HomeMy WebLinkAboutPermit Electrical 1991-08-08ti-
..RESIDF\TIAL..
zz-: North rrr r,roui"trcATTvil
/PERItlfi
Springiield, Oregon 9?477
82t1, Ld1,ng DLOl,sLon
726-3753 .
SPFIINGFTELD
!
C
tkJob Locatic'',.' \
?c,s Lot #Aesessore Map #
Subdiuision:
)tmet:
CITY
s1'ruN(;FrGLf,
m
225 FIFTB STRBBT
SPRINGFTEID, ORBGON 97477
INSPBCTION RBQIIBST: 726-3769
0FPICE: 726-3759
1. LOCATION OF INSTALI.ATION
\l8/^r5 vtR6tN//) '5--
BI,BCTRICAL PERIIIT APPLICATION
City Job
3. COUPIATE TBB SCBEDUI.B BEIOS
A. New Residentlal-Single or
Multi-Family Per dvelling unlt.
ice Included:
Items Cost
I,BGAL
Suml- //o OI
JOB DESCRIPTTON
Fo<<> €D ,4 i t(xil ec-^s
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelllng
Service or Feeder
Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amPs
-
401 amps to 600 amPs
-
601 amps to 1000 amps-
Over 1000 amps/volts
-
Reconnect Only
200 amps or less
20L amps to 400 amps
-
Over 401 to 500 amps
-
Over 600 amps or 1000 voltr
$ 8s.00
$ 1s.00
$ 40.00
$100.00
$130.00
$300.00
$ 40.00
40.00
55.00
80.00
s see ilBtr a,5ove
Permlts are non-transferable and expire
lf nork is not started vithin 180 days
of lssuance or if work is suspended for
180 days.
2. COIITRACTOR INSTALI,ATION ONLY
Electrical Contractor
Address
ci Phone
Supervisor License Number
iration Date
B
$ s0.00
$ 60.00
Exp
Constr Contr. Number
Exp iration Date
Signature of Supervlslng Electrlcian
0wners Name \N t-A€Dt<-rc JP
Address,38l v'tRG t/v tA !5'f
citys {R,,ta)a 5teu2 Phone 7,PA '\9 i I 7
OIINER INSTALI,ATION
The installation is being made on
property I ovn which is not intended
for sale, lease or rent.
Owners Signature:
Tenporary Services or Feeders
Installatlon, Alteration or Relocationc.
D.
E.
$
$
$
Branch Clrcults
New, Alteration or Bxtenslon Per Panel.n,' (t)
one circuit \ $ gs.o0 5i:
Bach Additional
Circuit or vith Service
or Feeder Permit
-
$ 2:90
-Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/0utIine Lighting-
Limited Energy/Res
-STIBTOTAL OP ABOVE
5Z State Surcharge
TOTAL
$
$
$
$
40.00
40.00
20.00
36.00\-DX CA
5
DATB:
RECEIPT
RECEIVED BY:
(]
7