HomeMy WebLinkAboutPermit Electrical 1996-10-9
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ELECTRICAL PmuIIT APPLICATION
Ci~ Job N~ber (\ \.o\?icC
*
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
225 uua "4At.6.. Zonina (' //
SPRINGFIELD, OREGON 9747] Ii) ~
INSPECTION REQUEST: 72~~'6!J' - -'1~
OPPICE~ 726-3759 Authorlzed Signature
1. LOCATION OP :mSTAI.LAn:ON
~ 1E.5 '-777d A4? Y)I-
1\ .M
3. COHPLETE PEE SCHEDULE BELOV
A.
(I~~ON \G\CO
- -'C).
JOB DESCRIPTION . _ 1000 sq. ft. or less
~f/Jt7/l:htCL d.d d .l~tZ/Z.t?i? ~/h~~ach additional 500
sq. ft or portion
Permits are non-transferable and expire thereof
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
'180 days. Service or Feeder
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
Installation, Alterations or
Electrical Contractory1;1~t?fd 7h-,,~ &. Relocation:
Address Po my ..2 7/",C; 200 amps or less
~ 201 amps to 400 amps
Ci tY~/1P'" 9'7fb.zJ'hone /J;,f'6 -ef" /:L . 401 amps to 600 amps
601 amps to 1000 amps
Supervisor License Number ~~L/n.) Over 1000 amps/volts
Reconnect Only
/oh /9i'
Expiration Date
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40,00
$ 50.00
S 60.00
$100.00
$130.00
$300.00
$ 40.00
Constr Contr, Number JJJ'7IJ;l..
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
J.a.J.QI J Qh
200 amps
201 amps
Over 401
Over 600
or less $ 40.00
to 400. amps $ 55.00
to 600 amps $ 80.00
amps or 1000 volts see "B" above
Signature of Supervising Electrician
fl/J ~~I /J
f " ,- ~. D. Branch Circui ts
Owners Name :;'v, .tJT~:lJtf.d/t fR '/{} /~ '7zUqo
. Hev, Alteration or Extension Per Panel
Address yJl} .6w .3131
, /1. cr1 ;u:B
Ci t,/:t:t:n1tdL1.i.f) Phone
OllNER INSTALLATION
One Ci.rcui t
Each Additional
Circuit or with Service
or Feeder Permit ~
,.....1....- $ 35.00 -.35.CJO
The installation is being made on
property I own which is not intended
for sale, lease or rent.
S 2:90 rf.Go
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
_ Limited Energy/Res $ 20.00
Limited Energy/Corom $ 36.00
Owners Signature:
DATE:
RECEIPT t:
,""...... v.... n y :
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5.
SUBTOTAL OF ABOVE
54 State Surcharge
3% City
TOTAL
L/d. 0 iJ
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