HomeMy WebLinkAboutPermit Electrical 1999-4-19
fho following project es submitted has the following
lonlng, and doas not raquira spacific land usa
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97477- . .
7~~Slgnalure _~
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
<gq I DI d 01'(' /w rd ~
LEGI)l.. DE:;jCRI1?TION .., )
/7 () ~ 2- 5<f ~ 0,. OtJ
ELECTRICAL PERMIT APPLICATION
C;ty Job Number
3. COMPLETE FEE SCHEDULE BELOV
7<6I3J'/
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
. , Installation, Alterations
Electrical ContractorL);v'~76;'~' ~/~rtr~nL~or Relocation:
rr~Nr
Address p, <2....-'R /)" "...Q.6-!/rt fo"o~,~N:.oreg0200 amps or less S 50.00
rvOtificati adf!pte riOON~s to 400 amps $ 60.00
City t;., "'1" t1.0 Phone 5.~O~~flt&r. 7id~€i'f!!)p,!fe~~09W2. amps $100.00
u090 \'0 01-00' hC6Q>lr.~OOQJtltRUO amps $130.00
Supervisor License Number ~gll:IJ;.::t/r,'l!aIlObt 1.0th~ O~~hvOlts $300.00
numb' nacant amccPp/50n e(J~;: $ 40.00
Expi ra tion Da te /{) / q q arfortha ar. (Nota: ,!rt.Of tha rut s ~-
l.anteri OrElrJon lJ.~ filap,;dft:.eiR;,ices or Feeders
Constr Contro Number Cj~/<I,'5 S1-800-aJ.ii' a/})liWeJ.D~, Alteration or Relocation
Ji!' 344 <"'on
~.
/ If) 0 200 amps' 'OT 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
JOB DESCRIPTION .
I no) VI) //-/11 P ~. 11'1'-1 r It' ;-td
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
Expiration Da
StJJ1I
'sing Electrician
~
Ownel's Name tl/771rL 13, /-I/Jrn,f
Address 'P.IO. ;R".,)[ 7<17"5
City~o Phone 1t./~-7.1"J{)
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
------------,--------------------------
DATE: . ..rI,,/'ff
RECEIPT if: ; tHHS"l /1
RECEIVED BY: tU' We-/
1000 sq. ft. or less
Each additional 500
sq. ft or portion
. thereo f
Each Manuf'd Home, or
Modular 'Dwelling
Service or Feeder
D.
Branch Circuits
Items Cost
Sum
$ 85.00
$ 15.00
$ 40.00
,.
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
no t i neluded
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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