HomeMy WebLinkAboutPermit Electrical 2001-6-8
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225 FIFTH STREET 1M ,ollowing projecl ~~:~~i~~ specillc land use
SPRINGFIELD, OREGON ;!07Ii\1J7and does nO '
INSPECTION REQUEST: a~~-~769 LJ2~
OFFICE: 726-3759 ZO~t--;' 'P,O I J
1. LOGt\TION O~ }NSTKL2:J.knature _ ~ 3.
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LEGAL DESCRIPTION
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JOB DESCRI~ '
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Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if work is suspended for
180 days.
.
Expiration Date
Address____~ ~~
City ? U<:I'"~
1
OVNER INSTALLATION
The installation is being made on
property I ovn which is not intended
for sale. lease or rent,
1:1" ~3J:~SH~ S'
~~~ners 19nature:
0... BI: $ ;:;: aJ3~ lW~
TOO'" r" 'F- - ' - '
].. (.0 D.!.l_J.JDJ......' r.., _____________________________
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RECEIPT 11:
RECEIVED BY:
ELECTRICAL PERMIT APPLICATION
City Job Number O/-c){75'$j--O/
COHP'~TE FEE SCHEDULE BELOY
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Dwelling
Service or Feeder
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 100u
D.
Branch Circuits
2. CONTRACTOR INSTALLATION ONLYB. Services or Feeders
,_. ./.." Installation, Alterations
Electrical Contractor Ie. S e{C'~t-,or Relocation:
Address 0,0, DeN 2 f/9~ J " 200 amps or less
t: ' 201 amps to 400 amps
Ci ty r: (/ ~4-." _ Phone...f., r;,&, 't:. 2.1~ 401 amps to, 600 amps
J ,601 amps to 1000 amps
Supervi~or License Number 3 ~~;?j; ,Over 1000 amps/volts _____
/0 / Reconnec t Only
Expiration Date /0 / /0/
C, Temporary Services or Feeders
Constr Contr. Numper 70rt?'7 Installation, Alteration Ol' Relocation
/).../?()A,r/
s~ature oj Supervising Et:ctrician
'YPJ~ 1J Ly -'
Owners Name~AtJJ'/J" ~5fi'"Vu
r/rI7~ I /J u~-t-
Phone 'l.Rr~ J'('O
Sum
$ 85.00
$ 15.00
,$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
volts
$ 40.00
$ 55.00
$ 80.00
see "B" aDOVe"
."
New, Alteration or Extension Per Panel
-L
One Circuit
Each Add it i onal
Circuit or with Service
or Feeder Permit
S 35.00 xs;...09
$
2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline 'Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
$ 40,00
$ 40.00
$ 20.00
S 36.00
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TRANS#:01-0005733
DA TE : JUN 08 2001
AMT RECD:2 $ 38.50
CHANGE:
CASHIER:003
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