HomeMy WebLinkAboutPermit Electrical 1995-3-27
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Z~ninQ.. C-u ELECTRICAL PERMIT APPLICATION
97t;M.7h1!,C
7 9.~~7,l~ Slonatu.... }J M
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
'1. LO~TION OF INSTALLATION
/...J (2,) ;t{.-fJ..r/lJ
City Job Number
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E9MprVTF. FEE SCHEDULE BELOY
7'5G)J.9 <
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
LEGAL DESCRIPTION
17192 32.. ~2-
to 22.l:l ~
JOB DESCRIPTION
f4r ? Lr/U.vroTt; AT C;tf8J/f'<fPI) Sl'~
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
Electrical Contractor ,J)]:Y.O III
fI-1;-u, -q:f; 2 l./.
'? (./4- )5'1~
-';?bJl/S
Address [I < ()RSUi:,y
Ci ty f U (,.,/= flJ+-, Phone
Supervisor License Number
Expiration Date //J-/':'f~
Constr Contr. Number "t r;9'1
Expiration Date <:-7-,-q~
OVNER INSTALLATION
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Dwelling
Service or Feeder
B. Services oi Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to~1000 amps
Over 1000 amps/volts
Reconnect Only
Items Co t
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAl.
200 amps. 'or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00'
Over 600 amps or 1000 volts see "B" above
,
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Si~abure of Supervising Electrician
,Jt~ ~'-1./
~ (I J~) D Branch Circuits
;wners NAme~~ . 7:(QJ~ /';;C
- - -/ ' New, Alteration or Extension Per Panel
Address 1/g{') m~.c~1'/ J'T. ,'1,6. .,
One Clrcult
Ci ty J',lt1"~ Phone Cil '511: ./~J'{) Each Addi tional
Circuit or with Service
or Feeder Permit I
$ 35.00 '3$-,(J 0
$
,2.cNY
2.00
"
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 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.
Ovners Signature:
----------------------/T---------------
DATE: 'S /2. 7/ 'iF
RECEIPT 11: / ('0 '7 ","..,- /1 _
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