HomeMy WebLinkAboutPermit Building 2000-10-04225 FIFilt S'['R[ET
SPnINGFIELD, 0REGON 974
lNSt'[rJ'l0N REQUEST | 72
oFPICE: 726-3759
I. LOCA'TION OP I TA
I, PIRHIT APTI,ICA'TIOII
Number a.o
B SCItBDUt,B tltit,0lr
l00O sr1.ft. or less
Each addltlonal 500sq. ft or portlorr
tlrereo f
Eaclr }larruf , d ilome or
Modular Dwellllrg
Servlce or Feeder
B. Servlces or Feeders
_ Installatlon, Alteratlorrs orU Relocatlonr
-o
. LEGAL
I ao3
.vlz$$igT-ature
O oo
t{ev Resltlerrt lal-slrrgle orl'lultl-Famlly lrer dwel.llrrg urrlt.
Servlce f rrcluded:
Items Cost
I
Sum
I
-J0B DBSCnIPTIKe-Ptace-ON
fr4y.1 c6r $ ss,oo
$ ts.00
$ 40.00
$13
$30
$ao
S 2.no
Electrlcal Contraeto
Address +
Cl ty Pholte b
Supervlsor Llcense Number ?> t 4K-
Explratlon Date )A *L.
Corrstr Cotrtrr Number
Explratlon Date tl -LJ-
Slgrroture of Supervlslrrg ElectrlclarrTa*th €.
orrrers Name
Address
cl ty 3?€\Ptrcne '7"/{ - l3L/7
Perml ts are trorr-trarrs[erable arrrl exlrlreIf rork ls not started vlthln 180 daysof lssuance or lf vork ls suspendetl for180 days.
7., cotlrRlstoR INSTALLA,uON ONLI
OUNER INSTALLATION
Tlre ltrstallailon ls belng rrade onproperty I own uhlch ls not lntendetlfor salel lease or rent.
Oenets Slgnaturer
DATE: /
ruicBl P'r I :
200 amps or less I201 amgrs to 4()0 amps
-401 arnps to 6O0 anrlls .--
6Ol amlrs to 1O00 arrr;rs._.-over 1000 amps/volts .-
Ileconnect 0rr1y
$s
$6
$10
0.
0.
o.
0.
0.
;o00
00
00
00
00
00
C
D.
B
Temporary Servlces or Feerlersftrstallatlorr, Alteratl<rtr or ltelocatlon
200 anrps or less $ 40.0020L amps to /r00 an,ps
..-..-_
$ 55.00Over /r01 to 600 amps $ 00.00Over 600 anps or 1000*voi[s see n[il aEdiE-
llranch Cl rcu I t s
New, Alteratlon or Extenslorr per l,arrel
One Cl rcuI t
Each Ad<lltlorral ----
Clrcul t or vl tlr Servlceor Feeder per:rnl t
S 35.00
l'llscellarreous (ServIce/feecler rrot lrrcludetl)-Each lrrstallailorr
Pump or irrigatlon
Slgrr/0utI lrre Llgh t lrrg--'.-.-
Llrnl ted Errergy/i-les e-_-_-
Llnrl ted Elrer gylConrm
$
$
$
$
00
0(,
(.)0
00
1r0
4rJ
20
36
sul!'t'oT^r, 0P AUOVB
)I State Surcharge
3'Z TO'I'AL.
_.|m
f.J
Cll ..r?c){ts
I(}O5" (:)
Or.J L.tO L.I(} --lo'ro
., z,eEfi}IDl
Irucutv[D [Y:R
5
Z,
LN(Jl
a(3
'a rirrl.
Sep-"€l-OO O€}:?slA JKG ELECTRTC
fiylrL)(n (\(,( t(ri
.-)
i:).{.r tlf:l L)
541 7463El55
st,r.r.aG, tt a l,j,
EtErr1lrcal Pglull T aIrFLlcATI0N
City .Iob Nr.ruber:
I tems Cos t
s 85. ${,
P -02
227 EIMI S'TRF.DT
SPRIl&;rrEU), 0Rf,(;0N 9r4?l
IIIPU(:froil i$QUF.Sr: tz6_.)t6g0PPICI:r 7?6.3759
t IIT,CATIOfI'zn Lz or INSTALIATION
ZYr, jT.
