HomeMy WebLinkAboutPermit Electrical 1997-3-3
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225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFPICE: 726-3759
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Cole '=5 _'=$~
Authorizod Signature h M
97477 ,
726-3769
1. LOCATION OF IN~TALLATION
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~ JOB DESCRIfTION .? '
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Permits are non-transferable and expire
if work is not started vithin 180 days
of issuance or if work is suspended for'
180 days.
. Ci ty () ~kt:dEt 0<
Phone
F'~7'2 7~--
Supervisor License Number
Expiration Date
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Constr Contr. Number .(, if9~{)
Expiration Date J(- I~ - f~
Si~aZ;;g~:tr~ci~
Ovners Name r t( I?./.A' F J/';;/7fE$' D.
Address /? (ilEA /O//f/7r-
City E/J.~rf))2 Phone/(r;tfl/7f
01lNER INSTALLATION
The installation is being made on,
property I own whiCh is not intended
for sale, lease or rent.
Owners Signature:
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'. DATE: .~::z Cf y_, , '
.. RECEIPT 1I:~ ~)Pi1~( 0
. RECEIVED BY:. 1.,( A
ELECTRICAL PERMIT APPLICATION
Ci ty Job Number l c /c:,6'q'
3. COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular 'Dwelling
Service or Feeder
C..
Sum
$ 85.00
$ 15,00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see liB" above
"
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
E.
Miscellaneous (Service/feeder
. -Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/R~s
Limited Energy/Comm
2. CONTRACTOR INSTALLATION ONLY' ,B. Services ,or Feeders
/7 Installation, Alterations
Electrical ContractorL'LcW~.1 ;CEil ~ c" or Relocation:
Address fit?t'/ J...(' elfln'H' Fr:v4'-..cA':-/,'j/. ~;<4'(M amps or'less
201 amps to 400 amps
401 amps to 600 amps
601 amps to' 1000 amps'
Over 1000 amps/volts
Reconn,ec t Only'
. . .
5. SUBTOTAL OF ABOVE
.5% State Surcharge..,
. 3% Administrative Fee
""'; '.," TOTAL..,... ;': ..,"..... , ..:-- ..'
."
. .,...
$ 35.00
$ 2.00
not included)
$
$
$
$
..In ,00
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40.00
40.00
20'.00
36.00
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