HomeMy WebLinkAboutPermit Electrical 1999-03-03SI'1lINGFIELE}
lrttLloo*l @fi,
INSPECTION REQUEST
oFFICE: 726-3759
225 FIFTE STREET approval,
SPRINGFIEI^D, OREGON 97 477 Zoning
The following proiect as submitted has the lollowing
zoning, and does not require specific land use
tlc-
7ztel69 3-e-q
BLECTRICAL
Ci ty Job Number
SCBSDULE BELOV
A. Nev Residential-Single or
st
.00
.00
.00
B.Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less S 50.00
201 amps to 400 amps ---l S 60.00
401 amps to 600 amPs
--
5199.00
6oi ;;. to looo amps:TlF- S13o-oo
over 1bO0 amps/vol tq . -- $3O0.00
Temporary Services or Feeders
Installation, Alteration or RelocatC
Authorized Signature
1. LOCATION OF INSTALLATION
p A t 7'l{
JOB DESCRIPTION
l" tn DaxAa E
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
LBO days.
2. CONTRACTOR INSTAII,ATTON ONLY
Electrical Con tractor 6A 5TS/o€ &ea a,rr,
Address VX29)60*frG€ Lrt,
Ci ty 5r((p Phone 7ql^/Yqq
Supervi-sor License Number 3s/V 5
Expiration Date I I ol
Constr Contr. Number l/777O
Expiration Date o^ v-11
o
200 amps''or Ie
201 amps to 40
over 40L to 60
Over 600 amPs
Sum
ton
40. 00
s5. oo
BO. OO
e rrBr aE6G-
)SS
0
0
or
$
s
$
se
amps
aaaru." /0 t r--
of Supervisi Electrician
Phone
OI{NER ALLATION
Branch Circuits
Nev, A1teration or Exterrsion Per Panel
one circuit i $ 3s'oo ?SlO
Each Addi tional
Circuit or vith Service
;;-r;;;";Permit / s 2'oo 2 Cc
si atu
0vners Name
. cit
DATE:
SUBTOTAL OF ABOVE
5% State Surcharge
i7 ia*i"istrative Fee
TOTAL
amDS
1000 volts
D
The installation is being made on
oi:op.tty I ovn which is not intended
ior- sale, lease or rent'
Ovners Signature:
(
E Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign /0ut1ine Lighting..--
Limi ted EnergY/Res
Limi ted EnergY/Comm
$ 40.00
s 40.00
s 20.00
$ 36.00
RECEIVED
5
ing uni t.
Each
Modular
SerVice or Feeder
clqDtJz
ll ( ' 3Q 2) od.J oo
5 fq f cizO
FD_16
FIRE DAPIAGE REPORT
OR
ELECTRICAL HAZARD
DATE: l-) y -<17
TO:
FR0t"1:
SUBJECT:
$2 o<t, oo<)
Building Department
Springfield' Fire Department
Structural Damage to Building
Address or 'location of building lO 7 l6 7b+r*K
Name of or./ner Eyn<u
Type of bui ldins A*. Ct t.'fYY1;4^_i enru <-fi
(Dwei 1 i ng,Store, ldarehouse,etc.)
Estimated value of building
Estimated loss to building $Ju, o-.>'A
^ )y 9?
Location of damage in bui'lding cd
q7 SiJin
l, Exteri ot, Interior, etc. )
Structural weakness as a result of the fir"
L{-t s \ni^,;ih Crm ol,zT.e,
(Bu d rafter 's, Beams , .]oists, etc.)
Additional pertinent information
Electrica'l Hazard 't1
(lliri ng , 0utl ets , etc. )
Lr
( Roof,
cc UO t-2c{ 77
%
Siqned
Date of fire