HomeMy WebLinkAboutPermit Electrical 1992-07-22C'TY OF OPECO'U
5I''IIN(;FII:LL'
225 FIFTE STREEf,
SPRINGFIELD, ORBGON 97477
INSPBCf,ION RBQUBSTz 726-3769
0FPICE: 726-3759
luale7d0 SamaSa(e)
AS
ELECTRICAL PERHIT APPLICATION
City Job Number
BELOII
sidential-Single or
Family per dvelling unit.
Service fncluded:
Items Cost Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
-Modular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
s 40.00
Services or Feeders
Installation, Alterations or
Relocation:
%
1 LOCATION OP INSTALI"ATION
TJGAL DESSRIPTION
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COIITRACTOR INSTALI^ATION ONLY B
Electrical Contracto
Address 3/ I 5t ru.h d(7 200 amps or less $
201 amps to 400 amps
-
$
401 amps to 600 amps _ $
601. amps to 1000 amps_ $
Over 1000 amps/vo1ts $
Reconnect Only $
HuI t
cirv&4i&
s0.00
60.00
r.00.00Phone 7{7 Altrtr
Supervisor License Number 37 3t'-S
Exp iration Date /0.-
77ot 2a-,eConstr Contr. Number
Expiration Date /, ^ ??
Signature of Supervising Electrician
200 amps or }ess S 40.00
2ol amps to 4oo amps
-
g 55.00
over 401 to 6oo amps
-
$ Bo.oo
Over 600 amps or 1000-vofts see rrgrr "[ffi-
Temporary Services or Feeders
Installation, Alteration or Relocation
130. 00
300.00
40.00
C
Owners Name
Address
ci ty-Phone
OVNER INSTALI.^ATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
Owners Signature:
DATE:
RECETPT
D. Branch Circuits
Nev, Alteration or Extension Per Panel
one Circui t !---- S 35. O0 2-;,'oEach Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Ptrmp or irrigation $
Sign/Outline Lighting- $
Limi ted Energy/Res
-
$Limited Energy/Comm $
STIBTOTAL OF ABOVB
5Z State Surcharge
TOTAL
3€--
'r"75
00
00
00
00
40.
40.
20.
36
5
RECEIVED B
7T
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