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HomeMy WebLinkAboutPermit Electrical 1991-8-21 (2) SI"IINGt'IL:LU 225 FIITH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ~"'f ~~ ELECTRICAL PERMIT APPLICATION City Job Number 9/059J / 3. COMPLETE FEE SCHEDULE DELOV 1. LOCATION OF INSTALLATION 5105 .])~. ~~ LEGAL DESCRIPTION \, ()ti::'3 5~ O\\~4 A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum JOB DESCRIPTION O~S\&.~ ~ 1000 sq.ft. or less Each additional 500 sq. ft or portion . thereof Each Manuf'd Home or Modular Dwelling Service or Feeder $ 85.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for '180 days. $ 15.00 $ 40.00 2. CONTRACTOR INSTALLATION ONLY D. Services or Feeders Installation, Alterations or Relocation: Electrical Contractor Address City Phone 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 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Supervisor License Number Expiration Date Constr Contr. Number C. Temporary Services or Feeders Installation, Alteration or Relocation Expiration Date Signature of Supervising Electr~cian 200 amps or less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ BO.OO Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alteration or Extension Per Panel O\Jners Name Ro~1c M<: ~8:Y . Address 5 \05 -=:b~ s.+ Ci ty~I\lL Phone 1/fCp-4CpJO OVNER INSTALLATION , ? S-.t'O One Circuit ~ $ 35.00 0 Each Additional . Circuit or \Jith Service or Feeder Permit $ 2.00 The installation is being made on E. property I own which is not intended for sale, lease or rent. Ovners Signature: Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) --------------------------------------- 5. DATE: 7':7 - 2/ - 9/ RECEIPT i: -)4 \ / )1 14 . RECEIVED BY: .1(YK~iF'U~ '- SUBTOTAL OF ABOVE 5% State Surcharge TOTAL $ 40.00 $ 40.00 $ 20.00 $ 36.00 .:~ 5:"0 /,75 -3 {.,.'75