HomeMy WebLinkAboutPermit Electrical 2001-10-24-CITY OF
4Uilll l9
Date
225 FIFTE STREEI l'lrrr^ri7^'r 'iinar!rra
SPRINGFIEI,D, OREGON 97477
INSPECf,I0N REQT EST: 726-3769
OFFICE: 726-3759
'FlTNGFIELC,
ELECTRICAL PERHIT APPLICATION
Ci ty Job Nurnbe, O,-00?670 /
3. COHPI,ETB FEE SCBEDULE BBLOS
Nev Residential-Single or
Hulti-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less.
gach additional 500
sq. ft or portion
thereof
Each Hanuf'd Home, or
-Hodular 'DveIIing
SerVice or Feeder 7
Services or Feeders
Installation, Alterations
or Relocation:
$ 8s.00
$ 1s.00
0o /oo
LDK
D
1 IOCATION
IJGAL DESCRTPTIONL 170
JOB DESCRIPTION
U r {Le1
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. COI{TRACf,OR INSTALI..ATION ONLY
3 OF INSTALI,ATION3.7+u 5 r A
Su
i
\
I
$/.
i
t
I
I
Electrical Contractor
B.
&"2-u'
T
Supervt-sor License Number
Address 2/Z 7#e fr*
Ci ty ,.-rr.,,--Phone 73f-/Sctc:
200 amps or Iess
201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps_
Over 1000 amps/volts
Reionnect OnIy
Temporary Services or Feeders
Ins.tallation, Alteration or Relocation
200 amps''or less $ 40.00
201 amis to 400 amps
-
$ 55.00
-over 600 amps or lbOO voTts see uB" abffi
vf5*s
s s0.00
$ 60.00
s100.00
s130.00
s300.00s 40.00
rxpiratio n oare ,lf/*Qf
-
Expiration Date /z/ al
constr contr. Number 6 Zt>Z EF^ --
Signature of S rvisins Electrician
tborr*-
Ovners Name (,z-J S
Address G -<- U/ zs
Ci ty {Phone 7%. ozzz
OVNER INSTALII\TION
The installation is being made on
property I ovn vhich is not intended
for sa1e, Iease or rent.
Ovners Signature:
DATE:
Nev, Alteration or Extension Per Panel
One Circuit
Each AdditionalCircuit or vith Service
or Feeder Permi t I
E. Hiscellaneous (Service/feeder not includer
c
D. Branch Circuits
$ 3s.00
s y'.oo 3
-Each installation
Pump or irrigation
Sign/Outline Lighting-
Limi ted Energy/Res
-Limited Energy/Comm
$
$
$
$
00
00
00
00
40
40
20
36
5 /o3
-721
z
U
RECEIVED B Y:
SUBTOTAL OF ABOVE
7 f/" state Surcharge
' 4Z Adnini.strative Fee
Tornt,
i) L+
't'
3// i 7
I
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