HomeMy WebLinkAboutPermit Signage 1995-08-04SIGN PERMIT APPLICATION
225 Fifth Strcet
Springf ield, OR 97 477
SPRINGFIELO JOB NL.,.BER-
lnspection Line: 726-3769
Oflice:726-3759h,
SITE ADDRESS Mo
ASSESSORS MAP: t
OWNER
LVD
TAX
PHONE 5ro
o
E
ADD 4\
CITY: €A.A P,6Y6;.f STATE:o+ZIP:
BUSINESS NAME, FIRUI ETC L
tl3 a Ol^)L
DESCR|PT|ON OF PROPOSED SIGN(S): (please check and complete all appropriate inf 1b5-r
14td llot
Billboard _ Other
Total Height above Grade:7o '^ tt' t+x.
Horizontal Width of sign or cnclosurc:
V Yes No VALUE
cTffirmit iilequired) OF SIGN:
_ Wall
Dimension from Grade
to bottom of Sign Enclosure:
(al Type
(c) Type
-
Single Face X-
X Freestanding
-
Projecting
-
Roof
Double Face
Square Footage:1q,b
Vertical Dimension ol sign or e nclosure
lt
Electrical lnstallation:
(lf yes additional electri6t-b"
Material Sign is constructed of
List ALL existins sisnage and attach a photoeraph of oach sisn: [1[ #l9Ttf}(q $,.lfit$ TO RF Ff,,nOVpSl
Sq. Ftg.
Sq. Ftg.
(b) Type
(d) Type
Sq. Ftg.
Sq. Ftg.
\^\
E:
C
ADD
CON CTION ER:*',)n,o
EXPIRESCITYBIJSINESS LICENSE NUMBEB
Sign Distiict a t
Zoning
Sign Permit Fee
REOUIR;D INSPECTIONS:
OFFICE USE
Land Use:
Code Section:
Approved By:
r Attachment
after lasteners are
Ouad Area
L
Electrical /r^n
ffiiletion of sisn
DATE:
Site
to be made Prior
to.sign, placement
./-V Footing
pri"t ta placement
of concrete
pri", t" energizing
elect(ical installation in&tallationinstalled/prior el
nal Com nts and/oL Conditions:
By ,signature, I state and agree, that I have carelully examined the completed application and do hereby certify that all information herein
is true.and correct, and llurther certify tn.t rnv uno all work performed shall be done in accordance'with the ordinances of the city ol
Sprin,gfield, .and the Laws of the state o{ oregon pertaining to the work described herein' I lurther certify'that only contractors and
emptJyees who are in compliance with oRS 701.055 will be used on this proiect'
I lurthcr agree to ensure that all required ins
the permit card is located at the Iront of the
of the sign(
Signoture
Amount Beceived:
pcctio ns are requested at the
property, and the app of pla
Date
time, that proiect address is readable lrom the street' that
nr*ittrcmainonthesitcatalltimesduringtheinstallation
?r-
Date Paid:Validatioo
Receipt Number:Beceived BY:
t1t-rl
I
SIGN PERMIT APPLICATION
225 Filth Strcet
Springlield, OR 97 477
SPRTNGF!ELO JOB Nu..IBER
Zfr,
lnspection Line: 726'3769
Ollice: 726'3759
Mo LVDSITE ADDRESS:
ASSESSORS MA P: I TAX LOT
OWNER:r.i.g .A. ?RO Ucf< ca PAil)'pHor'rr,5t
@o r lSouutr-J C?B cAo1y,)-/ BoADADDRESS:
CITY: + A P,7apar5[STATE o\ZIP:
LBUSINESS NAME, FIRI/I LVD,il3 c-Ov\)
DESCRtpTtON OF pROposED slcN(sl: (please check and complete all appropriate in{ormation}
-
Wall
-
Freestanding
-
Projecting
-
RooI
X Singte race
-
Double Face
-
Billboard 2( otnt'
Square Footaoe Total Height above Grade t t4t-
Vertical Dimerrsion of sign or enclosure:2,-Z',Horizontal Width of sign or cnclosurc : Zt'ot'
t wt-b"Elcctrical lnstallation: r' Yes
-
No
(tf yes additional electrical permit is required)
Material Sign is constructed of : l'tElA-.?oL'f ,.AQ-
_ Marquee
FA+ct - C.4.NCP/
6tt
VALUE
OF SIGN:
ooDimension Irom Grade
to bottom of Sign Enclosure:
ListALLexisting sisnage and attach aphotograph of oach sisn:ff-{-FX517H(" 4tGf-19 To EF RFI?DVED.
