HomeMy WebLinkAboutPermit Electrical 1996-5-15
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225 FIFTH STREET OMS ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 72~L.:II";,,.J6Ignalure r; ,,, Job Number 9~/"~
OFFICE: 726-3759
1. LOCATION OF INS:rfl1.LATION II
.-::I t::;'e., J (J#a-H/\ //151. TJ4 J:::I ;p -
<:""' LEGAL ~E P;UONu;J .
~Jj!J~~ IU/\ f:::,V.
1?-o'7J ~'7-~ c>~ ~~.
, )OB f:>ESOOPTION r _/ _' -#-
/-Iz57T 774/J srN-'(?tflLl2Md-t
Permits are non-transferable and expire
if york is not started vi thin 180 days
of issuance or if york is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contl'actor_ ~~.&~
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name e:?~~ :4""Z1.~~~ D.
- / - v ,.-~"
Address -2~ / 0~h ~~~
Ci ty ~?~p Phone ?? ~,~~-
,. -"77CT?";>
OYNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, leas'e or ren t.
0;t;;:$~d5l
2~___________~_~___________________
DATE:_ ~/'5"<3~
RECEIPT ll: "2 ~6 ~
RECEIVED BY;/, /' f-" -.
"7
3. COMPLETE FEE SCHEDULE BELO~
A.
Nev Residential-Single or
Multi-Family per dvelling
Service Included:
uni t.
Items
Cost
Sum
1000 sq.ft_ or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Dvelling
Service or Feeder
B. 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
$ 85.00
$ 15.00
$ 40.00
S 50.00
S 60.00
$100.00
$130.00
$300.00
S 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 100U volts
Branch Circuits
$ 40.00
$ 55.00
$ 80~00
see liB" above
"
Nev, Alteration or Extension Per Panel
.'
One Circuit I $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
E.
5_
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
. TOTAL .
$
$
$
$
-.rS--'~
... I '75-
/.~-S"""-
-=??- ~
40.00
40.00
20.00
36.00
"
,