HomeMy WebLinkAboutPermit Electrical 1999-7-13
,B. Services or Feeders
Installation, Alterations
Electrical Contractor()2F-~,f:";F7>T S""P\ltec or Relocation:
-,' , '~W
. Address P()80)(~.3J , ,?QO"amjl~~~i\I}:'ess _ $ 50.00
'Ole~on 1a.IOiDlWe f,Q;\ 1mb' amps $ 60.00
Cit)(:J-0?...12. ~ Phon~~~O?\90b~ 0~\aJii~p.~1j26.0(J.-amps $100.00
. '/Il\lle'" ~el.'''o i}g'ilniPS' .tq~~1 amps $130.00
Supervis l' Li cense Number (~'fJ.~.,.\rol\ C~~_oo~otro'V,~u~:f>Ra~t.Vol ts $300.00
, 0 p.f'.952-\l obta.il\ ~~.'ll\ed~\~\on $ 40.00
Expiration Date' (0-/- Of if\O ~ "n\l{l\a.~ n\el.~l'lO\ ti\i~l'lotl
OU\:lv'\il\~t"ece,,'Olel1l!ln\,l~~~ervices or Feeders
Constr Contr. Number .:3'i?'oor ca\BO'\Olt"e's~_~~rlation, Alteration or Relocation
nUl" cel\tetl
Expiration Date Cf-N'-C!O 200 amps'.OT less $ 40.00
201 amps to 400 amps S 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 VO~ts see "B" above
.
zonIng. and does nof require specific land use
approval.
Zoning 1" 0 It-
Dale' ..tJ / \ IJ .vle(
fJr\ '\
U
Authorimd Signaturp
225 FIrrH- ,STREET - , ,
SPRINGFIELD. OREGON 97477
INSPEcTION REQuEsT:' 726-37'69
OFFICE:' '''726'''::3759'-
1. LOCATION OF INSTALLATION
q^~ 10/'11YLO/1'.
LEGAL DEScirp;~ON
l7o~ 2~ '1'1-- OJz.~
JOB DESCRIPTION
--tiea.L~'I-'" (' ~ccl'
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2.
CONTRACTOR INSTALLATION ONLY
Siznat~re of Supervising Electrician
v... "7.. --P /\/W~ (1-)1 lAM. /
Ovners Namti:>oml~n f\~~.QA\; n
Address clGl..>tn.l.
City
Phone (4b -folj-q I
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale. lease or rent.
. ners Signature:
---------7--7,------------------
DATE: S 7 If?
RECEIPT II: 'II 7,~ 8'90 .
RECEIVED BY: i.F Wa.d'
S.-~FIELD .
-.... ...,.. .
ELECTRICAL PERMIT APPLICATION '
Ci ty JotJ, ~lIlI!b~r 1'f 1/017 '
3. COMPLETE FEE SCHEDULE BELOV
A. Nev Residential-Single or
Multi-Family per dvellin& unit.
Service Included:
Items Cost
Sum
1000 sq. ft. or less
Each additiQnal 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Ovelling
Service or Feeder'
S 85.00
s 15.0e
$ 40.00
D.
Branch Circui ts
"
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
--L
S 35.00 c~~ 6Q
S 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res S 20.00
Limited Energy/Camm $ 36.00
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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