' (al TYPe
.' (c) Type
Sq. Ftg.
Sq. Ftg.
(bl Type
(d) Type
Sq. Ftg
Sq. Ftg
CONTRACTOR/INST
ADDRESS:
CITY:STATE:ZIP:
CoNSTRUCTloNCoNTRAcToRSREGlSTBATloNNUMBER:-EXPlRES:
CITY BUSINESS LICENSE NUMBER:XPIRES: _
OFFICE USE
Sign Dist'rict
Zoning
REOUIRED INSPECTIONS:
Site
to be made prior
to -sign placement
Land Use
Code Section
Approved By:
Area:
I
I
DATE:
Footing
prior to placement
of concrete
Attachment
after fasteners are
/6ectricat
prior to energizing
electrical installation
Fiinrt
completion of sign
installationinstalled/prior cover
:
Addltional Comments and/or Conditions
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein
is true'and correct, and I lurther certify that any and all work performed shall be done in accordance with the Ordinances of the City of
Sprin'gtietd, ,and the Laws of the State o{ Oregon pertaining to the work described herein. I further certify'that only contractors and
employees who are in compliance with ORS 701.055 will be used on this project.
Receipt Number:
the a
Received By:
-45
I lu.rthcr agree to ensure that all required inspections are requested at
the permit is located at the front ol the property,
of the sig
Signature
, that proiect address is readable lrom the street, that
s will remain on the sitc at all times during the installation
b-4
Date Paid
te
Validaticio:
,I
Amount Received:
Sign Permit Fee:
SIGN PERMIT APPLICATION SPRINGFIELD JOB Nu,YlB
225 Fitth Street
Springfield, OR
SITE ADDRESS:
97 477 Zfr,
lnspection Line: 726-3769
Oflice: 726-3759
ASSES SORS MAP: t
OWNER:
LVD- <trRr
0
TAX
Qrh 5tE:
Mo
g
@o t bot-LlFJ6 ?B cegy,J Ro+DADDRESS:
CITY €,,4F\grtrVrf.i STATE:O4t ZI?:
BUSINESS NAME, FIRIU ETC tl3 a o EC-E
DESCRtPTION OF PROPOSED SIGN(S): (please check and complete all appropriate information)
_ Wall
-
Freestanding
X Singte race
-
Double Face
Scluare FootaOe 11 -t
Vertical Dimcnsion ol sign or enclos u,",73t/2"
Total Height above Grade: t l{I t ll-b
Horizontal Width of sign or enclosure:o g
Electrical lnstallation: u(r"r- No VALUE
(lf yes additional electrical permit is required) OF SIGN:
_ Projecting
_ Billboard
_ Boof
)( other
_ Marquee
tl
ooDimension from Grade
to bottom of Sign Enclosure:!t4 '- b"
Material Sign is constructed of
(a) Type
(c) Type
Sq. Ftg
Sq. Ftg
(b) Type
(d) Type
Sq. Ftg.
Sq. Ftg.
