HomeMy WebLinkAboutPermit Electrical 1996-03-18CITY OF SPR OREGON
225 FTT.M STREET
SPRINGFIELD, OREGON 97 477
INSPECf,ION REQUESTz 726-
0FFICE: 726-3759
approval.
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SUBTOTAL OF ABOVE
52 State Surcharge
3Z Administrative Fee
TOTAI
The lollowing proiect as submlttad has tho
iljiiLcj, .iiiJt6ej not roquiro epccillc land
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LEGAI
JOB DESCRIPTION(-.
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.,ATION ONIY
Electrical Contractor J",(k
Address o.o
I tems
1000 sq.ft. or less
Each additional 500
sq. ft or Portion
thereof
Each Manuf'd Home- or
Modular Dvelling
Sertice or Feeder
B. Services or Feeders
Installation, Alterations
/r4tt'C" or Relocation:
o(
ELECTRICAL PERHIT APPLICATION
U X,rrU"t I QA35J
3. COHPLETE FBE SCEEDTILE BELOV
Nev Residential-Single or
Multi-FamilY Per dvelli.ng unit'
Service Included:
Cos t
$ 8s.00
$ 1s.00
s 40.00
C
OF INSTALLATIONw'll *A
Sum
City €,-,qtt,tQ-PhoneT €5c(.G3Y/
Supervisor License Number Txit-s
Expiration Date,
Co nstr Contr. Number ?s710
Expiration Date 0
Signa ture of SuPervising Electrician
200 amps or less /-
201 amps to 400 amPs
-
401 amps to 600 amPs
-
601 amps to 1000 amPs-
Over 1000 amPs/vo1ts
-
Reconnect 0n1Y
TemporarY Services or Feeders
Instatlaiion, Alteration or Relocation
200 amps''or less
201 amps to 400 amPs
-
Over 401 to 600 amPs
Over 600 amPs or 1000-voFs
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55. O0
BO.0o
"-"
ttBtt aSove
s s0.00
s 60.00
s100.00
$130. 00
s300.00
s 40.00
S
$
$
s
s 40.00
$ 40.00
$ 20.00
$ 36.00
40.00
D Branch Circuits
Nev, Alteration or Extension Per Panel0vners Name ui fz (
Address I IiqLlu {e
E One Circui t
Each Additional
Circuit or vith Service
or Feeder Permit
E Miscellaneous (Service/feeder not included)
s 3s.00
s 2.00
Phone Z
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent'
0vners Signature:
-Each instaflation
Pump or irrigation
--Sign/0ut1ine Li-ghtlng-
Limited EnergY/Res _-Limited EnergY/Comm
5 50 _oDz.!;o
DATE:
RECEI
I
RECEIVED B
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