HomeMy WebLinkAboutPermit Electrical 1998-8-3
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jecl as eubmmed has the
The ~~~ not require speclf1c land
zoning. ... ~
225 FIFTH STREET approval, fl.. ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 zonill\l..iD, Cf JD,LD
INSPECTION REQUEST: 726-3769 n, 'J AI{, Ci ty Job Number 7 '1
OFFICE: 726-3759 Dale,\) "~ '
, Authorized Signature ,~': :>8: deHEDULE BELOV
1. LOCflTION OF I~STALLATION
u;~q9 (~/A";f/? A. NevResidential-Singleor
Multi-Family per dvelling unit.
Service Included:
JOB DESCRIPTION 10QO ~Ji.~. or less
:2 / ('e 5q.l-'-I J/DLt5 2- ~'e on laW r~ffl~~(\.cJti\li~onal 500
;}l.rli7- J tEEN1\V"'~' t~dbythe<B[jl.g"fl ~fOfPOrtion iii
Permits are non-transferab \dWtlJle~il~\l~ ihoserU\t1Ii~~Rr~~01' ~ $ 15.00
if vork is not started vi t ~&c!tlen~er'10throu@a6l4\fkaR~ '~yHome or
of issuance or if vork is ~~dlCfu'tO , conielold!h!~ yelling
180 d in y obtain ... """""'~ 0 ,6 F d $ 40 00
ays. 090 You ma 'Note: ,,""'. " Rmrr ee er .
o " the center. \ Ut'lity NotlllCa
",.m1\99 0 ellon ,..:,""....
2. CONTRACTOR INSTALLATION ONLl'lerlorthe r OO_"s.~..a:>"""'.s or Feeders
, nllm centeJis1-8 "1nstallation, Alterations
Electrical Contractor_.d"L.I'5 (,u./'~ or Relocation:
Address ')41 J. L(~.......... 200 amps or less $ 50.00
201 amps to 400 ~s $ 60.00
Phone ({~&"J~.9-E: 401 amMtlf<'\~0JQIm'Ps 5100.00
~ S\-\~QJ.E~tru" ~9...wQQ~ps $130.00
Number &'7.fi'i:i\!".PERIvlIi OV~i~9~sYvolts 5300.00
. uOR\2EO U\}\lJ'C'rinne.c.tO~ty\"OR $ 40.00
/ V ... I'" '7 ~ t-,Ui.... OR IS t-,et-,NU
COIvI",t:.N~O 'T,~wary Services or Feeders
/700 "'IWr,n~'1P.fIlli't'allation, Alteration or Relocation
"",
/- J ;1- 'f q 200 amps or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" aoove
~Gf~:f~~~ 7)~ Of) ()
Ci ty ~L..1UU!
Supervisor License
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
J)J,iLAAJ ~
Ovners Name--r!5 itA ~e+E f.
Address /7/tv 15'2. Sf J..,4M:...
Ci ty f (1 Q 'Z~ h ~ ~ Phone 49- C; -0'755
ZI
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Owners Signature:
~ATE~---~)f-:f--~2t~------------------
RECEIPT 11:' - l().<hq(IJ.I(
RECEIVED BY: '/___ (j:I /,f /'0.
D.
Branch Circuits
It ems
Cost
Sum
/
czs.oo
W1Pu
5 85.00
Nev, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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