HomeMy WebLinkAboutPermit Electrical 1996-11-06BubmittsC has tho loll
Sr.{INGFIELO
ELECTRICAL PERHIT APPLICATION225 FIFTE STREET
SPRTNGFTELD, oREGoN 974
fNSPECf,ION REQUEST: 72
OFPICE: 726-3759
Zr:ni
uire sPecific land ueo
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Manuf'd Home. or
-
Modular Dwelling
Service or Feeder
B Services or FeedersInstallation, Alterationsor Relocation:
200 amps or Less
201 amps t
401 amps t
601 amps t
Over L000
Reconnec t
SUBTOTAL OF ABOVE
52 State Surcharge
32 Administrative Fee
TOTAL
1. LOCATION OF INSTALIdTTON
3
JOB DESCRTPTION
2. CONTRACTOR INSTALI.ATTON ONLY
Electrical Contractor
?,0, 8ox
hJM Ci Job Nurnbertv
coHPI{rTE FEE SCEEDUT^E BELOV
Nev Residential-Single orMulti-Family per dvelling unitService fncluded:
I tems
7a/5a z_-
3
A
Permits are non-transferable and expireif vork is not started vithin 1BO daysof issuance or if vork is suspended for
180 days.
Cos t
s 8s.00
s 1s.00
$ 40.00
oo
OO
Sum
tDt,oo
e@
Address rk6
ciw (Y]fe(a- ,1'l\71 Phone'l- +\'bq 7
Supervisor License Number 4oi q -9
Expiration Date o--qs
constr contr. Number 1AZ LO
Expiration Date
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps''or less S 40.00
201 amps to 400 arp"
-
S 55.00
over 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000 voT[s see "B", aEovE-
D. Branch Circui ts
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Serviceor Feeder Permi t
s 3s.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Ou tline Lighting-
Limited Energy/Res
-
Limi ted Energy/Comm
o 400 amps
o 600 amps
-o 1000 amps-
amps/vorts
-
Only
s s0.00
s 60.00
s 100. 00
s 130. 00
s300.00s 40.00
\
Signa ture of S
Owners Name
Address
Ci ty
Electrician
Phone
The installation is being made onproperty I ovn vhich is not intendedfor sale, Iease or rent.
OVNER INSTALLATTON
0rners Signature:
DATE:
s 40.00
s 40.00
s 20.00
s 36.00
5
BRECEIVED / rouo-4-*-
Ytb
1t-
0 (