HomeMy WebLinkAboutPermit Electrical 2002-02-27225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
I. LOCATION OF INST
1068 N.20th
TWf\ilowngpro,ect a
l2$trylgld does norapproval
Zoning dY-
,'t -FEE SCHEDULE BELOW
or
per dwelling unit.
Items
I
Cost Sum
$106.00 $
$19.00 s
$s0.00 $
$63.00 $ 63.00
$7s.00 $ -
s12s.00 $ -
$163.00 $ -
$37s.00 $
$50.00 $
$s0.00
$69.00
$r00.00
$
$
ELECTRICALPERVT PLICATION
require specific ffif[guim,'nu"'5zaz.7-7^cs submitted has
- A1-oZ
ew
LEGAL DESCRIPTIONiao3-S5 tL Ot600
JOB DESCRIPTION
Service Change
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or ifwork is suspended for
I 80 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor JB ELECTR rNc.
Address 4685 lsabelle
City Euqene. OR 97402 Phone-541-@529.-
Supervisor License Number 3872S ilrtI\GE'
TH\S
Expiration Date
Service Included
1000 sq. ft.. or less
Each additional 500
sq. ft or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600
60r
N()r
Constr Contr. Number
Expiration Date 10t1t02 3t14tU
Electrician
Name
Matthew Bryan
Address _1068 N.20th-
City Sprinofield. OR 97477 Phone 726-6881-
The installation is being made on
property I own which is not intended
for sale, Iease or rent.
Owners Signature:
FOB
AB
Services or Feeders
ANY 180 DAYPE
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or I 000 volts see
B above
D. BranchCircuits'' '.' . '
New, Alter"ation.or Extension Per Pariel
., ,,.\\,
'..
On" Circuit ' 'l'
,, Each Additibnal Circuit orwltf, m"
'..,.prfeeaerPerlnit I.\U\' ''' i' i '.
"
-
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or inigation
Sigr/Outline Lighting
Limited Enerry/Res
Limited Enerry/Comm
5. SUBTOTALOFABOVE milrrut
7o/o State Surcharge
8% Administrative Fee
$45.00 $
$
$
$
$
!
\
$43.00 $
$3.00 $ 3.00
$50.00
$s0.00
$2s.00
$45.00
66.00
4.62
JB Job # _02-151-TOTAL
5.28
Street
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$ .,'"-69h
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