HomeMy WebLinkAboutPermit Electrical 1998-12-10The lollowing propct as aubmittedtrae the fo$ouving
l1"i"o do€s nor,Eq,rtEBpedio lrrr;
SI'TIINC:F IELL!
BLECTRICAL PBRHIT APPLICATIONc4-"225 FIFTB STREET
SPRINGFTELD, OREGON 9
INSPECf,ION REQI.JEST:
0FPICEz 126-3759
qV / soT
'' Yb'Y oF2BTfxYrroN
JOB DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
OAR
2. CONTRACTOR INSTALI,ATTON ONLY r,-r@0
Erectrical contrac tor €A5TSlo€ A'€c'Iltc'
Address zx2g3
^og.flG€
Llt.
ciw SFQD Phone lql'/Yqg
sup ervi-sor License Number 3S/V 5
Expiration Dar.e l0-l -Ol
Constr Contr. Number )1777O
Expiration Da te )O'V^11
Si t of erv1sl ng Electrician
Ovners Name
City Job Number
FEE SCMDULE BELOIT
Nev Residential-Sing1e or
Multi-Family per dvelling unit.
Service Included:
I tems Cos t
1000
Each
sq.
.ft. or less s 8s.00
di ri
s 1s.00
$ 40.00
L ons
3
A
lK0 0 Sum
200 amps or less
20L amps to 400 amps
-401 amps to 600 amps
--601 amps to L000 amps
over 1000 amps/volts
-Reconnect 0n1y
s s0.00
s 60.00
s 100. 00
s130.00
$300.00
s 40.00
s 3s.00
$ 2.00
36co
wo
C. Tempor-ary Services o_I-ESR{fiffiRK
r ns t arla t ***
::*HrJI;ffi?6
r${o ca t i o n
200 amps'"or les'b'' "-'.,^1,,..,,-nRS 40.00
Over 40L to 600 amps
-
$ 80.00
Over 600 amps or tbOO-?oFs see rrgrr
"ffi
D. Branch Circui ts
Nev, Alteration or Extension Per Panel
aaaress 2 0
. City ne
OVNER ,TION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE:
I
One Circui t I
Each Additional
Circuit or vith Servige
or Feeder Permit -)
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/0utline Lighting_
Limi ted Energy/Res
Limi ted Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
$
s
$
s
00
00
00
00
o
40
40.
20.
36.
05
RECEIVED
ru\es
f-
.jd#.:i:rl Scl
l1o-lV Lt> oiYcl)
FD-16
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: (
TO:
FROM:
SUBJECT:
Loc tion of damag e ]n
*
Building Department
Springfield Fire Department
Structural Damage to Building
Address or locat'ion of building ZCL zd, s+*;
Name of ot,ner
Type of bui ld ing
(Dwe11ing,tore, [^larehous , etc. )
Estimated val ue of bu'il di nq ooo
Estimated loss to buil ing
Date of fire
borubui 1 di ng a
N
(Roof, Wall, Exterior, Interior, etc.)
Structural wea ssasa ult of the lre
\
Additional pertinent information
(Burned rafters, Beams, Joists,)
El ectri cal ard {
(1,{i ri nq , 0u
'?U (.ot tz- B - qgcc
T
Sign
o<A :E'
\
t