HomeMy WebLinkAboutPermit Electrical 1998-11-09225 FIFTB STREET
SPRINGFIELD, OREGON 97 477
INSPECTION REQLTEST | 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
J
CAI PBRMIT APPLICATION
Ci ty Job Nurube ,? ?/ o(os
3. COHPLETE FEE SCEEDIJLE BELOV
c
SPFrINGFIELO
sidential-Sing1e or
Family per dvelling uni t
Service Included:I tems Cos t
Q{,,
a
D",t
!r-
A Re
Mu
7{0 t
20L amPs
40L amPs
601 amPs
Over
Reco
/voI ts
$ s0.00
s 60.00
s100.00
s130.00
s300.00s 40.00
3lg
I ' '.
Sum
luded )
JOB DESCRIPTION
t4D/.CI t.1€
Permits are non-transferabl'e a1{ expire
it-""tf. is not started vithin 180 days
of issuance or rf vork is suspended for
180 daYs.
2. CONTRACTOR INSTALT.ATION ONLY
Electrical Contractor --.
Address
Services or Feeders
installation, Alterations
or Relocation:
200 amPs or Less
400 amPs
600 amPs
1000 amPs
"h$hffi;
B
---.Phone
to
to
toCi tY
Supervisor License Number ?oz3 5
Expirat ion Da te lo * I - 2/ C.
Constr Contr' Number .-
Expiration Date
Signature of SuP ervising Electrician
0vners Name
Address 'l 1 Sf,
<_-)Per Phone726- /3{
::*# 'n
200 amPs't"ot.'I€St;;i il;; i" +oq
-4.P3'"-+'::n;;--"tF0F'oo
over 401 to 6oo bmb's --l s ed:99
-Over 600 .rnp" o'-ibOO-7oft" see "B" above
D. Branch Circuits
Nev, Alteration or Extension Per Panel
r g3s.oo 35
Ci tY
OVNER INSTALLATION
The installation is being made'on
Droper ty I ovn 'f'-ili'- is io t intended
iot't"il, lease or rent'
Orners Signature:
Miscellaneous (Service/ feed
-Each installation
PumD or irrigatron
-
iinluoutrine Lighting-
t lilited EnergY/Res .-
Limited EnergY/Comm
$
$
$
$
Serv r ce $ 2.00
er not inc
40 00
00
0.00
6.00
One Circui t
Each Addi tional
Circuit or vith
or Feeder Permi t
IZz
E
04
,)
)J
SUBTOTAL OF ABOVE
5Z State Surcharge
i7 ea*inistrative Fee
TOTAL
DATE:
RBCEIVED B
5
vq.(i /z
Z €tl_
rri'i tlrlT
MtJUU-&er
Serv i
obtain rules by
Utility 00
Lvi
CITY OF SPRINGFIELD,OREGON
S; ..r, :IEL.,
T_Tj9_mitt€d. I,ss rho f ol towin grequtro speciflc land ue.r
225 TIFTE STREET
INSPECTION REQTIEST:
OFFICE: 726-3759
726-37
1 OF INSTAILATT
JOB DESCRIPTION
t
Permits are non-transfer Ie and
if vork is not started vithin L8t
of issuance or if vork is susPen'
180 days.
2. COMRACTOR INSTAII,ATION ONLY
Ovners Name
ELECTRICAL PBRHIT APPLICATION
Ci ty Job Nurnber ?( tobs
COMPTETB PEE SCEEDULE BELOV
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
sq. ft. or less
additional 500
s 8s.00
or portion
t $ 1s.00
Home or
t ions
s 40.00
U
n rt
3
A
1000
Each
Sum
n
5'ove
r
rs
ation, Altera
,cc tar
q/a/ 3rs/ /7t/ 5tr
6Phonery Gertart PcqtC
Numbe
lanc1rtcEIeng11Supervof
t:
a
res
c
I
E1e
s
Add
pEx
Si
1
s
r
L
tn
L
Co
5
1
4
ca
o
S
et
Li
Da
ro ?,onoca1RetcATt+r i
r
o
o
o
t
o
t
t
t s
amps
amps
amp
ss
0
0
00
ts
o
ra
1
s
e
vo
to
amp
You
rbeumN
20
20
40
60
0
1
1
1
amps
amps
amps
amps
1000
1e
40
60
10
L
1
$
s
s
$
s
$
s
00
00
00
00
00
00
50
60
00
30
catio
.00
.00
.00
ilBil a
ReIo
s40
$ss
$so
see
1
sup
Exp
Con
a
r
a
r
t
r
e
i
s
i
300
40cenrv
er
r
eed
on
F
o1
amps
1000 voTt
1 r
on
n
on
so
I
Co
1
e
r
trt
etDat
gna
'amps
s0ve
1 <-
-D. . Branch CircuitsU\t
Address ZDO S .rYu l( <+
cit Phone 1lta. taa(
OIJNER
The installation is being made on
property I ovn vhich is not intended
for saIe, lease or rent.
Ovners Signature:
DATE:
Nev, Alteration or Extension Per Panel
gne Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
sign/outline Lighting-
Limited Energy/Res
Limited Energy/Comm
--SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
s
s
$
$
00
00
00
00
40
40
20
36 w
RECETVED
c
5
SPRINGFIEI^D,OREGOITi.,$Bfi7Jd
4Ny i80 DA
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