HomeMy WebLinkAboutPermit Electrical 2003-5-23
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SP!lLD
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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..JOB DESCRIPTION c
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Permits are non-transferable and expire
if work is not started within 180 days
of' issuance or if work is suspended for
180 days.
ELECTRICAL PERMIT APPLICATION
City Job Number (OiMzooJ- 003/ Z.
COMPLETE FEE SCHEDULE BELOV
A.
New Residential-Single or
Multi-Family 'per dwelling unit.
Service Included:
~
Items Cost Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 40.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
Installation, Alterations
Electrical Contractor iU.LJL'(1 Li~Sll<N.~, or Relocation:
Address?l:A N'E L..:..-.MRARb NnTICE: 200 amps or less
7') , I~MI~O].iI~'-"l!'~XPffie~nl&'~/ORK
Ci ty~L A MIn phone.:::lD3' Z:31-,.rci"HoK,zE~~1~1~~~I-'~~ ~~~i/'~~ ~IIJT
. Supervisor Licen.se Number 34-3 SIG:1JMMENCEOv~\l1j)000A~II;'Pk"f...Q,t~l1f
ANY 180 DiWEi<fulinAAt Only
Expiration Date
.,
Constr Contr. Number {g4167-
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
---------------------------------------
DATE:
RECEIPT, 11:
RECEIVED BY:
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting~
Limited Energy/Res
Limited Energy/Comm
Expiration Date -Z - Z. -{)I.f- 200 amps or less
. 201 amps to 400 amps
Signature of Supervising Electric~~?on law reQUI,Q,v_epJL401 to 600 amps
~ ~h\ 1,=~~..:_~~.JIol~JI t~dbytheOreg~~.rJRoq' amps or 1000 volts
l~ ~rulL:=tJIJO_ .. "resetfortl
~ A~ ~IOli\i'l'.i",[lVUmlll. Illu""'rD~e~BranchOcircuits
Owners Name c....I"= 11'.. '_'M?~.U010thro~gh ~~^~~~~~u~\ .
I Co C~.-.' "(11\ m:\y .mtrlll1.~oples ofNe1llli/.:'A'Heratlon or Extension Per Panel
Address /1'-( lU1MY;:?~,ti"\~\.;'.)te: the teletlil~e
~ f C'- ~~~~ ' j: H',' c\i.1on;Utility (OnefiCl~tc~i ~
Ci ty .-:> r ~ Phone er 01 . ~;"',)-332-23~~~.h Addl tlonal .
vi,jlllt:;:l ,.;J . .......... Cireui t or wi th Service
OVNER INSTALLATION or Feeder Permit
5. SUBTOTAL OF ABOVE
7~5% State Surcharge
1'6IAL
/0% ~,~
$ 40.00
$ 55.00
$ 80.00
see "BII
above
$ 35.00
$
2.00
not included)
$ 40.00
$-46':'UD ~o 5D~
$ 20.00
$ 36.00
46,;:6 50
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