HomeMy WebLinkAboutPermit Electrical 2002-10-29225 FIFTH STREET
SPzuNGFIELD, OREGON 97.177
INSPECTION REeUEST : j 26_37 69
OFFICE: 72(:-3i59
ELL CAL PERMIT APPLICATION
/27City Job
I. LOCATI ON OF INS TAILA TIONf
LEGAL DESCRIPTI ON
o 3oz 6tZ
n5
JOB DESCRTPTION nO\
3. COIV{PLETE
A. Nen'Rc.sid entill-Single or
Multi -Family per tlrlelling u
Scn,i ce Included:
.o 7,
sq. ft or portion
thereof
Each Manufd Horne or
Modular Drvelling
Sen'ice or Feeder
B. Serlices or Feeders
In.stallation, Altcrations or
Relocation:
20() irrrrps or lcss
201 anrps
.10 I anrps
60 I anrps ;
Oirer 1000
Reconnect
nit.
Ilems Cost Sum
---- $ io6.o0 =-_-
$ 19.00
Perntits are
if rvork is not started rvithin v
ofissuance orifrvork
ItiO days
Nutno(t
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Addre
PIrone
Supcn'isor Liceuse
Constr Col*6. Number
Expiration Date
Signaturc of Super-vising Electrician
Ol,ners
,| $50oo i-b
$50.00
-- .s69.()0
$100 00 _
see
or less
201 anrps
Over 401
Over 600
"B" abo\re
Pump or irngation
Sign/Oulline Lighting
Limited Energr,/Res
Liutited EnergtlComm
11
OWNER INSTALLATION
The installation is being utade on
propen!'I or.vn rvlich is not intended
for sale. lease or rent.
i.1 r/n
Cit1,.F
Orrners Signature:M
$ 3.00
$50.00
$50.00
$25.00
s+5 00
0 N{inimum Electric Permit Inspection Fec is S{5.00 * Surch:rrgcs
1. SUBTOTALOFABOVE
77, Stnte Surchltrge
8%, Administrative Fcc
-=55--qee
:;?)
TOTAL t 7 5o
7(}()7-
Expiration
OAR
sq.ft. or less
additional 500
amps
amps
amps
amps/volts
}IOTICE:
r80 CIAY
-Each installation
$43.00