CONTRACTOR/INSTALLER
ADDRESS:
CITY:ZIP:STATE:
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER:
-
CITY BUSINESS LICENSE NUMBER:
EXPIRES:
EXPIRES:
OFF]CE USE
Sign Dist'rict
Zoning
Sign Permit Fee:
REoUIR;D INSPECTIONS:
Site
to be made prior
to .sign. placement
Footing
prior to placement
of concrete
Land Use:
Code Section:
Approved By:
Attachment
alter fasteners are
Ouad L
Vldtectricat
prior to energizing
FFin^l
completion of sign
DATE:
installed/prior to cover electr.i cal lnstallation lnstalla
i
Addltional Comments and/or Conditions:
By nature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein
is true'and correct, and I lurther certify that any and all work perlormed shall be done in accordance with the Ordinances of the City ol
Sprin'gfield, .and the Laws of the State of Oregon p ertaining to the work described herein. I lurther certify .that only contractors and
employecs who are in compliance with ORS 701.05 5 will be used on this Project
sted at the proPer,time, that project address is readable lrom the street, that
Receipt Number:
a approvcd
Received By
I luither agree to ensure that all required inspections
the permit card is located at the front of the property,
of the sig
Signoture
Validaticio:
I
Amount Received:
are reque
will remain on the site at all times during the installation
Date Paid:
List ALL existing signage and sttach a photograph of oach sign:
\
?,-4:q 6
SIGN PERMIT APPLICATION
225 Filth Street
Springf ield, OR 97 477
SPRIr\lGFIELO JOB Nr,.,tB
Zfr,
lnspection Line: 726-3769
Olfice:726-3759
SITE ADDRESS:
ASSESSORS MA
OWNER
P:l
Mo K LVD '
=J-R.r
,9,
TAX
PHONE:5
k-tot iZroUtil C #4,r-.lvar-J RADDRESS
CITY: q A e7aY6;'.[STATE:o\ZIP:
BUSINESS NAME, FIRII ETC.L
il3 (-o14
DESCRtpTtON OF PBOPOSED SIGN(S); (please check and complete all appropriate informationl
Wall
X Singte race
Dimension lrom Grade
to bottom of Sign Enclosure:
-
Freestanding
-
Projecting
Double Face Billboard
+_ | I,_(o,,
Roof _ Marquee
X other
Square Foota0e 11" I Total Height above Grade:
Vertical Dimension of sign or enclosure:23'/2"Horizontal Width of sign or enclosure:
Electrical lnstallation: y' Yes
-
No VALUE
(lf yes additional electrical permit is requiredl OF SIGN:
AwaL, ?ot-YA h{A-rE.
t I tl
I il
Material Sign is constructed of
List ALL existing signage and attach a photograph of oach sign:
(al Type
(c) Type
Sq. Fts.
Sq. Ftg.
{b) Type
(d) Type
Sq. Ftg.
Sq. Ftg.
g-Q-
CONTRACTOR/IN STALLER:
ADDRESS:
CITY:
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER:
STATE:- ZIP:
EXPIRES:
EXPIRES:CITY BUSINESS LICENSE NUMBER:
OFFICE USE
Sign Distiict
Zoning
Sign Permit Fee:
BEOUIRED INSPECTIONS
Site
to be made prior
to.sign, placement
Land Use
Code Section:
Approved By:
Area:
I
DATE:
Electrical y' rinat
prior to energizing completion of sign
Footing
prior to placement
of concrete
Attachment
alter lasteners are
installed/prior to r electricpl installation inStallatio
:Addttional Comments and/or Conditions:
By si , I state and agree, that I have carefully examined the completed application and do hereby certily that all information herein
is true 'and correct, and I lurther certify that any and all work performed shall be done in accordance.with the Ordinances of the City ol
Sprin'gfield, 'and the Laws of the State of Oregon pertaining to the work described
employees who are in compliance with ORS 701.055 will be used on this proiect.
