HomeMy WebLinkAboutPermit Electrical 2002-07-1606/24/02 XON 15:18 FAI 5417203089 crlY 0F SPRINGFIELD
ELECTRICAT, PERMT A}PTJCATION
City JobNumbcr (f Z -C-,o 8Y0 -C I
3. COMPTETE FEE SCHEDI'LE BELOW
A. New or
per dwelling untl
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3"t69
OFFICE: 7264759
Erecuicat contElfxorfu:G,5:ryz& rzj! / L o s
500
orportion-fim€of
EachManufdHomcc
ModulrrDuclling
Serrrice orFecder
@ooz
Items Cost Srun
s105.00
$ 19.00 _
$ 50.00
I, LOCATIONOT'
LEGAL DESCR,IPTION
c /( 0o
JOB DESCMYIION rro\
Permits arc uon-tansferable I
if urotr is uot sbrrid wihitr lB0 days
5\gfrat'l"oof issuauce orif work is
I 80 days-
I
crty4lvt-o-"vertw
Srpewisorliccnse\I\nbd .l /, 1 7L-E
Expiration Date I C-I - 2oo2-
,Y6r 1l Z'L'o.
Constr Contr.ELE
I}piration 0-OL
Sigrraturo ot Supcnrislng Elec{dcian
Name &LJ . d4c
fe
4. SUBTOTALOTABOVE
7% Stato Surcherge
87o Admiaistretive I.ec
TOTAL
153-00 _
s 50.00
or Feedcrs
or Rclocrtion
20O anps orlcss
or Extension Per panel
One Circuit
--
$43.00
Each Addirional Circuir or wi0r Servicc
or Fecdcr Permit _ $ 3.00 _
E: Ybj.UTcous (Service/teeder not iactuded)
-Erch irsbllariou
Pury orinigrtiorr
Sigd0utltuc Ligldig-
Linited Ercr$r/Rcs
Limied Encrgy/Comm
,7)
Adrtrcss S 877 >o rJ ?6-.{',+ AJ
ll G"*1.7{( 7A
OWNERINSTALLATION
Tbc instellarion is beiag made oa
property I own urhicL is not intedodfrsalc, Icaseorrcar
Owners Signaturc:
$50.00
ss0-00
_ $25.00I s/,s.00 i;
Minimun Electric Pormir Inspcction Fec is $45.00 +Surcharges
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tf.0 o
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2- coNTRACToR INSTALIaTION oNLy B. serviceo or f,.ecdorc
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