HomeMy WebLinkAboutPermit Electrical 1997-11-14225 FIFTE STREET
SPRINGFIELD, OREGON 97 477
TNSPECTTON REQUEST t ".;7 2,6;$,1;6
OFFICE: 726'3759
(u
it-/+-n1
Drn9 ,,.. .... .
SP}l' -iFIELO
ELECTRICAL PERHIT APPLICATION
City Job Number q 1 / b3<
COHPLETE FEE
1 LOCATI.{ts.-\INSTAILATIONON OF
CY\e-K.r=o:z lF-t-l utd Nev Residential-Single or
MuIti-FamilY Per dvelling unit
Service Included t
,,u,na
A
I.,EGAL1oL DESCRIPTIONn1_vL 12 f,D
1000 sq. ft.
Each additi
Cos t
$ 8s.00
s 1s.00
s 40.00
4{
Sum()
JOB DESCRIPTION
Electrical Cont ractor @ -S
Address /)*
Ci ty Phone 3t{a- lt €t
Supervisor License Number -s
Service
B. Services or
Ins tallat ion,
or Relocation:
200 amps or less
201 amps to 400 amPs
SUBTOTAL OF ABOVE
5% State Surcharge
32 Administrative Fee
TOTAI
40L amps to 600 amPs
-
60L amps to 1000 amPs-
Over 1000 amPs/vo1ts
-
Reconnect 0n1Y
TemporarY Services or Feeders
in"i.ri.ilon, Alteration or Relocation
ess
0
sq. ft
thereo
o
Permits are non-transferable and expire
ii vort is not started vithin 180 days
;i i;;;";ce or if vork is susPended for
1.80 days.
2. CONTRACTOR INSTALLATION ONLY
rEach
Modu
Expiration Date r)-l -qq
1 00
s130.00
$300.00s 40.00
55.00
80.00
s see rtBtr a Eve
5a "3
Expiration Date Q-t \t -c)o
S ure of SuPervising Electrician
AX Et)
Ovners Name
Address Dr ) f5cl(.LeO')
Ci ty Phone | -8oo -3lz?.-3&S
qaao
200 amps''or ]essioi ;;; to 4oo amPs
-Over 40L to 600 amps -..---.-
Over 600 amPs or 1000 volt
Branch Circuits
Nev, Alteration or Extension Per Panel
one circuit $ 35'oo
Each Additional
Circuit or vith Service
;;-r;;i"tPermit
-
S 2'oo
E MisceLlaneous (Service/feeder not included)
C
D
0040$
$
$
OVNER INSTALLATION
The installation is being made on
piop"tty I ovn vhich is not intended
ior sa1e, lease or rent'
0vners Signature:
-Each installation
Pump or irrigation
Sien/Outline Lighting-
Limited EnergY/Res
--Limited EnergY/Comm
00
00
00
00
$40
s40
$20
$35
5
DATE:
RECEIVED
W,-'l
The
zan
l
Constr Contr. Number 3?CtYl
a--o{Y=,
qS-so
,@
c Ll c,G-)'