HomeMy WebLinkAboutPermit Electrical 1992-6-8
S.-IIINCr-IELD
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ELECTRICAL PERMIT AP.PLICATION
97477 ~il~.~"'loVling'pr"jeol(\r.slJbmitlad hosto" ;,," n f'\ m 1 f\ ,
726-3769~~" ~' .?nd "v., h"t require opecifjc(!:i,ty,~Job Number -\ 01 ...)...-/
. ;"""'1 ~ PLETE FEE SCHEDULE BELOII
1. I1C!'fn O~~Lr~N ~ ~ 1Q.' .
- . UJ ":=":Q!~._t(j~~.t~~;;~~~~i;;~S~~~i~i~; unit.
\ itS~~~N ~ Q \ '1 Service Included:
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
11\ In. C} :tt\ - Installation, Alterations or
Electrical Contractor\\. \I\. 9~ ( O(\lliL~ Relocation:
Address~ C\lllr\'\\l"l\J,J\t) \\ W 200 amps .or less
C ".\ 1]/ --A' l' Q\ 10 201 amps to 400 amps
Ci tyL)l 'l. o,m PhaneQQI-...u.: () 401 amps to 600 amps
~/.2...A '2AS 601 amps to 1000 amps
Supervisor License Number~~ Over 1000 amps/volts
\0 . \ 11 f'l Reconnec t Only
Expiration Date ''-'\rl-..
Constr Contr. Number c.."Y-)hQI"PJ
Expiration Date If),. \4 . q~
~~)Electrician _
11\t\~~h)~m Branch Circuits
^ '~n New, Alteration or Extension Per Panel
Address" I.' (nOr jaIL.
Ci ty 5\\QJY\ Phone nR~~~:~h C~~~~~~onal
Circuit or with Service
or Feeder Permit
225 FlITH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
00 ~~E~\n~ 1-'"f (' --1.
Permits are non-t~nsferable and expire
if work is not started within 180 days .
of issuance or if work is suspended for
180 days.
Sig~f
iers Nam
OIINER INSTALLATION
The. installation is being made on
property I own which is not intended
for sale, lease or rent.
Ovners Signature:
~~~~~---tQ-~~~t:f~-~~----~--------
RECEIPT #: . 0 - - ~ ~\J)
RECEIVED BY: (~Il Lt' / .
Temporary Services or'Feeders
Installation, Alteration or Relocation
40
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
1000 sq.ft. or less
Each additional 500
sq.ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
C.
200 amps
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
Items
Sum
Cost
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
(
$ 40.00
$ 55.00
$ 80.00
see "B"
above
volts
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
$~