HomeMy WebLinkAboutPermit Electrical 2002-5-29
225 FIFfH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
'.
~
~ 0 ,01.- ELEC-rnA PERMIT APPLICATION
(' il. 0 I) TRANS#: 01-0009288
~ I V Cily Job Number 0- - D 0 ~1(P~O ( DATE:MAY 29 2002
~ J-l_ AMT RECD:2 $ 167.50
\}J '!l. COMPLETE FEE SCHEDULE BELOW CHANGE:
CASHIER:061
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
I. LOCATION OF INSTALLATION
&:-, LA II VY\ A. ~ () "'Sr:
LEGAL DESCRIPTION
/7. O.a. ~'I' ~?_' ()?"\7!7)
Items Cost Sum
lOB DESCRIPTION _ 1000 sq. ft. or less
~eJ...:> 1'",-'0\ ""'" 0'.) F\I;S-\-.,,".. Each additional 50
pc.,,\". ~..,-'--- o~ ol.-b ""'~;:) t\ p.lD. crNer sq. ft or portion
Pennits are non-transferable and expire thereof
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
180 days.' Service or Feeder
$106.00
$ 19.00
$ 50.00 .
2. CONTRACTOR INSTALLATION ONLY
H.~-~s\(rN
Electrical Contractor .,",::>~",,., -L 1>.,,)<,,;"0.
B. Services or Feeders
Installation, Alterations or
Relocation:
Address ~=:, . '5. ~ "::>T. SU:,k \ 15
Expiration Date
I..{ . \ '8 . ok!
200 amps or less $ 63.00
201 amps to 400 amps $ 75.00
40 I amps to 600 amps $125.00
601 amps to 1000 amps _ $163.00_
Over 1000 amps/volts _ ...iMC\\\'iQ 5.00
Reconnect Only \~t \i "~'o.oo ~
c. ~l~~~i~~:~t~~ iO~
~\~I!l
(>.\)I\S\~W'~~~\O\)'
c. '_~'to amps
er 40 I to 600 amps
Over 600 amps or 1000 volts see
liB" above
$50.00
$69.00
$100.00
Cily.59""~,\~I'-L",--Phone~lo. ;:z,;>,I.;;2
Supervisor License Number _.0't' S}q
,
Expiration Date 10 - 0 L
Constr Contr. Number I;;J 'i1. 6'i'.w
s;;zrv~
Owners Name -:S;"""" los::,
Address
so 7 '-(
rnhAl S'l
D. Branch Circuits ~o.;; \0
New Alteration or Extension ~erJPaneI\~\\'l ~'Co
, _ ~ (1301. ~eQ,O\' ~e\ \~()\'
One Circuit ",-~'\.;t> ~eO e'O'lJ.(e ,,';;:$4:?,;Q(i,_
.0\'<>'" 0. 'Q'l e (.;;~ 01'-'" - (.;;\0 e
Ea h Add' ""naJ' ;;!.e ..n'!i ",-'<:oS .L~",e "'0'<'
c ltiO (uucnkor,wlID elV1Ce,.<'o" ~."o~
c.'~ c,'().- :\ :(\''"' ~.... ;;.,,"''' ~"
o:;'l.'eed~p~t.,\\e()~\~'1 co~\~"S",\e :'{s:3. 0 _
.o\\O~ ",\\0(1" f:\()'\' ,,'Q\'lJ.\(I\~o\e:\~,,'l ~b.'"
E. Miscellaneous (SetVicelfeeaer;notJncluded)J
!~chl!'fsUillalio'iI "ce(l'O- ~eg ':"".'f,!:><-
\(\ - n. \ - "':..,..... e fO\J\J
Pti,\%'OrJ!m,gatib1l;\X' \'0 \' $50.00
Si~01itfi~~&it~~( I $50.00 ")0.0<>
Limited'BllergytR'es $25.00
Limited Energy/Comm $45.00
Cily S f' r,~ Phone '7 gg -,-(3'l''f
OWNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
T90:~3IHS\j:J
: 39N\jH:J
:a:J3~ lW\j
ZOOZ 6(; A\jW: 31\ja
88Z6000-TO:#SN\j~1
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
So.OO
~. 'OD
Y.oo
TOTAL
S7 . 'bD