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HomeMy WebLinkAboutPermit Electrical 1995-11-7 __to J zoning, and does no req approval. (~ ' Da\.-+(o~il ~ tt ~ A Al 225 FIFTH STREET Authorized Signature ..J,YV SPRINGFIELD, OREGON 97477 . INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ~Lo~aTION OF INSTALLATION r-- :serOO MA1 A) sr (' LEGAL DESQUPTION n O"L s I 3. I .C:> f"1'Z. I .0 ~ 1--1 1::'-7) ,...,'" 2,Im JOB DESCRIPTION ';:>-....1 A-nD eN E' , I \ ' - F2- 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 ,B. Electrical contractor_'1? ~ (t\0 Dfrl' ELI;" Address Lf 2.. 7 fCO'b./'r-Lf::" J:J CZ , City EY/-C Lt: f"IPhoneSt{ 7- '??a'fF- Supervisor License Number .:s c; / I.( S Expiration Date ~ J//7 J?? Cons tr Con tr. Number 'if ( 0 f ( Expiration Dat,-~~A .~~ oJ/n/7? Signature of Su~ising Electrician ~~ Owners Name ivA-i.-L f-' (C,u{q,f-J Address :s yo 0 Ci ty.5 f'Je. (.->, ff~L!J Phone OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: DATE;-f\-:'-~::-~~------------------ RECEtPT #: U~ q ':::> l- 4 RECEIVED BY: _N. T 'It P<<!..-H -Af)() . ..,';" / ~~~CAL PERMIT APPLICATION City Job Number <15002....1- 3. COMPLETE FEE SCHEDULE BELOY A. New Residential-Single or Multi-Family per dwelling Service Included: unit . . Items Cost Sum 1000 sQ.ft. or less Each additional 500 sQ. ft or portion thereof Each Manuf'd Home, or Modular 'Dwelling Service or Feeder $ 85.00 $ 15.00 $ 40.00 Services or 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 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 ~ .so' C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'OT less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 $ 55.00 $ 80.00 see liB" above D. Branch Circuits New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) 5. $ $ $ $ ,~ 50.lfb . 4.Sc. 1.50 ~ 40.00 40.00 20.00 36.00 SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL /