HomeMy WebLinkAboutPermit Electrical 1998-3-25 (2)
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ELECTRICAL PERMIT APPLICATION
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NU ( ..... c.\-\~LL E'j..?\R~ N01
\~\S ?aBM\"b"FfPf{'f\Bn~p>~dtlLE BELOV
~OR\1.EO UNO NOONEO fOR
P.U\ A. d!t1'O\Recs~Mitial-Single or
CO~Ml/iE.N ~Ru~~twroily per dwelling unit,
~N',I ..~\'- '~~rVlce Included:
Items Cost Sum
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SprllNGFIELO , .
7. . .., I - <. 113 approval;
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Zomnp
225 FIFTH STREET
SPRINGFIELD, OREGON ~
INSPECTION REQUEST: A~U~
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
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/ 1(f~~fj~oDI DO
JOB DESCRIPTION
;Ve-w e~ S~
1000 sq,ft. or less
Each additional 500
sq, ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
Permits are non-transferable and expire
if work is not"~tarted within 180 days
of issuance or if work is suspended for
.180 days,
2. CONTRACTOR INSTALLATION ONLY
$ 85,00
. $ 15,00
$ 40,00
B. Services or Feeders
Installation, Alterations or
Relocation:
Electrical Contractor DJ:..X&U Euu.-
Address 33 /~ b w .MMLrr;.N
Ci tycJ2F.,hrJJt::...R Phone Y;1S-~YO
Supervisor License Number ;SIP/4-.5
200 amps or less ~
201 amps to 400 amps I
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts ,
Reconnec t Only .
Expiration Date---Jll'-J- ljg
Constr ContrA Number ;:~~I'.fL{
Expiration Date ?- )~-1d
$ 50,00
$ 60,00
$100,00
$130,00
$300,00
$ 40,00
00
)cJcJ
&,0 00
3l:?(j ~
C. Temporary Services or Feeders
Installation, Alteration or Relocation
$ 40,00
$ 55,00
$ 80,00
volts see ~B" above
200 amps or less
201 amps to 400 amps
Si~i5ure of s..upervising Electric.iah Over 401 to 600 amps
~ Over 600 amps or 1000
~w:erlJame~ (UJlJn -- ryl-!{fyfZ"iR.J;)/rw!;anch Circui ts
'l1^ V( ..' n New, Alteration or Extension Per Panel
Address---:j' U() _ O~ ^--
vi.. ;.li~ .Phone L1<tY,. 2292-
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
TALLATION
One Ci.rcu it
Each Additional
Circuit or with Service
or Feeder Permit ~
The installation is being made on
property I own which is not intended
for sale, lease or rent,
. E.
Owners Signature:
~~~E~----:rt~-~7t1qr---~~--------------
RECEIPTtf I 1 - On21-2.0eJ
RECEIVED BY: V!. 1/1 /17 If ~ ~
~'\..~
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
,
.~
'.
$ 35.00
$
2~,90 lie>
not included)
$ 40.00
$ 40,00
$ 20,00
$ 36,00
{&)'~6
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