I.IGAI, UESCI(IPIIO!'
ucflfl.srE fyf' sctlEuull: DELoU
Nev Reside:rrial ..SinSle orllultI-Family per drelling urr;i t -Service Included:
t
A.
Sun
Addre-.;s L_!f_-?_D=
^J
J{
city :tFbD e *rone .J\L yh(A
Superr,isos Licerrse Nunber 514 t -5
Ezpiratlon oatc l0-
SigDat:uEe of Supervlslrrg ELectriclaa
tl^^rlrl
Onners l{arne deb,!{l)
{+
.{dd.resr s?-\-.(-{-./U ,1/-
Ci ry Fhou: -lqLI I 1 1
1000 eq. f r" ,,r3 !q's5
Each adr.litlooa.l 500sq. [t or porriorr
thereo f
Daelt FirrruL'rJ [osre or'
-
Xo<lular l)u+l ling
Servir:e or feeder
D. Services or Feetlers
f nsrallat ton, A.l.tera!iousor I(r:]r;uutirin:
2(lO amps <,r f es.t
201 arcps to (0O arnps{r0l anps to 600 ahps *--
6Ot amps to l00U amps-Over 1000 amp.</,ulr:,
-
Ilecourect ODly
L
E.
?00 anp.n "s21 less S rrg.tlu _&-2Ol aups ro 1100 B-t,s
-" i -SS-rftfOlrer /r0l to 600 anrps -- S OO-00 ;--
ovcr 6(XJ ,rmps or fOOO U;lis see "9" aUrFc.
ll5arrch Circul ts
Nev, [flqgation or Extr.rrtion Fer parrel
One Crrcrri( S 3l_0()Earh Ailtli tiorralcirr,ult ui lri th scrviconr Fer:dpr Perrui t l; :f -O0
lliscellaneous (Service/foe,lcr lor includerl)-r,d'-'r lurLai laIt(ril
Punrp ur irri,6atir:rr SStgn/0rrtlir,cr Ljglltir,y. - al,ini te d Energy/Rcs SLinitedEnergy/Conn - - S
gr PrIoN , /.€u,)tLb
Pernlr's afe non- rraiis{erable arrd expirelf uor.lc ls rrot srrrrcd vlttrip ittO-U;;-uf-l.ssuance or if rork is .""p""j.J'f",180 days.
2. c(,F|IAACf,ott I3{SIAI.IAIIoN otil,r
Electrical Cuntracror JK.b _eLSI_
s 'r5.00
s (0-0n
S }U.H,s 60-00
-sloo.00
sl30. eo
\\JUU - UU
S 1.0- 0U
coesrr conrr, Nunber ({5lZq 'l'ttrporat:y ..iervi ces ot Feedcr.slnsLallation, Alterat Iorr r.rr Rplocat
Expiration Dale
l otr
ovrER INSIAU.TTTIOI,I
The lrrstallatior: is belng marJe onproPcrty { bvn vhlch is iot fnteuAe4for saler tlia". or renr.; .
UYnPr$ Sigr.3tu1q.
r0. u(,
4().00
20. (x-t
36.00
DATE:
RECEIIFT.T:
3. SI'BTOI4L OF AJNJY':/1 !itatc, Sui r:!ra r.gr
3Z Adnrini$trativo Ir.:e
1'Ol'ALREEf,IVf,U 8I::--
't0 -_-___ z-:62 _
- - -J.l,S-t{t.-_
- ?8-
Flegistration
Numtlor:
Bogistration
Expires;
54.174ri3€55
45129
a4D4tO2
P-(f3
STATE OF OREGOh Cqry_Q_TBUCTTON coNrRAcroRS BOARDREG16TNAr,ON CERNF//GA?E
This certifres that tfge person nam6d hereonls reglstered as provided by taw as a
Ge n eral Co ntractor/All
NON.EXEMPT
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