HomeMy WebLinkAboutPermit Electrical 2002-1-29
. "IVOnCE'
" THIS PE' ""
AUTHO RMIT SH
225 FIFTH STREET COMMt::.NRI1ED UNO'Aj:L EXPIllf ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGO.lf~47'( qfQ cR THI . .IF THE .
INSPECTION REQUEST: .. 7Q60.eWI OR IS AS . S PERMIT WORRi ty Job Number ()1- 0 ILl{ (- C I
OFFICE: 726-3759. . PERIOD ANOOAil::. IS Nn7"
" ,'':'iD FgWiPLETE FEE SCHEDULE BELOY
1. LOCATION OF INSTALLATION
i56~ mf:diO L(J . A. Nev Residential-Single or
. f, "11); Multi-Family per dvelling uni t.
LEGAL DESCRIPTION ~~~~/Vh Service Included:
IIO~ Z7~3 D4,;wr.IIt~ ,.,,~/OIV." Items Cost
0. v"//ij"Wo. U lI. Vr&
JOB DESCRIPTION Vbo.l?e~'I106;:ol)/&'(/OI)/qlOOO sq.ft. or less
tAl I cur !JJ,Jl'I/<ml..$e/I!, 0"., '00. 91; 7J (16)/ ~a&h addi tional 500
7u"'),-"}I,,~fe;, ""00" ~O~ '1)€EAl?il4l or portion
Permi ts are non-transferabr@''iW.(}IIlli6'~O/l)ro &l"ill.t'l1E!1~e(YJ.-o
if work is not started wi thi1b 'ftfIilAl(fi,{y,.s l1co .~gl)~ lli~~/(d Home or
of issuance o.r if work is suspEt'}cle@I6t({&o/)/El,s- ~~J'~elling
180 days. '.5' ,~'..90'l(j,9:/h O/t,ije[.%i.?::f!II~ Feeder
~th. 9/9il & rlt. '00
2. CONTRACTOR INSTALLATION ONLY J'.J\t;l~~~:or Feeders
J '- E I ~ ~~r.i?~lation, Alterations
Electrical Contractor ~ E (QC{.rI(. ~r miocation:
Address_ASDIL{ CD1 ..eV\('~r l---I()(li1~ I?d 200 amps or less I
r" 201 amps to 400 amps
Ci ty r J"LI\Ji Phone (oH~ - qlf \3 ~ 401 amps to 600 amps
, . 601 amps to 1000 amps-----
SupeL"visor License Number 4(rt./- s Over 1000 amps/volts
( 0 /1 / ~ /\.013 . Reconnec t Only
Expiration Date LJJV
f
I05Lfl5
3/1/0;)
.
Constr Contr." Number
Expi ra t ion Da te
SigngQ obs:ro:i:trician
Owners Name Clu.<i./6ve- ~(~O......
Address 156)" #c/Y1v LJ
I
Ci ty
e:;frD
Phone
OIlNER INSTALLATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
Owners Signature:
DA~E~--------f~~~l\-~~---------------
RECEIPT~: . _ . j. ffi t,_ "
RECEIVED BY:~ .f'1"L.)lS~. .
Sum
$ 85.00
$ 15.00
$ 40.00
P
$ ~OO
S,{Q:OO
$100,00
$130.00
$300.00
$ 40.00
b5>
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps.'oT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see liB" above
"
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit Ie)
$ 35.00
3
$ ;t. 00
30
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
TOTAL
$
$
$
$
~3
"'.51
7.'f'i
1; iO b. ciS"
r
40.00
40,00
20,00
36.00