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HomeMy WebLinkAboutPermit Electrical 1991-10-28 225 FIFTH .>.""". SPRINGFIELD, OREGON 97477 ~ INSPECTION REQUEST: 726-3769 City Job Number q II Z 7 / OFFICE: 726-3759 1. LOCATION OF I]{STALLATION ,7/':;-7 1Tr'n?.J.€z!L&" " ' gJ, LEGAL DESCRIPTION /'7t!J;:> )'7 610 &:?s ~~ JOB DESCRIPTION S~/C:C ~6 Permits are non-transferable and expire if york is not started vi thin 180 days ,of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor BlAt f d~LC: Addr~ss ;2..93 /Jtnul /?/>~ Phone Y' Y>.s - 0 9' J.. ?- 3. COMPLETE FEE SCHEDULE BELOV New Residential-Single or Multi-Family per dwelling unit. Service Included: A. 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 Sum $ 85.00 $ 15.00 $ 40.00 B. ,Services or Feeders ,Installation, Alterations or ?''!<:<11(:' Relocation: Ci ty 7"<< ~ .....-' c I Supe~visor Expiration License Number b< t? ? cr Date /C? -/ ~ j?.;L. s 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 ~ $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 s-01!e:L Constr Contr. NumbertJ '/ .:LP6 Expiration Date/:2 - /(;) - ;? / C. Temporary Services or Feeders Installation, Alteration or. Relocation Signature of Supervising Electrician &:~ C~ /' Owners Name Address City Phone O\INER INSTALLATION The installation is being made on 'property I own which is not intended for sale, lease or rent. Owners Signature: DATE: /c/ -2 'b - ~ / RECEIPT I: '7/ /:; ')'~ RECEIVED BY: - '''t~ 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps 'or ,1000 vol ts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above ' New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm One Ci.rcui t Each Addi tional 'Circuit or with Service or Feeder Permi t E. 5. SUBTOTAL OF ABOVE 5% State Surcharge TOTAL $ 35.00 $ 2.00 I not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 ~~O trt) ?~ ~2. :>,0 I