HomeMy WebLinkAboutPermit Electrical 2002-10-24
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELECTRlL.-..:L PERMIT APPLICATION
City Job Number ()'Z -o07? Z -c (
2. CONTRACTOR INSTALLATION ONLY B, Services or Feeders
~ Installation, Alterations or
Electrical Contractor G 4 E: f \e c -t\^ ('c.. ,.J jI\ c.. Relocation:
Address PO DO X [090 200 amps or less
201 amps to 400 amps
City A \ be) ~11.! Phone 5Lj/~ q 0 7, 9fo2 7 401 amps to 600 amps
,() (J 5 601 amps to 1000 amps
Supervisor License Number (Xi cO Over 1000 amps/volts
- . Reconnect Only \0
Expiration Date ' ' "I 0 ! I / 20 03 v,\'(,e'i> i~\\~\\i
" ' , - , '~' " I) C. Temporary Service~~~~~(\ e\ \0(\."\",
Constr Contr. Number J LI Lf 0 n 1I1stallatiO~~}~l~ot~0Alg~~OO\
, . () f / \0~'U ~eo. 'o~ e '{\).\'o ~~ 9 ~eS 'o'!
Expiration Date 1 I 5 Z () 0 '3 _('\,>(;.\~"\ ~~(J}! ~ .~~10\).~~ 0 ~ \~e '(\): 0'(\'0
IX ~\O~ '{~ ffi,eSE ol\Q~ ~~ 0 \'O\'O?~ ~\o'{\
'f" \(\ -.;(~ ~~(\ '{'O~O '.b~rz;
, _. - /. .. I ' . OO~~X\(\~ 'o'{ \~'o ~ '\ ,rooQ''5
-.l D. jjr~~~'(,~-
O\'\lllers Name ~l..[ C5"Yl..... [/>vI (e..7 (\ New Mt'eration or Extension Per Panel
,
Address ?O t3 () Y7...o41 One Circuit
City CU('lA'/ ,R..-ll":- \ Phone Each Add~~~~~cuit or with Service
OWNER INSTALLATION orFee~~~~~\ $ 3.00
~ \~ ~ \~ '
The installation is being made on E. 0ti&i~~/feeder not included)
property I own which is not intended ~~. ~~~\; ~ \~ lation .
for sale, lease or rent. ~'\),,\'\ ~~~~ ~~\)r; ~~ or irrigation
~\ro \> ~t~\) \)~ \~ ~!gnlOutline Lighting
Owners Signature: \. ~\.~~~~\.,~\) \><(.~\~"Limited EnergylRes
. ~ ~~~ ~ \)~ Limited Energy/Conlll1
C; \:-{ \ IQ
~\'6 Minimum Electl"ic Permit Inspectioll Fee is $45.00 + Surcharges
3. CO~LETEFEESCHEDULEBELOW
1. LOCATION OF INSTALLATION
3tof3e Os rle~y
LEGAL DESC~TION
1701... l 74'3 0 97CJQ
ne loll owing
'tted nas t S,e
JOB DESCRIPTIO}J,_ A. A 0 " ec\ as sub!'f\'- ecilichfit'l~ ~y.J.'t. or less
_ MMJ rt. 0 ~(\\Ning P;~" not ,eQUlre sp Each additional 500
, , al,D..... A ~ '
zon\n~ ' ~ . { '-"':.. portion
Pennits are non-transferable l3\fld (e~ire ning ~ther '
if work is not started within 180 days 2.0 '\ () r ~:k~_ ~a~h~ Home or
of issuance or if work is suspeB~~ for---"- ~ar D,::elling
180 days. " 0 Signature Service or Feeder
".;,Ill,U(lt.t:l
A. New Residential-Single or
MUlti-Fainily per dwelling unit.
Service Included:
5, SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
TOTAL
Items Cost Sum
t: $106.00 fOb coO
&
$ 19.00
Ll4.oo
$ 50,00
A
$ 63.00
$ 75,00
$125.00
$163,00
$375.00
$ 50.00
$50.00
$69.00
$100,00
$43,00
$50,00
$50,00
$25,00
$45.00
;;( :J.. 0 ,() ()
IS. Va
/7.00
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