HomeMy WebLinkAboutPermit Electrical 1999-7-13
SPRINGFIELD
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The following projecl es submitted has the dig
zoning. and does not require speclflc la~ use
225 FIFTH STREET epprovel, C <!.... , ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ZOning i_\"?,<; '\ _, _ .
INSPEC:ION REQUEST: Di!a,6-J"~':' ~ c5 to g;, ~ ~ City Job Number qqD tt.~1
OFFICE. 726-3759 r lao SlgnalUr. ~~. t> .... it(
""'''U I 3 :=:' :1l.g :(;OHPLETE FEE SCHEDULE BELO\I
1. LOCATION OF INSTALLATION r;j ;:I ~ to ",.. ~ z:
~tOc(Jlos.-t
Sf/If'? dYl~ ~ rt 3- 3 ~.~ ~eii Residential-Single or
? ;.. C; ~ g (l) ~lh-Family per dwelling uni t.
LEGAL DESCRIPTION ~,~ ';go b $- ~9ice Included:
1/0~3?JLl-J. O:l,~OD ,"Om~o;"mJg Items Cost Sum
" .~' :'" e. '0 -t 0. 0
co (0 _:3 _ ':S O"...::J .
JOJ;! DESCRIPTION 9 g g g ~ gl'I'IUE> sq. ft. or less S 85.00
OLL +Li IlJL 1-4 ~ ~ <P. C ~ ',2, ~ ~i~ addi t ional. 500
~ () i\' ~:;- \\\ =r ~~,jg ft or portlon
Permi ts are non-transferable and ex~a, ~ 9.. 0 (fl tale!J;-eof $ 15.00
if work is not started within 180.dat~ ~:;-~~~h\\\Manuf/d Home. or
of issuance or if work is suspended -foi.~ ~ \Si (fM~'@.ar'Dwelling
180 days. b\ i5 ~ ~ %~~ce or Feeder . $ 40.00
g'i6,"g~~o
2. CONTRACTOR INSTALLATION ONLY ;:Ie. 7:x!rvices or Feeders
/ Installation, Alterations
Electrical Contractor /o/d;. ,&",,, "<,,,. :z,c, or Relocation:
/
200 amps or less
201 amps to 400 amps
Phone.>o/I 3V.2-/ lc.? 401 amps to. 600 amps
601 amps to 1000 amps
Supervisor License Number I/"2 upT Over 1000 amps/volts
J / 0 ;p.... Reconnec t Only
Expiration Date J(} Oz 00 ~ 0 ~ ;; 9 ,
~ ~ 15. -oTemporary Serv1ces or Feeders
Constr Contr. Number t.7't/f ~ ~ ~ ~I~tallationl Alteration or Relocation
o 0 ~ ;;. .-
Expiration Date ()7,/oCJ 101 ~ 8 ':, ;-,700 amps"or less
- ,,'.' 0 S v~Ol amps to 400 amps
Signature o~s ~eiSing Electrician g\ :0 is ]'Over 401 to 600 amps
i. // - ~ 0 en g; ~,ver 600 amps or 1000 voL ts
. r... ~ !./~ _ 9 6S --4 '"
....... ~D~ ijfanch Circui ts
o ers Name nock. 61 <.W~ 'is "'CJ m
'2, ';j ~w, Alteration' or Extension Per Panel
Address 6;-1'17 (JntUJI 1(9 ~ :r!
11 :.' O~ Circuit
City ~,r, '11~;;' lid Phone ~ ~E~' h Addi tional
~ / 0 rcuit or with Service
O\INER INSTALLATION -'-i r Feeder Permit
Address..2o'/ 3.(.{&.('^~ sf.
Ci ty J',",,-,_
....
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40,00
$ 40.00
$ 55.00
$ 80.00
see "B"
above
..
$ 35.00
$
2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lightin~ $ 40.00 ~
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
------------f.-~-----------------------
DATE: 7/0/17 . ~ ' /'
RECEIPT 11: ' , n-SLf 0" L '" II 1 1/
RECEIVED BY: I1Y W~
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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