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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