HomeMy WebLinkAboutPermit Electrical 1999-11-9
NOTICE:
225 FIFTH STREET 97477THISPERMITSHALLEXPIREIFTHE%O~C~L PERHITAPPLICATION .
SPRINGFIELD, OREGON ~--~
INSPECTION REQUEST: 726_#W9'lORIZEDUNDERTHISPERMlT<S.NY>TJob Numher qg 0 '1/f I
OFFICE: 726-3759 COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD 3. COMPLETE' FEE SCHEDULE BELOII
1. LOCATION OF INSTALLATTON .
196..) P^'_"~r I?r!c~' fOo.~.f- A. New Residential-Single OC'
---, , Multi-Family per dwelling unit.
LEGAL DESCRIPTION Service Included:
17 0"2, ~ c., ?,() N ocri)
Items
/~qq
Cost
Sum
JOB DESCRIPTION ~,..rr>-ehr-y--'
0L' u.,_.l...,o 01_,-'-/1...... _ .J: /..,.._ Ie._Irc1iJ <',s-fe_
I . ,,( /,
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if vork is suspended for
.180 days. '
1000 sq. ft. or less $ 85.00
Each additional 500
sq. f,t or portion
thereof $ 15.00
Each Manuf'd Home, or
Modular 'Dwelling
Service or Feeder $ 40.00
.B. Services or Feeders
Installation, Alterations
Elec trical Con trac t?r .s..L.~. ......,.L ,_~ r:;,.- A-tr.H.<.1, or Reloca t ion:
Address /2./1"'0 .A/I'- <:;<;...~ ,-I-, <;',;'" 7",c,>.J 200 amps or less
- - - 201 amps to 400 amps
Ci ty I.L_,.".....--; L..JA Phone..3!;o..::.7<",~-jl./.3- 401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
2.
CONTRACTOR INSTALLATION ONLY
Supervisor License Number Lb -=l-'Z.t2FT
/0 I,." IC'>"'L.
/ I
Constr Contr. Number 0<>5:<;0.,.....
Expiration Date
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
1c-,1",I=
i ,
Signature of Supervising Electrician
~~ZI9~_ ",/
(l..l)"'i'''''-'--'o
~~...AU"
200 amps"oT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Expiration Date
D~ Branch Circuits
Owners Name
;<f?:,TC
l,t)
Nev, Alteration or Extension Per Panel
$ 35.00
Address-iS'
One Circuit
City ?Uc../~ Phone 34;>; -<J(PllL Each Additional
o " i'. ," . 1L.1":'.Jr2qO" ,aw, :::.ui{3:-. '.'Oll tLCi rcui t or wi th Service
O\INER INSTALLA'f.lON,I", ,I.i",,::,,' r,1I :hr ()rf Gon U" dt:or Feeder Permi t
"~I' ':. 'inrti ~
The ins talla t ion, is being made on . E.: _\Jo!i!scellaneous (Service/ feeder
property I own v,hich is not intended n,-Each installation
for sale, lease o~. rent. ~~E~mp or irrigation
. .111,11I.W '. Ol;',.:atia.,~gn/Outline Lighting
Owners SIgnature: ('" "'?;' " '"") Limi ted Energy/Res
. Limited Energy/Comm
---------------------------------------
5. SUBTOTAL OF ABOVE
':j,z% State Surcharge
3% Administrative Fee
TOTAL
DATE:
RECEIPT #:
RECEIVED BY:
1(-'1-<;"1
O:>'told-."'-I
eku)
$ 40.00
$ 55.00
$ 80.00
see "B"
above
"
$
2.00
not included)
40.00
40.00
20.00
36.00
$
$
$
$
3C..cc
7,~l
I.oa
~~.C'C',
'"11",,",,,,