg, ,. g~ "'''''
approval.
. L:p tl.
225 FIITH STREET Zoa,ng-
SPRINGFIELD, OREGON 974770.",) 5-~ ~i'
INSPECTION REQUEST: 726-376~ f'lM.
OFFICE: 726-3759 ALI.;,crized Signature .
1. IdCATION OF. ~Sf~LATION
~ 2 /J fth/./~ ~ 7:-
, .. I
LEGAL DESCRIPTION
/g02... /")5" / 2- rJ9~,e;D
JOB DESCRIPTION
<;" ;=: A?~
-' ,
, Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
ELECTRICAL PERMIT APPLICATION
City .lob Number
'9;rs/~
3. COMPLETE FEE SCHEDULE BELOY
A. New Residential-Single or
Multi-Family per dwelling uni t.
Service Included:
Items Cost Sum
1000 sq. it. or less 1- $ 85.00 ~S~
Each additional 500
sq. ft or portion 3e> ~
thereof ~ $ 15.00
Each Manuf'd Home. or
Modular'Dwelling
Service or Feeder $ 40.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
Installation, Alterations
Electrical contracto~~1 f;;""~J;-nC" or Relocation:
Address 3/ t s.o ~:I /I,! fT . 200 amps or less
. 201 amps to 400 amps
CitY~n//~I~ Phone 401 amps to. 600 amps
,. ~ 601 amps to 1000 amps
Supervisor License Number '3731-,5 Over 1000 amps/volts
Reconnect Only
Expiration Date /()- q-i
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
:JtJ 3cJ-fC Installation, Alteration or Relocation
Constr Contr. Number 77rJ7?-
Expiration Date /()- 't'r
Signature of Supervising Electrician
~_dekJe
awners Name J::2ft/aJ AJpblUtU
Address
Ci ty Phone 7~ - t;.fc,f
OYNER INSTALLATION
The installation is being made on
property I oyn which is not intended
for sale, lease or rent.
Owners Signature:
-----------------~~71-. --------------
DATE: 5'(,~ IJ
RECEIPT #: / 2-~fit,
RECEIVED BY: .~
CJUl)lr#/t,4,~ (PlJT tlsev)
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
D.
Branch Circuits
"
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
//~~
. $".7'>
?,~
/")//20
:J-i_2.0
40.00
40.00
20.00
36.00
(1~}/r 78-~ A)..)1!Fl...
,
) .,
.
.
'}\Jfi! fI1 0 f~
225 .FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-=-\769 City Job Number
OFFICE: 726-3759
1. LO~TION OF Ifl~~TIONkt-+
4 \ o?() t:'\(lU A A ~ 1\ ~ 0 n l.
I~~~~ION J;rnn
-tLffi~~~'"i <l r ~'u 'x"
Permits are' non-transferable and ex~e
if work is not started' within 180 days
.of issuance or if work is suspended for
'180 days.
CONTRACTOR INSTALLATION ONLY
tric~l Contractor . ~
~::., " ". ~ 6/)
. Supervisor L~~e ~ r . ~
Expiration Date ~ /\
umber~ J I
~.,
Expiratio Date
. . re of sup~~is~ng Ele~dan ..
.' ~
': ~lffiers Na,m~r\\) H,) (\. \ \ I.) .
Address 4-\c;\\-n ~ ~\,a '(" ~
City ~Hi. phone'1.41QJ.rA'04
~ ~ALLATION
The installation isbeirig made on
property.~ own.which is not intended
for sale, lease or rent.
~rs,Siwture:, 1 .'
A;~~"7i}~<r"i-i:/ C;.'~'"'i .'
l..( /'_. (~', ./<; " :~// ,'-
.; I '." t'.__.:"/o// '_d .;~ . //P'L' GL..........
DATE:
RECEIPT, I: .
RECEIVED' BY:
2./?, 1- /. TI
. ., .IC/<'(-.?f.J'.-.
"./ 1/ /~~/L-;
3. COHPLETE FEE SCHEDULE BE LOll
A.
New Residential-Single or
Hulti~Family per dwelling unit.
Service Included:
Items
B.
200 amps or less \
201 amps to 400 amps
Over' 401 to'600 amps
Over 600 amps or 1000.volts
D. Branch Circui ts
Cost
Sum
$ 85.00
$ 15.00
fj 4.(0.00
.,) {-"
) $ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
or Relocation
$ 40.00 1:0. c
$ 55.00
$80.00
see "B" above
New, Alteration or Extension Per Panel
'One Circui t
Each Additional
Circuit 'or with Service.
or FeederPermi t
$ 35.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or. irrigation' $
Sign(Outline Lighting $
Limited Energy/Res $
,Limited Energy/Comm $
5. StiBTOTAL OF ABOVE -4 D ~ct?
5%'State .Surcharge ~.(X/
. : TOTAL,' .
..1-. '::l.,Df,.." M.,,,,,',^ w,.p J.:).O