HomeMy WebLinkAboutPermit Electrical 1999-9-24
The following project as submittad has the following
zoning, and does not require speCific land use
225 FIFTH STREET approval. (' c...
SPRINGFIELD. OREGON 9747~",ng no. ~~ _ qq
INSPECTION REQUESTbate726-3769 ~ -.
OFFICE: 726-3759 11
Authorized Signature
ELECTRICAL PERMIT APPLICATION
Ci ty Job Number Q90999
.l.
C0i1PLETE FEE SCHEDULE BELOY
1.
LOCATION OF~NS:ALLAT ON
/ PO"" fJt2~iZP-lG -
New Residential-Single or
Multi-Family per dwelling
Service Included:
LEGAL DESCRIPTION
(7!J'~? I? (; Z,60(
.- - )
~JOB DESCRIPTION ~OT E: 1000 sQ.ft. or less
~l'hI>gl_ -r/7 J.Jk:X-IN- I ~~"ITSHALLE~~~,500
.. -. ",no S . .ft or or 10n
Permi ts are non- transferablelUMl-ffllffil UNDERTItI 8f61ITlrfNOf
if work is not started WithincMDORISAI3?/;'qbdM!IY.\fCllI Home. or
of issuance or if work is SUSl1en e Qyr PERIO' D Modular 'Dwelling
180 days. ANY 180 A . Service or Feeder
"
2. CONTRACTOR INSTALLATION ONLY .B. Services or Feeders
. /. Installation, Alterations
Electrical Contracto~~ 1E'.~,~r Relocation:
Address /?o. L3~ /O~I 200 amps or less
201 amps to 400 amps
City LA-RAlG: /(M. Phone 0//7--9/01 401 amps to. 600 amps
601 amps to 1000 amps
Supervisor License Number .:1903:;' Over 1000 amps/volts
Reconnect Only'
Expira tion Da te
/~-o 1-0 )
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Signature of Supervising Electrician_..Z .
h P tI.?i: g::l 0 o~
::l :oOi:!'.~'-\
( AA..-t..f .1., _ ~ - C') _........~o ~
. .. - - 3 ~.'..(".:t' \l ~~ Branch Circui ts
Owners Name FoOD P1 ElL ,i't!,?, Q 'fj, 6 %:::
()_g._.':'~IOCNew. Alteration or Extension Per Panel
Address 'IS'"66 5, /ov K,tlI. fA "\ ~ ':: W ~ "; ~ ;
'~ i0 to) n ,'- ~, 1 .- One Circui t
Ci ty /"'IUIE' ())'Io-oP';( Phon,{,Sl>J )~'Ib :t1q.,n-,.~ ":Each Addi tional
,.). ~. '; ., : ':Y Circui t or wi th Service
,) , I : . - .' or Feeder Permi t 1'0
J ~ i, ~ ~ J
The ins talla t ion is being made on' -. "; " E.
property I own which is not intended
for sale, lease.or rent.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
Constr Cont;. Number 5?q7lJ7
Expiration Date
3-17~O
200 amps' 'or less'
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
01lNER INSTALLATION
Owners Signature:
"
l'
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5. SUBTOTAL OF ABOVE
~ State Surcharge
3% Administrative Fee
TOTAL
DATE:
RECEIPT 1I:
RECEIVED BY:
Q,J..4-C, i
n?,o::,{~1.l
~
uni t.
Items
Cost
Sum
S 85.00
$ 15.00
S 40.00
/
~.!!!!-
S 50.00
$ 60.00
$100.00
$130.00
$300.00
'$ 40.00
volts
$ 40.00
$ 55.00
$ 80.00
see "B" above
.'
.,;.
-1- S 35.00 ~!!J-
s
2.09 ./(,0. <e-
no t included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
,.:J.45.$
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