herein. I f urther certify .that only contractors and
I luitlrcr agree to ensure that all required inspcctions are requested at the time, that project address is readable lrom the street, that
the pe rmit card is located at the f ront ol the property, and will remain on the site at all times during the installation
of the sign(s)
Signature b-4
Validatioo:
Receivcd By:
^q5
Amount
Receipt
Date Paid:
d)
t
O8/o3/95 09:04 6SOf 726 3689
PLUMEI
tate
FENCE
$
SIOEWALK
SPlfl) r)li\'. Sl,lR
?.oo/-P.?a
-TDE MO N
SUBTOTAL
SYST
DEV
F
I
TOIA JL,RMIT FEES
EXCLUDING ELECTRICAI, I
@ooz
CO M M ERC IAL/ I N DUSTRIAL
PERMIT APPLICATION
225 Fltlh Street, Springfield, Oregon 97477
JoB NUMBE R 7)q3-(4> ' "
INSPECTION LINE: 726-3769
OFFTCE: 726-3759
SPRINGFIELO
rAX LOT lloooi_11 0a4 a
I ttl __ltoHA\4/lLBLypLOCATION OF PFOPOSED WORK:
ASSESSORS MAP;
ADDRESST (oool ?op.g|(",Eg- c-a*Vod KAAD
",rr,eAt] RAHoFI -. . srArE Ch,,ZIP:
D ES c R I pr I o N o F wo R K, TJFEaBADEBBf,ROorhS z \arr-DEr.l DIQ?V Ay= /
O'THER VALUE: fut o4 -x__NEW--_* REMODE AOOITION {lEr/OLlSFi
YlcD*tew Br{/,D. @ttw_@
ADL)I.tE.Sg PHONE
EXPIRES PHONEADD
4
CONTRACTOR'S NAME
PLUN4BING:
G ENEBA
MECHANICAL:
ELECIRICAL:
CONST.
CONTRACTOFI .d
Ftrtr CHA RG F
s10.00
,t/*
No.FEE
Slngls Flxtur6
Relocated Bldg(new flx. addtl)
Water Service
fr
Sanllary Sewer
Ir
Slorm gew€r
Ir.
Backllow Devlceb?A
W2lbr*qAP9,4/*tztt //84'/r,;87 -Z*rc aus
Perrnit tssuance
rOTAL PERMITTOTAL PERMIT
I
ru:
< 100,000 BTUs
p ance
rner & vent
o(
Floor lurnace and vent
Furnace/burner & vent
> 100
Sta(lonary evap.
mounted unlt heater
uspen
separate
LAND USE:
r OF UNITS:
CONSTR. IYPE:-_
HEAT SOUBCE
-_
_ OFFICE USE ,,HANDICAP ACCESS:
FLOO}PLAIN
LIGHTING POWEB BUOGET;
WATER HEATER:
OCCY GROUP:
I OF STOBIES:
QUAD AREA:
I OF BLDGS:
VALUE
TOTAL VALUE OF PROJE
X
x
x
Pryy)ryffi88:JgtZ4{8:a-DDATL BY
2*-eBUILDING PERMIT
MECHANICAL
b_5% State
Surcharge
/z&
5% State
Surcharoe
PAVING
-O2/
CU RBCUT S
47r.22
owNER,c++FrrctJ . rJ.q.n. PRopuqTg srrt.{PtFlY pHc)NE: GLo)O+z-qEn
q+5b3
Roeg<T u;FE*^%' NAME
o^"rir.o, .
d
cooler
9nt System apart
orn AC or hto.
NO
I
or
and duct
ZONING:
80. FT.$/so. FT.
SO, FTG MAIN
SQ, FTG ACCESS
SO. FTG OTHER
%
M ENT ^/t/,r,
" 08/03/95 09:05 SSO3 726 3689 @ ooe
excess of 2500 P.S.l. (306 a,1)
STRUCTUBAL WELD$:
Performed on the lob. (2722 tl
HIGH STRENGTH BOLTING:
Durlng all bolt lnstallation and
ti ghtenlng operations. (306
a,6)
SPRAYED ON
FIREFROOFING: U,BC.
