HomeMy WebLinkAboutPermit Electrical 2002-01-15225 FIFTH STREET
SPzuNGFIELD, OREGON 97477
6-3759
COMPLETE
A. Nerv Residential-Single or
Multi-Family per dn'elling unit.
Seryice Included:
Items Cost Sum
$ 106.00
N
JOB D ON
AS submitted has
zoning, and does req uire sPecific
Permits are non-transferablean@UR!ire Lif work is not started rvithin 180 -l oof issuance or if work is
180 days.
Authorlzed Slgnature
LEGAL DESCRIPTION
l7o L3i3l Oosoc)
2. CONTRACTOR INSTALLATI
trt I/t
Electrical Contractor L9 I Pt^
tirereof
Manufd Home or
ON ONLY B. Serwices or Feedcrs
Installation,Alterations o
1000 so.ft. or less
P$+$ffifl"nar 5oo
sq. ft or portion
$ r 9.00
,1)ru lrl**,"c
J
5U3 -qo 7/
Relocation
63.00 _
75.00 _
125.00 _
200 amps or less
201 anrps to 400 amps
+{)l ilnrps to 600 amps
$
$
s
License N a-r -a*I amps 100
'DL
Signirturc of Sup er-r ising Electrician 40
Over 6
"B" abo\re
Address
Supen'isor
OWNER
Phone
$3
s 50.00
-A$50.00 5 t')
s69.00
00.00
$43.00
Additional
or Feeder Pennit
E. n-Iiscellaneous (Serlice/feedcr not
-Each installation
Punrp or irrigation
Sign/OLrt line Liglrting
Limited Energy,&.es
Linrited Energv/Comrn
Nlinimunr Electric Permit Inspection
inclu
Fee is S45
$50.00
$50.00
s25.00
$-r5.00
00 * $uYcltl;'.e5
5o
6O
Orvners Signature
1. SUBTOTALOF'ABOYE
7oh Strte Surcharge
8% Administrative Fee
3't)<o
TOTAL 57 5o
1.
ELEL-TRICAL PERMIT APPLI CATION
cit-v- Job Nr*r,.rd2 -OoO HK I
400 amps
7Z
Orvners N
L*,.
Over 1000
Expiration
Constr Contr
Expiration J
D. Branch Circuits
Neu'Alteration or Extension Per Piinel
One Circuit