HomeMy WebLinkAboutPermit Electrical 1999-12-28GRFGOA'C'TY OF
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EI.ECTRICAL PERilIT APPLICATION
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TH,S PERMIT
Date
Ai/lhorized Srgnalure
225 FIFTE STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQITESTz 726-3769
OFPICE: 726-3759
1 0r
AUIHORIZED /L?
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Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COIITRACTOR INSTALLATTON ONLY
Electrical Contractor EI
1000 sq.ft. or less
Each additional 500
sq. ft or portion
theredf i tlir,,\INrach ilatnr,f
Mod
Ser
0090. yo uB. Servi
Ins t
One Circui t
Each Addi tionalCircuit or vith Servior Feeder Permi t
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Admini.s trative Fee
TOTAL
f tems
ir.
Cos t
$ 8s.00
$ 1s.00
$ 3s.00
$ 2.00
Sum
aaaress P Lr \3cx. lt+8)
Ci
Supervi.sor License Number lbSts
Expiration Date lD-Cl-Cr
1899
Q-oi-oo
. or Reloca isl
200 amps or less
20L amps to 400 amps
phone 7Yt-&13 40L amps to 600 amps
601 amps to 1000 amps s130.00
s 50.00
$ 100. 00
Over 1000 amps/volts $300.00
Reconnect 0n1y $ 40.00
c-
D. Branch Circuits
Nev, Alteration or Extension Per Panel
V,tc
I
I
I
Constr Contr. Number
Expiration Date
si re of Supervising Electrician
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
201 amps to 400 amps
-
$ 55.00
0ver 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000-volTs see rrBrr a66E
'" ..'" Sheilca h''lrleil
Address
Ci Phone
OVNER INSTALLATION
The installation is being made onproperty I ovn vhich is not intendedfor sale, Iease or rent.
Onners Signature:
DATE:
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/OutIine Lighting
Limited Energy/Res
Limited Energy/Comm
1q 35,0c
*,coceA
40.00
40. 00
20.00
36.00
$
$
$
$
5
RBCEIVED B
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