HomeMy WebLinkAboutPermit Electrical 1994-11-22
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The, following proj~cl us clIbrnK1ad h"t$ tlio followtrlg
zc;.inng, and docs not roquir€l t.peci!Jc lend uov
appro"'l~l.
225 FIFTH STREET .
,SPRINGFIELD, OREGON 97417nmg
INSPECTION REQUE'ST:"J.t.726-3769 '!r2-.1."; '-I
OFFICE: 726-3759 . _.' . ,
Authoflzod ~,gnoturo----1' IV\.
1. l-PCATJ.Q.N OF IN~ALLATION
3'1.1 /d/t-/A/ :;;t1f ,
()j)W~tfr~rr~f~~E
} 7 D ?~ =., ( 07 '2...-Zlr~
, t
!l-/)JJ j5'}l~wm. Lttlkf'l- F/fI'v' f/t
biH-PJ II'Ociii7 ,.
'~erm!fs are no~-transferable and'exPire
if work is not started'vithin 180 days
of issuance or if. work is suspe~ed for
180 days.
L-DC,;...-
ELECTRICAL PERHIT APPLICATION
City Job NUlIlber. q ~ Lil3
3
A. Nev Residential-Single or ~'
== ::,:,,,,
Servi~e Includedl '
, Items Cost." Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
ESQh Kanuf'd'Home or
Modular Dwelling
Service or Feeder
S 85.00
$ 15.00
S 40.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders'
,I &I L? '17.' Installation, Alterations
Electrical Contractorl-.f'\ .olfll-I/ 'lh1/ JiDCor Relocation:
AddressIPY W, '0" S/Je. . ~ , 200 emps or less
. JI (/ 201 amps to 400 amps
Ci t , Phone 7,7tfid tJ 401 amps to 600 amp.s
II 601 amps to 1000 amps
Supervisor Li~ense Number /..,.7 3S Over 1000 amps/volts
. 10. If /15 Reconnect Only
Expiration Date I' "
Constr Contr. Number OZfpqq
Expiration Date /';;"/IJ/qtj
,
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
lnstallation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 100v VO!ts
$ 40.00
$ 55.00
S 80.00
see "B"
Si?e of Supervising ~~cian
., ,.. -IL 6.
Owners Na~()[)IJ FeiilJu/s !..o /Ja~
Addressjl/;; /J7H//IJ
C ~'J '7d () /I /' One Circuit (
City <oJ fJ u. Plne '/7, 7 tJrJ f:;> :\ Each Addi tional
, bon (}'K 61l1etJ ;t/II/& ) Circui t or wi th service/
OVNER INSTALLATION " I or Feeder Permit
x
soove
D. Branch Circuits
New, Alteration or Extension Per Panel
$ 35.00 35. ()Q
$ 2.00 ;?,(J[)
The installation is being made on
property I own which is not intended
for sale, lease or rent.
.
E. HisQellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
$ 40.00
$ 40.00
$ 20.00
$ 36.00
~7, rJO
/. '05
/ /1
,,:>'1lf f9
Owners Signature:
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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DATE: ()-2z'lt .
A(,';r.!t>f II: '1 c::r;rd?-'
RECEIVED BY: . (o-:t~ '-