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HomeMy WebLinkAboutPermit Electrical 2002-6-18 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 -- ~ ELaCAL PERMJT APPLICATION City Joh Numher Ol-o 0 I L r-C ( 3. COMPLETE FEE SCHEDULE BELOW LEGAL DESCRIPTION _f70.3'L~31 I. LOCATION OF INSTALLATION J '120 017""'1; r A. New ~&~i#otl~-Singlc or su~!l\i\led \I~~c la.oMIiWi-F:unil;' per dwelling unit. 'aetas . eS\Jec . . log ~'O\ \ ,eQUI< SCIT.ce Included: \ol~ ,AS 00 :~~..cP~ '10 0 lAtCL hems a.~~'0"a.\.. .! /0 "V 200'Og 7 0 1000 s.ft ess , \ additional 500 sq. ft or portion thereof Each MnIlufd Home or Modular Dwelling Service or Feeder COSI Sum JOB DESCRIPTION Ibvt tp $106.00 f?//fL oa\l;:: - S'gna\Ute . ed \ Permits arc non-transferable an!llll.~~l~ if work is not slartcd within 180 days of issuance or if work is suspended for 180 days. $ 19,00 $ 50.00 2. CONTRACTOR INSTALLATION ONLY n. Sell'ices or Feeders Installation, Alterations or Relocation: Electrical' Contractor S'T1ltlEe Eu"c.~1 c. Address j~o'~ SE- OJ..oc.c City M'L";~~~ . Phon~3-1./"2-~o~' 200 amps or less 20 I amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts - Reconnect Only $ 63.00 , $ 75.00 $125.00 $163,00 $375.00 $ 50.00 ",.1 Supervisor Licen~e'Number 34":5 ,.' " . " '. ExpirationDate,.1; / II" s':" . . .' '. . C. Temporary Scrvi~es or'Feed~' ~\ "'Constr C\)I\tr. Nu,!!ber .'I48Z.3' Installati~n; Alteration orlU; i~n , , '.:. ," . '. sor&~"..~' ~ . "ExpirationDate?>liD-/64.', '. 200amp~~~~~~(;j '- "~ignature,of Supervising Electrician . ~il'~~ :. _ \ /iJliJ." LL- ~~~~.f-:~~~~: 1000 volts see Owne'.'s.' Name 'j'j,'~ <..0 1="G>-,cl5 '\~~~t~t, or Extensfon P, c. r Panel , . , I l A ~"'~ ~./v.::,~":'ti-,:- . Address ~ : S . V6cJdlAd.. 'flYe- ~ One Circuit /,l'~ ;'I?~ ",i~" S$y., '.' ~:!.- ;~\'-' O('!' 'If:00 C)"'');~rt'.;'" CitvJ..b.."...lt, .~r.......' .Phonc '7 gt. . lf9 ~ Z. Each Addi(ii>n~L~iibui1?ordvi\h,S2r\'ice - or Feeder;P~rmit>>~vO'~\\0~)'\~'~O" $ 3.00 OWNER INSTALLATION ~.~ \)~\.v-<..~v~,o '0'" ~,0 .~~, ,..; ~<:i ~,. R;"" ,,~, ,,<,>v ~o . The installation is being made on E.,l\liscell:mcousi\Se'\"icClfceile.; notlincllldcd) v">,.... "':/ :-..)"'" -~\ ,0"'- "\". n ,. property 1 o\m which is not intended , ~' _.I' .d,E~.!.iliI\~taIl1t.l~n r:::0~~,,~? for sale, lease or rent. . d~o (,~ p,lililp oh irngation'=' ~!' $50.00 '\ .~\: {..-' ,.\... ~, ~~'fJ-f\"- -. ~o~ ,,g- S\gll/Outlinc Lighting $50.00 \.~ 0,". ...~>.:: .i\'''' ~"(\~ ,.' " .," L\Illlted,EnerOvfRcs $25.00 ,\ '-j'V \"'~... ~v !\,,~-' '.f) rl'iimitcd,E,iergv/Collllll $45.00 v ~v ,... . ,,\i i'\linimuJ11 Elcctdc Permit Inspection Fcc i.s SolS. on + Surcharges I $50.00 $69.00 $100.00 :s-a $43.00 Owners Signature:' 100: ~mHS\!8 : 39N\!H8 O~'L~ $ 1:083~ lW\! 6006 81 Nnr:31\!O 6~96000-10:#SN\!~1 TOTAL 50 ).-0 '{(}OJ $7~ 4. SUBTOTAL OF ABOVE 70ill State Surcharge SOlo Administratirc Fcc