HomeMy WebLinkAboutPermit Electrical 2000-11-22
'It d has the !ollowing
The !ollowing project ~s :qU~i~~ s~ecilic land use
zoning, and does no r
approval. iJi
225 FIFTII STREET Zoning
SPRINGFIELD, OREGON 91477 u. z.~,(ri)
INSPECTION REOUEST: ~t~
OFFICE: 726-3759 AuthOrized Signature
3. COMPLETE FEE SCIIEDULE DELOII
1. LOCATION OF INSTALLATIO~ .
oZ5?5? 5 fJl9fJl/D (', &;if12- . A. Ney Residential-Single or
(/~ ( V"i:tit Su1.,,~ faPJML ;lti-FamilY pel" dyelling unit,
LEGAL DESCR1PTION\. J (7-';,. J S rvice Included:
i70 Z. 3000 0200/ (~ Items Cost
ELECTRICAL PERMIT APPLICATION
rity Job Numberc,)6-o/70(,-0I
J
JOD DESCRIPTION- . ., , Ll _ 1000 sq. f t, or less
. JfII-srft-{l... tA-fU'JM..C..JlLDow'*WMh. Each additional 500
1111- ' .l!?t\'sq, ft or portion
Permits are non-transferable and expire \hereof
if york is not started yithin 180 days Each Manuf'd Home, or
of issuance or if york is suspended for Modular'Dyelling
180 days. Service or Feeder
2. CONTRACTOR INSTALLATION ONLY
.D.
Services'or Feeders
Installation, Alterations
or Relocation:
Electrical ContractorL.R~ Brabham, Inc.
Address 68 West "Q" Street
200 amps or less
201 amps to 400 amps
401 amps to, 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Ci ty Springfield
Phone 747-6638
Supervisor License Number 14735,
Expiration Date
10/01/01
08699
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
Signature of Supervising Electrician
~ !4~---
'/7 () D Dranch Circui ts
Oyne r s 4l'ame V 0 i {1t SJ}.,.:Jd {/fl;n~ Ti th . .
'7'10 III ~ Ney, Altel'ation or Exter.sion Per Panel
Address <71005 v~ / :;;;>/IL- .
/. ~J U '_. 1 I. "0.1 One Circuit I $ 35.00 35,-
Ci ty -;;7 t ftl, Phone 2-lP' -; l'f J Each Addi tional
/ '1_ Circuit or yith Service _
OIlNER INSTALLATION ( ;e {rA,WcJa. or Feeder Permi t I $ 2,00 Z.
The installation is being made on E, Miscellaneous (Service/feeder not included)
property I oyr. yhich is not intended -Each installation
for sale, lease or rent. Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Encrgy/Comm
Constr Contr, Number
Expi ra t ion Da te
12/18/00
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
Ovners Signature:
------~--------------------------------
5. SUBTOTAL OF ABOVE
711Y. State Surcharge
3Y. Administrative Fee
TOTAL
DATE:
RECEIPT #:
RECEIVED DY:
(1Izz/ere
3,lS'S3
l>tf
Sum
$ 85.00
$ 15,00
$ 40,00
$ 50.00
$ 60.00
$100,00
$130.00
$300.00
$ 40.00
volts
$ 40.00
$ 55.00
$ 80.00
see liB" above
$ 40,00
$ 40spO ......
$ 20~~
$ 36;:1:1''''''' 2;
rrYl'f1 01
C"J.. #
~7 ~i5o
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