Standards 43.8.
SPECIAL GHADING,
EXCAVATION AN D FILLiNG:
Durlng earthwork, (306 a,11 &
Chapter 29)
GLU.LAM BEAMS: lnspectton
Certllicate by an approved
agency, furnlshed to the Clty's
Buildlng Divlslon before
beams are placed. (2501 U,BC.
sTDS, 25-10,11),
STRUCTURAL MASONHY: (306
a,7\
tln addition to the inspec-
tions specifled, the Building
Offiolal rnay make or requlre
other lnspectlons of any
constructlon work to engure
compllance wlth the Bullding,
Clty or Development Code.
REOUIRED INSPECTIONS
It ls the responsiblllty of the permtt holder to see that all rnspectlons are made at the proper tlme. To request an inspectlon, call
726476A (recorder), state your City deslgnated Job number, 1ob address. rype of ulspectron requested and when you wlll be ready
forlnspectlon.RequestsreceivedbeforeT:00a.m,will bemadethesarrrjworklng.tay rrrqrestsmadeafterT:00a.m,wil| bemade
the followlng work day.
SITE tNsPEcTloN: To be X RoucH PLUMBTNG - pAVtNG: After gravet is tn
made after excavatlon, but ELECTRICAL & place but prlorio placing
prlor to setup of forms, MECHANICAL: Nt work r:; i,, asphalt or concrete,
be covered until thesev UNDERSLAB pLUMBING, inspectlons have lleen martr, SpEC3AL 1NSpECT;ONS: tn accordance' ELECTRICAL & and approved ilction 306 0f the state specriiiv cooeMECHANICAL: To be made A??,A ^AAF! i special inspector shall bb employed
before any work ls covered. ATTIC DRAFT STC)PS & .,y ilre ownei/ Contractor durlniCURTAIN WAI-LS orstruction of the followi ng w6rk. A/ FOOTINGS & FOUNDATTONS: copy of the special teJttng reports sha[io 0",,,"E after trenches are FIREPLACE: Frior ro plactnll 5e iurnished io the Bulldlig Divlslon.
excavated and forms afe facing materldls and before
erectedt all steel ln place, but frarning lnspebtro
- STRUCTuRAL coNcRETE: lnprior to placlng concrete.
CONCRETE SLAB; To be
made after all lnslab bulldlng
eervlce equl pment, conduit,
plplng, accessorles and other
ancillary equipment items are
ln place but before any
concrete ls placed.
UN DERGROUN D: Plumblng,
electrlcal, gas, sanltary sewer,
storm sewer, water and
dralnage llnes. To be made
prlor to coverlng or filllng
trenches.
UNDERFLOOR: Plumblng,
electrlcal, mechanlcal. To be
made prlor to lnstallatlon of
floor lnsulatlon, decklng or
floor sheathlng.
POST & BEAM: To be made
prlor to lnstaltatlon of floor
lnsulatlon, decklng or floor
sheathlng.
FLOOR INSULATION &
VAPOR BARFIERS: To be
made prlor to installatlon of
decking or floor sheathing,
MASONRY: Steel locatlon,
bond beams groutlng or
vertlcals in accordance wlth
uBc 2415.
ROOF SHEATHING AND
NAILING: Prlor to lnstalllng
any roof coverlng.
