HomeMy WebLinkAboutPermit Electrical 1995-4-14
The ~olbwing project os submtttod has the folio
zor:ing, e..nc d06s not require speciflc land use
Dpproval.
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225 FIFTH STREET Dmt-f/ 14-~ -{ ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477' fVV""--
INSPECTION REQUEST: 726_~rlzedSlgnatura . ':0 ~'7 Job Number 9"5""@/-:::;'
OFFICE: 726-3759
1. LOCATION OF INSTALLA;rrON
2.5196 brooD V'S"[A D&...- A.
I , LEGAL DESCRIPTION 1+0 32t..1000070b
\-C>T q GI'W\DllleW co:,rA:TeC; -Sort1llt~&J) .
0. JOB DESCRIPTION
Jec.u~ '5l.1o;;1Efl"'\
. ,
Pro. ~')'111.0.3
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.
Electrical contractor~-r--
Address 15CJ\ PeaF..L S-,-.
CityE'v"l~ Phone ~1..Ic1.- I~\ ~
Supervisor License Number Z' /777
Expiration Date
3. COMPLETE FEE SCHEDULE BELO\I
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular'Dwelling
Service or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
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
I terns Cos t
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Constr Contr. Number .~q.,~V 2,.'l..Perc.ctf Installation, Alteration or Relocation
Expiration Date
Signature of Supervising Electrician
1.,,1( y J--P;:
ers Name tt:> -V ~'" -:fo.nltMY D.
Address J.58o brot\O \!l<;TI>. \:)('
CitY~('ll''\~Meu> Phone.1!:l/n~ (O3~8
O\INER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
---------------------------------------
DATE:
RECEIPT #:
RECEIVED BY:
'1-/&./. ~S-
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200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
'-'" .
.'
New, Alteration or Extension Per Panel
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
$ 2.00
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
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
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