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HomeMy WebLinkAboutPermit Electrical 2001-6-8 -. , , 'lied naS 1M ,01l0wln9 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. Cj ~-1--h4 U! ze g . A. . LEGAL DESCRIPTION /~C)z. C\0 Ad. /f~ JOB DESCRI~ ' ~~ I- 1./ J1;l (J 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.., _____________________________ I:I:LgOD6Af~:~SN~~l 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 .F;.... . ' 7'-09 ~?"~J j-.tIf ?'i" \n ...) V, 'V II!...;!. ,~,~~ . - , JLI. . . ." . .", . TRANS#:01-0005733 DA TE : JUN 08 2001 AMT RECD:2 $ 38.50 CHANGE: CASHIER:003 " ..- ..- .. . .