HomeMy WebLinkAboutPermit Electrical 1997-07-085PR..JFIELD
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1. LOCATION OP INSTALLATION
LEGAL DESCRTPTION
DESCRTPTION
2. COMRACTOR INSTALLATTON ONLY
Electrical Contractor
Address l?<J tSdl)
city ruogtg Phone
Supervisor License Number
Expiration Date
Constr Contr. Number 2d -ha
Expirarion Date
Signature Su s ectrician
Ovners Name
Address
3. COMPLETE FEE SCEEDT'LE BELOII
A. Nev Residential-Single orMulti-Family per avel:.i.ng uni t.Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereo f
Each Manufrd Home. or
-
Modular Dvelling
Service or Feeder
ELECTRTCAL PERUTT APPLTCATTON
City Job Number 7t
B. Services or FeedersInstallation, Alterationsa or Relocation:
200 amps or Less /20L amps to 400 amps ..--
401 amps to 600 amps
-601 amps to 1000 amps-
0ver 1000 amps/volts
-Reconnect 0n1y
225 FIPTE STREET
SPRINGFTELD, oREGON 97477
$ISPECTf0N REQUEST: 726-3769OFPICE: 726-3759
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zoniilg, artd does not requiro 6J;,:..,cei.i)rovat. I
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Authodzed
Sum
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for180 days.
s 8s.00
s 1s.00
$ 40.00
$ 3s.00
s 2.00
,t^ O0bo\s s0.00
s 60.00
s100.00
$130.00
$300.00s 40.00
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aE'oie
00
00
00
Brt
$ 40.
$ ss.
$ so.
see tt
c Temporary Services or FeedersInstallation, Alteration or Relocation
cit Phone
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
0uners Signa\.ure:
DATE
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permi t *}-
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/OutIine Lighting-
Limited Energy/Res
-
Limited EnergY/Comm
200 amps''or less
201 amps to 400 amps
-over 40L to 600 amps
-Over 600 amps or 1000-76fTs
SUBTOTAL OF ABOVE
5% State Surcharge
1i. la*itistrative Fee
TOTAL
')p
{:
00
00
00
oo
e
$ 40.
$ ao.
$ 20.
$ 36.
5
BRECEIVED
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