FRAMING: To be nrade a{te r
the roof, all framJng, fire
blocxlng and bracing are ln
place and all plpes. chlmneys
and vents are complete and
the rough eleotrlcal, plumbirrg
and mechanlqal are approved
INSULATION & VAPOR
BARRIER: To be made after ali
lnsulation and required vapc,l
barriers are ln place but
before any lath or gypsum
board interlor wal; covering rs
applred
FIRE & SEPARATION WAIL
Located and constructed
accorcling to plans
LATH AND/OR GYPSUM
BOARD: To be made after ai,
lathing and gypsr.r'rr boaro,
inteflor and exteri,rr. is in
place but before any
plasterlng ls dpplied or before
gypsum board foints and
fasteners are taper-t and
f inls h ed
SIDEWALK & DRIVEWAY:
Bequired for all concrele
paving wlthtn street right <-l1
way, to be made after all
excavatlng complete and form
work and sub-base rfiSteriai ri
place
CURB ANO AFPROACH
APRONS: Aftsr forms are
erected but prior ro placing
concrete.
/x
X
v
A DDITIONAL COMMENTS;
-.
S|TE PLAN REVIEW BOAED: Must bo requested 2 days ln advanoe
of ths date you wlsh inspectlon All prolect condltlons such as
andscaping, parking lot stri,)ing, etc. musl be completed before
requestlng thls lnsper:tron
FINAL BUILDING: Requeste(j af ter tho flnal plumblng, electrical,
rnechanloal and Flre Departrilent inspectlons are made and
approved'. No occupancy of rhe premises can be made untll a
Certlflcale or Occupancy has oeen lssued by the Buildlng Divlslon
and posted i.rr, the premisr::,
a/f:Eg^2*?f
FINAL PLUMBING
FINAL ELECTRICAL
FINAL MECHANICAL
F]NAL FIRE DEPARTMENT
v
PLANS REVIEWED BY
AMOUNT
RECEIPT
DATE PAID:
By signature, I state and agr€e, that I have carefully examined the oompleted applicatlori and do hereby certlty that all lnformatlon
hereln ls true and oorrect, and I further certlfy that any and all work performed shall be done in accordance wlth the Ordlnances
of the Clty of Sprlngfleld, and the Laws of the State of Oregon pertainine ro the work derioribed hereln, and that NO OCCUPANCY
wlll bemadeof anystructurewlthoutpermlsslonoftheBulldlngsafetyDlv,5isn iturthL'r ,,,:itifythatonlycontractorsandemployees
who are ln compllance wlth ORS 701.055 will be used on thls proiecl
I further agree to ensure that all requlred lnspections are requested at tne proper tirne, that project address ls readable from the
street, that the permlt card ls located at the front of the property, anc, the approved sel of plans will ramaln on the slte at all
4js€o6-.Slg nature rDate
StTU on.tlmes du s
o ?RtRe
/A*-*,
VALIDATIO FECETVED: - /%-zz.,_ 129?i AECEIVED BY:
SPI, l) i)li\'' . Sl.)R
t
SPI :FIEL[)
CITY OF OREGON
Dde
225 FTFTE STREET
SPRINGFTEL,D, OREGoN 97471 Artholtad
INSPECTION REQUESTz 726-3769
0PPICE: 726-3759
1 LOCATION OF INSTALLATIONIt ttotlnulf BLvD SPRtNG f rtt-b
Signature of Supervising Electrician
)-fu/ /-J
ovners ruur" C-ilfilialJ qlA
Address b9l BOt--'rlJ(sG€ Cr+
OVNER INSTAILATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Orners Signature:
trnd u.
