HomeMy WebLinkAboutPermit Electrical 1999-6-7
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225 FIFTH STREET ~Q'.sl 9"1J9()"t,i/" ELECTRICAL PERMIT qLICATION
SPRINGFIELD, OREGON 97477 ~'l "%:1,910
INSPECTION REQUEST:' 726-3769 "1"1"9 i/IJO'~ Job Number q 0 ~La I
OFFICE: 726-3759 "6
1000 sq.ft. or less
N()~~itional 500
THIp;j'~fsH~IT &~~7RE IFTHE WOSlk15. 00
AlJ!:TJdeRll?Eiil f)NDIII<l'llI2H&PERMIT IS NOT
CO~~~~~{~~~DONED FOR $ 40.00
ANy ll.lD UAYPERIOD. .
B. Services or Feeders
Installation, Alterations
Electrical ContractorMdr"t;", "'Bros. S"',yI5~e.or Relocation:
Address01.04 <:T"....+ter~ 200 amps or less $ 50.00
201 amps to 400 amps $ 60.00
Ci typ lI'je....e 0 ~ Phone &-fd.~.l~ 401 amps to. 600 amps $100.00
I .,..1 V S/~ 601 amps to 1000 amps $130.00
Supervisor License Numbe~~' - .:~ 1" Over 1000 amps/volts $300.00
Ie) I / '1'1 ~ Re'H)..rn~Ci:'.)0nl~gon law requires y$ui.O.OO
Expiration DateY' / r ,h--_A- fo!'OWrule~adoPt~dbytheOregonUtility
C. ,'I!em\iortauY"Ser,V.l'~%s19EJlg5'~~sel forth
jIin'MBiJ..~<!:t9\9fl.iJ04i!i Wj!,\'jll~~</9AA'9~9f-a t i on
0090. You may obtain eopies of the r~e~ by
209al!!fIIB~ie>celff~f.~Note: thg !gleph n~O' 00
2p.~rr~l?'ior~P,eiqYM9'Q1l'mtn:t. ~ ~z:ifie' ti~~' 00
Over Orntor1'Q Oo'l.mp.s:::>~ ov.OO
Over 60lf a'ffi'p~ o'l.Ut60U'VOHS see "B" above
1. LOCATION OF INSTALLATION
,I)' 7{" Mair'l ....1':.; '~;"'3.f.'~(dJ II i.,
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JOB DESCRIPTION
Te.r;~aKi Pala^...LJ
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2.
CONTRACTOR INSTALLATION ONLY
i
,
Cons tr Con t r. Number fD4 ,( ~
Expiration Date
3/J.;:l./ :JODO
~e.~J~an
Owners Namej:i-fl\.e. t&~
Address~LP MiLf\ ~et-
City~. fI!tPhone.D-q.<><loLq
OYNER INSTA LATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~~~:~-:~Tit17~.--~;~-~~:------
RECEIVED BY: l' - /2i -(A_
New esidential-Single or
ti-Family per dwelling
Service Included:
D.
Branch Circuits
""i<. ~
Cos t Sum
Items
$ 85.00
.'
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$
2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
l ~
$ 36.00
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NJ .uv
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40.00
40.00
20.00
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