HomeMy WebLinkAboutPermit Electrical 2002-9-13
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ELECTRICAL PERMIT APPLICATION
City Job Number C) '2 -0 / / 0 I -0 I
225 FIFTII STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726.3759
L LOCATION OF INSTALLATION
I 010 ~ O~ 'N\.1.ll'" J...o I~ A._tl.e:-v ~sjdentialZSingle.or,..n ,,',: . ~;T'''. .';"= ~ -. T
I'~..n. -~'t:.,:~'."~~4__~,!,,~r:~:":"~:~~~: :':.~!f'~:~:'t.. ';.I~:'{ : <.I.:.' ~t ;d"\-J" MUlti~Fariii1yper dw~ning~~t.'71..-,;/
'LE"OALDES'CRIPTIQ&"""" -'-' .,.,."".,......,..,. "S,.r_'~.I"'I' ,I" ",_ ,: '.'!, '.,
'. /:70;J;J;"4 c.. L.-f.. 05'~Ob" -~, .c,.. elVlce. nc uded: "-,c",
....._-~_. . ....... - '. . t ssuom1tl6uhasthefollOwing Items Cost Sum
Tile follOWing prolge. a . acitic land use
JOB DESCRlPTIONng. and does not require sp 1000 sq.ft. or less $106.00
_, t'U,"O-. 0 .QtPf~~ 1.J:2f]- 1"och additional 500
Zoning q __ "" -\7-- sq. ft or portion
Permits are non-~e,,,,hl. ond eXjlire . tf\ 0 thereof $ 19.00
if work is not started withi2 !!I8Pllilm. . t &.ch Manufd Home or
of issuance or if W31'1r?JI~:kpended for Modular Dwelling
180 days. Service or Feeder $ 50.00
3. COMPLETE FEE SCHEDULE BELOW
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
Installation, Alterations or
Relocation:
Electrical Contractor_IJIEGDN GD~:~ SERVlf1.
Address Po ~Ol{<9~9':l
"\',
,Constr Contr. Number
_~~oo I
200 amps or less $ 63.00
201 amps to 400 amps $ 75.00
401 amps to 600 amps $125.00
601 amps to 1000 amps $163.00
Over 1000 arnpslvolts _ $375.00 _
~OlU~~onnect ~ttEXPIRE if '\'HE ~ $ 50.00_
lHIS PER::Elt~rW!~e~RMIT IS NOT
'1\.tref~~A~~ fOR
CAN'Y 111n nA,Y P&RIOIl.
'2M"amps or less
20 I amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts see
llBIl above
$50.00
$69.00
$100.00
-
City _r ~~ ~hone Rl.t,~ (Ie ~ (
Supervisor Li~se Numb~ I ~q~...::s .
Expiration Date ". /0 - I - oc.j
Expi;"tion Date ~ - (It - 0 '-t
Signature of Supervising Electrician
-Z1 AN>VJA. ~ (109-.. /
Owners Nam~ 1M......
D. Branch Circuits
l:90:mIHS\!:J'
: 39N\!H:J
~L'l:~ $ G:a:J3~ lW\!
GOOG ~l: d3S:31\!O
96~Ol:OO-l:O:#SN\!~1
N AI . E'''''''PU\p.O P I
ew, terattonlm\' xtenslOn'\ ,er ane
n \I:1Vl< . On u\. . 'J
ON"orego \\'Ie orag e\ \01'\\'1 t..J A ~
Address ~ l\tn::,~'\ One.c;liratii'J r"\eS are S5'2 0ni:.L $43.00 ~ ~
" leS ",,"v, ,\'lOSe'" p.fl, 9 .
':11101J11 rU Gq(\\et. "Mn'lf\\'IO "" ,.,laS '0'1
Cilv Phone ll.f-"") E'-"O!\\',\'lca\iO" Each-AdditioiiliLCircuitor'witli,Service
~~ '20\)'-"'''' n<n\\1"'" ~O'\J
OWNER INSTALLATION ,~ Op.fl, 95 'or F'US"r,.P.efinit '\\'I3\e1e?, \ioO-.-- $ 3.00 _
1(\ '101.1 f(\a'1 r ~tI\o\e., ~o\illca
Th ' stall' . b . d 00911 Mi"- 11"p'(\\e ('S --l~uh\\ld ,. I ded)
em ationls e1ngma eon ro\\..;;..sce ~~}lf{ .SM....;'J.~~S't.Il~tmcu
property I own which is not intended C f(\\:)er Ic-Each iIllit@atio~~
for sale, lease or rent (\1.1 CPiiinp b1 irrigation
Sign/Outline Lightine
Limited EnergylRes
Limited Energy/Comm
/
Owners Signature:
$50.00
$50.00
$25.00
$45.00 ~
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
1../ ~ C-'O
..3 '&
_~ lc>'O
TOTAL
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