HomeMy WebLinkAboutPermit Electrical 1996-12-13
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225 ,FIFTn STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1.' LOCATION OF INSTALLATION
43.+"!:o /I4Jtlu 'S'TlZ-
LEGAL DESCRIPTION
.r)~2, '?J7 -T.~_ &:'y;~/
JOB DESCRIPTION
L I j,HrIA/t- ~~ nth') p/./-
. . ". ~~
Permits are non-transferable and expl~e
if \lork is not started' \lithiri 180 days
'of issuance or if \lork is suspended for
'180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor L.}(.
Address 4f'2, 5f/~
i
Ci ty ~e.J!:I? Phone
~t#(s ~r
$-re
4f4-7-0i'({
, Supervisor Licen.se Number '3oo~ - S
Expiration Date //)..../- "If
Cons t r Con tr. Number I') I r;r 3 ((
Expi'ra t ion Da~e
1,,- '? -7 7
OVNER INSTALLATION
The installatioh, is"beirig made ~n
property }ovn\lhi~h is not intended
for sale, 'lease ot Fent. '
Ovn~~s s~gnature:
.,'
DATE: /2 y:,~
RECEIPT, ~: .-:il y',e> 2-:-- " .' '
RECEIVED BY: ' ~ ~..
..'.'
.'
A. Nev Residential-Single or
Hulti-Family per d\lelling unit.
Service Included:
Items Cost
S m
1000 sq,ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof, $ 15,00
Each Hanufid Home or
Hodular Dvelling
Service or Feeder $ ~O,OO
B.
Services or Feeders
Installation,' Alterations
or Relocation:
lhri 4AlI,'h,ilrJ\I r:ml.,ct no cubmittArI p.n(l; t A
;' ,,: 'z:,;oo'" r=;;; f
[),'Is/i"l r~JOI(A
.Lt:J_ .~ - ELECTRICAL PERHIT APPLICATION
9 7 ~ 77, Au:ncm..,d Slgnsturo ...j t Yv-. I / ~ ~
726-3769 ~I \"HJ ';v:' Number 906/.('..;'*7
3. COHPLETE FEE SCHEDULE BELOV
200 amps or less
201 amps to ~OO amps
~Ol amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50,00
$ 60.00
$100.00
$130.00
$300.00
$ ~O-, 00
C.
Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps
201 amps
Over ~Ol
Over 600
or less
to~OO amps
to '600 amps
amps,or 1000
Signature of Supervising Eiectrician
AJ P'lj#~~.,'",,-' '
,r ~ ..__ D.' Branch Circuits
9vners Na,me. aA~x.-z:>,~
. -. ~ . . ....". #-
Address 7'~t:el' 4~?'
City, .~~ 'Phone "?Y") -22Y-e.
$ 40.00
$ 55.00
$ 80.00
.vOlts"see "B"
above
Nev, Alteration or'Extension Per Panel
Hiscellaneous (Service/feeder
-Each installation
Pu~p or {rrig~tion'
Sign;Ou tlihe Ligh ting
Limited. EnergyJRes
L'1mi tedEner~/Comm
One Ci r~ui't'
,Each Additional' ,
Circuif'or \lith Ser~ice
. or'Fee'der,'Pe',rmi t " S
E.
5,.
SUnTOTAL OP"ABOVE
5Z'State ,Surcharge
,TOT~,' .....
-+- '=l.,D.h MM" (\ \=f>-E'
I
1~
-
S 35,00
$
2.00 ,J'D ~-
not included)
$~O.OO
$ ~O.OO
$ ,20.00
$36;60
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