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HomeMy WebLinkAboutPermit Electrical 2003-5-23 ,fIj SP!lLD 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ~,,:;D' ~X ;p 3. 1. LOCATION OF INSTALLATION i9 Ii..\- W\RLDLA. K\:>. LEGAL DESCRIPTION j 7b3 Z S"2J 00100. ..JOB DESCRIPTION c HDOIC Vf' "",lb-N 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 ?t'I'2CJ ]5"0 4/z. . On SOO .. t 58)0