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
BLECTRICAL PERHIT APPLICATION
zonin!,
approvi
Z.i; , ', ,",,LU
(s t3ogCi ty Job Nu-mber
COHPITTE FEE SCHEDI.ILE BELOV
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
I,EGAL DESCRIPTION
l-7 03 d5 ,->3 tTcirro
JOB DESCRIPTI1(slArL StG
ON
^/
Permits are non-transferable and expire
i f vork is no t s tarted vi thin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATTON ONLY B
Electrical ContractorMEVER Staxl co, oFo4,
Address -73'1O LA^IDMA&K Cr.I
Ci ty T IGAAD pnone(qo)Gzn-Eta
Supervisor License Number
Expiration Date
Number rt{otl 2o- t?occs
C
Constr Contr
Expiration Date
(
3
A
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
20L amps to 400 amps
-40L amps to 600 amps _60L amps to 1000 amps_
Over L000 amps/volts
Reconnect 0nly
D. Branch Circui ts
s 8s.00
s 1s.00
s 40.00
s s0.00
s 60.00
s100.00
s130. 00
s300.00
s 40.00
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps''or less
20L amps to 400 amps
Over 40L to 600 amps
-Over 600 amps or 1000-7oITs Eove
$ 40.00
s ss.00
see rrBtL a
Sao
S40
$20
S36
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Addi tional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Eaeh installation
Pump or irrigation
Sign/Outline Lighting-T
Limited Energy/Res
Limited Energy/Comm
00
00
00
TEa.ce
5 lL-o'o2
tQDATE:
RECEIVED
o
FIELD, OfiIEGOA'ct TY OF SPF'IVG
1\"!
l'',;;.1
TE VTTTE SIBEEf, iJi]'J
stBrIGElnD, mmn 97177
1.OP
.rrOB
t
Orners Slgnature:
tFEIMIELD
BIACTRIGAL PMITT
Clty Job [turber
rBB SCIE)UIA BBTOS
SIJBTOTAL OT ABOVE
5Z State Surcharge
3Z Adninistrative Fee
TOlAL
q$5M
nrit u
zcn
,.II|SPBCIIOII REOIIBST;. 726-3769 (-
OFEICB: 126-3759
Pcmlts are non-transferable and explre
1f rork ls not started rlthln 180 daysof lssuance or lf uork ls suspended for
180 days.
2. C(ItIR.ACIUR IIISIAIIAITOil $ET
Blectrlcal Contrac ,or, TDEtrwL
Address ?0. b cry 1 BI
Clty Boo, n "
Explra tlon Date
Slgnature of Supervlslng clan
Grners Nane
Address
ct Phone
A. Nev Resldentlal-Slngle or
llultt-Pautly per rlvelllng unlt.
servlce rncludedc rtens cost
1000 sq.ft. or leas S 85.00
Each addltlonal 50O
sq. ft or portlon
tliereof S 15.00
Eech l{anuf'd Eole or
llodular.'Drelllng
Serilce or Feeder $ 40.00
B. Servlces or Feeders
Installatlon' Alteratlons
or Relocationr
2o0 anps or lcss 1I $ 50.00
201 auis to 40o arps T $ 60.00
401 anis to 6oo an'ps
-
$100.00
601 anis to'1000 "ips- $r30.@
over lboo anps/volt;
-
$3oo.oo
U
Sul
i0000@Phon"le-Lllil-il
Supervisor Lieeilse Nunber )(il'lU 't
Expl ratlon Date I
constr contr. ttunber-,i 64lrybL Tenporary Senrlces or Peeders
Installatfuinr Alteratlon or Rel'ocatlon
M8R I}ISf,AIJATIO{
The lnstallatlon lsr belng lade on
property I orn vhlch ls not intended
for sale' Iease or rent.
200 anps or less
201 anis to 400 arps
-Over 401 to 600 anps
over 600 arpa or 1000Gllts
Branch Clrcults
Nev, Al-teratlon or Bxtenslon Per Panel
One Clrcult $ 35.00
iech Addttional
Clrcuit or vlth Servlqe.
or Feeder Pernlt---"4 $ 2.00 l(:69*
Htscellaneous (Servlee/feeder not lncluded)
-Each install-ation
Punp or irrlgatlon
Stgn/Out1lne Ltghtlng-
Llmited Bnergy/Res -
c-
5
$ 40.00
$ 55.00
$ 80.00 aEffis€e iBt
D
B
$ 40.00
$ 40.00
$ 20.00
$ 36.00
OD
DATE:
RECBTVBD
soolD 'ugs 'Ago odds 6898 9AZ 80SCD 00:80 t6/9O/Ol
I