HomeMy WebLinkAboutPermit Electrical 1997-05-02225 FTTTE STREET
SPRINGFIELD, OREGON 97 477
ilriiscf,roN REQIIEST: 726-3769
OFFICE: 726-3759
SPAIh EL()
l-De_ELECTRICAL PERHIT APPLICATION
City Job Nu.nbe ,g -l D(t 32-
Nn"
COHPIJTE FEE SCEEDT.ILE BELOV
Nev Residential-Singl9. or
uut,l-P"riIY Per dvelling unit'
@fi,
5-z ?1
1. LOCAT OF INSTAIT.ATTON
I,EGAL p
Res
JOB DESCRIPTION
2. CONTRACTOR INSTAII'ATION ONLY
Electrical Contractor ADT Security :
Address s01 Pe r'l qr
Ci tY s e Phone 342-13t q
p
Ovners Name
Address )r.l LI -rtl^+
Ci tY Phone -qq L2
OVNER STALT,ATION
t000 sq.ft. or less
Eacn additional 500
sq. ft or Portion
thereof
Each Manuf'd Home' or
Modular 'Dwelling
Service or Feeder
Services or Feeders
iitiiir.tion' Arterations
or Relocation:
200 amPs or less
201 amPs to 400 amPs
-
'40L am-Ps to 600 amPs
-
eOf amPs to 1000 ?mPs-
6r"t rboo amPs/volts
-
Reconnect 0nlY
TemporarY Services or Feeders 'rnstallation, ^'ilt"iion
or Relocation
Supervisor License Number 949 JLE
Expiration Date
Constr Contr' Number 599 44
Expiration Date tL 127 /q8
Signature of ervis Elecfrician
1
3
A
.B
Service Included:Cos t
s 85.00
s ls.00
s 40.00
Sum
.00
.00
.00
s see rrBri a
$ 2.00
er not included)
AA
I tems
Permits are non-transferablg "ll expire
;;-;;;k is not siarted vithin 1"80 daYs
of issuance oni-'ott" is suspended for
180 daYs.
$
s
s
s
s
$
00
00
00
00
00
00
50.
60
100
130
300
40
40
55
80
$
$
$
c.
Nev, Alteration or Extension Per Panel
$ 3s.oo
200 amPs'"or lessiil ffi; io aoo amps
-Over 401 to 600 af,Ps - .
'O""t OOO amPs or l'000 volt
Branch Circuits
one Circuit -
-
Each Additionar.-Eii"rit or vith servrce
or Feeder Permit
MiscellaneouS ( Service/feed
-fach installation
iielzouttine Lightine-
l-iiit"a EnergY/Res !
bove
D
rhe ins tallat ionniinoil"fi"T"ti,3lo"o
DroDerty I o!'n !'l
ioi't"rl, lease or rent'
0mers Signature:
B
$?o 00
s 40.00
$ 40.00
$ 20.00
s 36.00
jk
(
DATE
RE A{nW
5 SUBTOTAL OF ABOVE
5Z State Surcharge
iijj.i.istrative Fee {zl 6s
Alarm Ins
I I