HomeMy WebLinkAboutPermit Electrical 1992-5-18 (2)
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225 FIFTH STREET . . 'r.\) I1ro'l~~~\~~~,i\~e ~pe"\\ ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97 4V('l,\O~o:r\d' c\"ISS "...... . Q2
INSPECTION REQUEST: 726~31~9. \ .' ^^ (\ -- Ci ty Job Number /.. 67 L.~
e.PP''''~.sr:-- .
OFFICE: 726-3759 201'\\i'9....-:-. ._
. oSl ,~ 3-. COK~J..ET-E-FEE . SCHED~ BELOV
1 LI..LLOCATION OF I~~T~\t~QJi--=-' 'e~ . .
TUx-6 c.on1ttJ/?L{f.J'{)., _~e.;\.II' A. New Residential-Single or
. ' ryclJ ') {lL( Ol..(~(X),Mult~-Family per dwelling unit.
,0 LE~ DESCRIptI7N __, 12 SerVlce Included: '
~!~ HI21- 7/CUc"Kl#7 Items Cost Sum
.. , ' ,/
JOB.DESCRIPTION ~' , /J;D ',1000 sq.ft. or less $ 85.00
I1J//C//IICj 7Wo V1L:fS U I./~ Each addi tional 500
I . -~-;- sq. ft or portion
Permits are non-transferable and expire thereof $ 15.00
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
'180 days. Service or Feeder $ 40.00
SPIIINGFIELD
2. CONTRACTOR INSTALLATION ONLY B.
Electrical Contractor ;1~~ ~
. . I
Address ~;;.oJ-Wegl (,+t...
,
'City .~e/V'€:- Phonefafro-Z3~
,. .
Supervisor License Number ~ - I)
Expiration Date /'0 - I -9 Z-
Constr Contr. Nu~ber;2.0 -/'/5 '--
Services or Feeders
Installation, Alterations or
Relocation:
. 200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000. amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date '
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see "B"
above
t7
Owners Name
. ,
, D. Branch Circuits
Address
New, Alteration or Extension Per Panel
'.
s4
$ 35.00
City
Phone
One Circuit
Each Additional
Circuit- or with Service
or Feeder Permit Jr
$ 2.00
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent~
Owners Signature:
E. Miscellaneous (Service/f~edet
-Each installation
Pump ot irrigation
Sign/Outline Lighting
Limited Energy/Res.
Limited EnergylComm
not included)
f)'-If8_-. '/ Z_
4<P1h ~
.4?~
5. SUBTOTAL OF ABOVE
5% S ta te Surcharge .
TOTAL '
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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DATE:
RECEIPT I: '
RECEIVED BY: