HomeMy WebLinkAboutPermit Electrical 2001-05-29SPFlr ;IELD
DEVELO P ME NT S E RVIC E S D EPART|I E IIT
225 FTFTH STREET
SPRTNGFTELD, oR-EGoN 97477
INSPBCTTON REQUEST| 726-3769
OFFTCE: 726-3759
1 ON OF INST
o
,
Permits are non-transf ble and expire
if vork is not started \.i ithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
maress/J 0 lr1 *E
cit phondt*?.5?-fu
Supervi Li cense Nurb"..?3}r-5-
Expiration Date
Constr Contr. Number
.o\
BLE TRICAL PERHIT APPLICATION
Ci ty Job Nunbe. O
3. COHPIATE FEE SCMDULE BELOS
A Nev Residential-Single or
MuIti-FamiIy per dvelling unit.
Service fncluded:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf 'd Horne or
Modular Dvelling
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Dt-
225 FIFTH STREET
SPRINGFIELD, OR 97477
(511) 726.3753
FAX t541) 726-3689
$ s0.00
$ 60.00
$100.00
s130. 00
$300.00
$ 40.00
Services or Feeders
Installation, Alterations
or Re]oca t i on :
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _
60L amps to 1000 amps_
Over 1"000 amps/volts
Reconnect OnlY
D. Branch Circuits
ON
Sum
/\L__-,
)nY
B
C
Expiration Date
Signature o
Ovners Name
Ci ty
aaaress 5 /
ing Electrician
Phone
Ll
Temporary Services or Feeders
fnstaLlation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
-0ver 401 to 600 amps
Over 600 amps or 1000 voT[s above
$ 40.00
$ ss.00
s 80.00
see ilBrl
E
Nev, Alteration or Extension Per Panel -Ar
-a-
--
one circuit \ $ 35.00 i*
Each Additional z--ne-
Circuit or vith Servic? -) >-
or Feeder Permi t [ $ 2.00 '2
Miscellaneous (Service/feeder not included)
OIJNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
-r.,.,,,,,{€E*,jFale, f ease or rent .
:LUU, tl-f InnVLl
; i?)-l; Qt "ex+{i gp6t ure :
nl" Ul + Lj " ULI-f'l lF{V
trtir i ; -i tutt. ltu;lLuuL, Err ^Ufi'_flUU
DATE:
-Each in
Pump or
Sign/0ut
Limi ted
Limi ted
SUBTOTAL
7% State
3Z Adnin
TOTAI
q
i
I
E
ItaI1tarr
in
ne
Ene
OF
Suist
.1't-T
RECEIVED
5
on
/
00
00
00
$ 40.
$ 40.
$ 20.
$ 36.
DT: