HomeMy WebLinkAboutPermit Electrical 2001-4-23
~
.
S.tl1FIELD
225 FIFTH STREET
SPRINGFIELD, OR 97477
To. lollow,ng project as submitted has thelollow,ng (541) 726,3753
lO~,ng and does not requore specif,c land use FAX (541) 726-3689
225 FIFTH STREET approval. LD YL.- ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 Zoning .
INSPECTION REQUEST: 726-3769 H ~ !)'?J-O I' r; ty Job Number Of-DO Z7i..( - 0 I
OFFICE: 726-3759 Del" ::f<1.A!
AJLllUIILaci Signature ~......--eet..".i :.:.t.Lt:. l6E SCHEDULE BELOV
1. LOCATION O~ :qISTALLATION
&-, 997 ( ~/It-C-ft?r2- A. New Residential-Single or
Multi-Family per dwelling
Service Included:
, ~ DESCRIPTION
aOL-02Z 3'
01'$10 D
It ems
JOB DESCRIPTION /'.
-F", e..~ ~yV/A o-~
1000 sq.ft. or less
Each additional 500
sq. ft or portion 7
thereof v
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
Installation, Alterations
or Relocation:
Electrical Contractor~lI"~ ILBroc:,
Address--.!:lO/S9 '~n~H W 1~Il,d
City ~(,j Phone ')Ur7'n'f
Supervisor License Number Llill c;
Expiration Date 10 '01-01
Constr Contr. Number 70 'U~.?1
Expiration Date 10'01-01
200 amps or less
201 amps to 400 amps
401 amps to 600 amps.
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
unit.
Cost Sum
$ 85.00 AS. 00
$ 15.00 -:y), cO
$ 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 or less
201 amps to 400 amps
. Over 401 to 600 amps
Over 600 amps or 1000
$ 40.00
$ 55.00
$ 80.00
volts see "B" above
sru)L:GPervi~~::rcan .
~ers Name Sc-off .l-/cd.,ES
GlA-cl r:-rt t i<,
Phone '726 r I bf'!
D.
Branch Circuits
Address
New, Alteration or Extension Per Panel
$ 35.00
bY77
Ci ty S Pf='D
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
OVNER INSTALLATION
$ 2.00
The installation is being made on
property I own which is not intended
for sale, lease 07 ren t ':'
Owners Signature:
Miscellaneous (Service/feeder, not 'included)
-Each installation '
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
E.
. 5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
DATE: Ot.{ Z. 3, Ci (
RECEIPT II: 5D"
RECEIVED BY: ,f', ((
$ 40.o.Q, ,
$ 40.00i ::;j
$ 20.~!f:.,.,
$ 36.QClJ;:ri~
0..:;:;:
("') .-:2:>..
:D 1".,)""00
"'1" -:n I--L
::c t'> ,
t-;''--' r-"'o
fT1:x:...........(.".JO
\?S:;..~ 'J ~
~o
Ct"-1'T1 t.n c::lI.........
..............Ol--'--.,J