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HomeMy WebLinkAboutPermit Electrical 2019-10-07i srltlN(;Iilli 0R[,(;oN Cl"t'Y 0t [.,]), @ 001 DeIls ElectrIc /r to?/04/ZOIS 14:50 FAX s41S15284? fZS FnU St"ocro Sprl4frolil'oRvl(?? Thls Pcrmlt le Issued under oAR 918.309-0000' rJsuspended lor ltO dnye of lssulnce or lf rvork nontrsnsfcrsble' Permlts erplre if work ls not stortod withtu 180 .rtlxo'l'l.o Pcrmtts sre dryr. Cutl ?e*ra rl rh{ tDLrex Qa-(vvt'+ )5 ilo^u Dt,hee Dl' t't o-f\d '0i o-d Q'P 5"/l '5to-*1173 I ARTUENTDEP ONLYu8E \ Datc: q?\\o) coatCoct CE,itGnt (PGTlnopectloorofNumborNoYesverifiod?includcd:rcrviccunlt'perRcrldontlalt S$1t6.00 lcss0t (4)ft.sq,L000trGovernment $s36.00fl. or PofllonEachaddi$onal 500 eq' thcrPof $s44.00Job site address:Limired encrg;tZIP:State:0 $389.00 laxloL.: 0r moduluhomcmanufacturodEachfccderol(2)servlcgRpfcrence:relocdtionalnratlon,installotion,fccderrl0rServlccc $sll2,00200 amPs or less (2) s$t31.00201 to 400 amPs (2) $$221.00401 to 500 arnPs (2) $J283.00Name:60t to 1,0fl) emPs (2) $$654,00AddressOvcr 1,000 nmp.e or volts (2) ZIP:State:$s89.00Rcconnect onlY (2) Fax:Phonc:relocollonalhralion,lnsrollollonfcedorr:ortorvlceg E-mail $sr9,00200 ornps or loss (2) 72.N201 lo 400 amPs (2) $$177.01)401 to 600 unps (2) scctlonfcodors abovoorsowlcesIorseo600Ovcrvols.,000EmPs Brrnch clrcults: new clleratlon, cxtewion per ponel a Fee for brauch circuiu with purclrase of a serricc or tteder fee: Business st.00 $lisch hranch cirouitAddress: b. Fee for branch circuits without puehasc ofa senrice or feedcr fcc; State: st9.00 $Flrst branch circuitPhone: $8.m sEach additionol bronch circuit1,.7\-E-mail: Mlrcollrncour |cesz serlrtice orleader not includedlicorue no.:CCB license no.: $tr.00 $tsach pump nr lnigotion circ'lo (2) s license no. $$Er.00Har:h slgr or outline lishting (2) Print namc of h."" Signaturo of signing superuisor:s89.00 spanel, sr02.00 $! (l)Erch rddltlonrl U8E $ (L) Entcr subtobl of gbovc fecs (Ivllntmum Pcrmlt Fco 3102.00) $(B) Entcr l27o surchargc (.12 x [A]) (C) Tcchnolosr Fee (o% of [A])$ $TO'IAL ftcs and surcharges (A ,.rrt.dit d 7llt20l9 BJonot ) e. I SiEnaturc: This tll I ATt, )o l'< f,/etfyl< !) 7C nnM ?.LA'.