HomeMy WebLinkAboutPermit Electrical 1994-6-28
. bmltted hRO tho 0 ow ~.J
The,loll0w1ng prole~ ~';~Iro epocKic 1a,1d use ~'t1
zon'ng, and doee n .., , ~-
225 FIFTH STREET approval. /l V ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 Zonln~ ~, - . (] "0 c. .., 7
INSPECTION REOUEST: 726-3769 1/2 t'1'i City Job Number -I" ...,..
OFFICE: 726-3759 ' Oet. '-JI ~ ....:.+
rJ]ut lzedSlgnaturo N-~IIPMlTE rr.r. 'SCIIEDULE DELOV
1. LOCA1'Jptl/ OF ,IJl.:i~ALLLA6V N . I() /}f)
LlLI t125t7lr u f1t/ A. New Residential-Single or
. ' Multi-Family per dwelling unit.
LEGAL D~~PTION Service Included:
l1o~~4 o7'3C:JD Items Cost Sum
C., Temporary Services or Feeders
Installation, Alteration or Relocation
:p/fM/lCRI,wM (! 1// S~~ru
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
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. v
2. CONTRACTOR INSTALLATION ONLY D.
Electrical contractorr:~jC. J~~
Address./J.,ID qlt,f)(L'((Jj ~fi(J~t;)9;U
Ci ty ;: u.fi) ~(:;; Phone Ltfj ~"S YV
{/
Supervisor License Number 5)~~'L&
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 ampslvolts
Reconnect Only
Expiration Date
10- {- q (..,
CJ(;7Q;A
)-jr-qr;-
200 amps
201 amps
Over 401
Over 600
'or' less
to 400 amps
to .600 amps
amps or 1000
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
~r..2l~./
Owners Na~e -S\'"'ll~\{\ ~ C'.D<D D.
Address \tj)J2S) & 1 ft~Q.lJ I\~)\Q?
Ci ty~~<<, Ph~ne&4S.q'1lo I (j
Dranch 'Circuits
$ 85.00
$ 15.00
$ 4().00
':$ 50.00
$ 60.00
$100.00
, $130.00
$300.00
$ 40.00
volts
$ 40.00
$ 55.00
$ 80.00
see "B"
above
New,' A~teration or Extension Per Panel,
One Circui t
,Each Additional
Circuit or with Service
or Feeder Permit
OYNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Miscellaneous (Service/feeder
, -Each installation
Pump or irrigation
Sign/Outline Lighting )Q
Limited Energy/Res
Limited Energy/Comm
E.
Owners Signature:
~~~~~-----\1?-~~~~~<lF----~~---~
RECEIPT #: \- J :- r ,,~. ~~
RECEIVED DY: ~
, 5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00
$
2.00
no t included)
$ 40.00
$ 40.00
$ 20.00
I $ 36.00
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