HomeMy WebLinkAboutPermit Electrical 2001-01-16C,ITY OF OREGON
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.tc t't.LOr'iyrEtt I rLrtviCc j uLpffe1Ol/Olrfftfdp roject as submitted has the follzontng and d oes not reguire specific land useappraval
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SPRINGFIELD, OR 97477
(541) 726_3753
FAX 641) 726-s689*-Zontng
225 PTYTE SIts.EET
SPRINGFIELD, oREGoN 974
INSPECTION REoSBST: 126:yl69zec Srsnatu,e
0FFICE: 726-3759
L. 6l PERI{TT APPLTCATTON
Job Nunber (>t^ Ooogo ^ O
3. COI{PLETE FBE SCEEDULE BELOS
A Nev Residential-Single or
HuIti-Famlly per dvelling unit.
Servlce Included:Items Cost Sum
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Hanuf'd Home or
-l.lodular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
s 40.00
B
t-
rfu'"
I. .LOCATION OF INSTALIATTON/ft:1-> /5n {r" Aue_
I.EGAL DESCRIPTION
I -7 o jZ\ j'O/oo o
JOB
2. COI{TRACTOR INSTALI,A:TION ONLY
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
Electrical Contractor ADT Security Services
Address 4660 Main Srree t, Blde A, //100
Ci ty Sprinsfield Phone 736-4973
Supervisor License Number 853 JLE
Exp irat.ion Date t0/Ot /oz
Constr Contr. Number 26209CL8
Expiration Date L0l0L/0t
Signa of Supervising Electrician
0vners Name /ot'rY ln Or
Address { r4rn <
Services or Feedersfnstallatioa, Alterationsor Relocalion:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps
-601 aurps to 1000 amps-
Over 1000 amps/vo1ts
-Reconnect 0n1y
s s0.00
s 60.00
$100.00
$130.00
s300.00s 40.00
Ci ty
OSNER INSTALT.ATION
The installation is being made onproperty f ovn vhich is not intendedfor sale, lease or rent.
Ovners Signature:
$ 'u/' 'Phone 7q 2*>7 / )
c.Temporary Services or Feedersfnstallation, Alteration or Relocation
200 amps or less $ 40.00
201 amps to 400 amps
-
S 55.00
over 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000 voTTs see "B, affi
D. Branch Circuits
Nev, Alteration or Extension per panel
One Circuit $ 35.00
Each AdditionalCircuit or vith Serviceor Feeder Permit g 2.00
Miscellaneous (Service/feeder not included)
-Each installation
E
DATE: otlQt r
RECEI
RECETVED'B '--4
Pump or irrigation
Sign/0utline Lighting-
Limited Energy/Re"
-Limi ted Energy/Comm -----:-
SUBTOTAL OP ABOVE
7% State Surcharge
3Z Admini.strative Fee
TOTAL
$ 40.00
$ 40.00
s 20.00
s 36.00
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